Exhibit 10.20


 


DFCS- Level of Care

For Profit FY 2005


 


STATE OF GEORGIA

DEPARTMENT OF HUMAN RESOURCES

CONTRACT


 


DEPARTMENTAL
ADMINISTRATIVE INFORMATION:


 


	
  Expense
  ý

  	
   

  	
  DHR
  CONTRACT #427-93-

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  Contractor’s
  FEI #: 04-2893910

  Contractor’s FY End Date: 09/30

  Contractor’s Entity Type: FOR PROFIT

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  NIGP
  Code: 95237

  DHR Program Code: 381

  Equip. Inv. Locator #:

  CFDA #: 93.568

  CFDA #: 93.778

  



 


	
  SECTION I
  GENERAL CONTRACT PROVISIONS:

  	
   

  	
  SECTION IA

  
	
   

  	
   

  	
   

  
	
  PARA
  #101 CONTRACT BETWEEN:

  	
   

  	
  (101)05/11/04

  



 


This contract is made and entered into by and between the Department of Human Resources, Division of Family and Children Services,
(responsibilities and obligations pursuant to this contract will be performed
by the Department’s division/office identified above and by the sub-unit and
individuals identified in Paragraph #103 of this contract), an agency of the
State of Georgia legally empowered to contract pursuant to the Official Code of
Georgia Annotated, Section 49-2-1 and as otherwise identified in Section II
of this contract (if applicable), and hereinafter referred to as the
DEPARTMENT;


 


AND


 


NATIONAL MENTOR HEALTHCARE, INC.


313 Congress Street

Boston, Massachusetts 02210-1218


 


legally
empowered to contract pursuant to the Georgia Business Corporation Code, and
hereinafter referred to as the CONTRACTOR.


 


This
contract is deemed to be made under and shall be construed and enforced in
every respect according to the laws of the State of Georgia. Any lawsuit or
other action based on a claim arising from this Contract shall be brought in a
court or other forum of competent jurisdiction within Fulton County, State of
Georgia.


 


It
is the policy of the State of Georgia that minority business enterprises shall
have the maximum opportunity to participate in the State purchasing and
contracting process. Therefore, the State of Georgia encourages all minority
business enterprises to compete for contracts for goods, services, and
construction. Also, the State encourages all companies to sub-contract portions
of any State contract to minority business enterprises. Contractors who utilize
qualified minority subcontractors may qualify for a Georgia state income tax
deduction for qualified payments made to minority subcontractors. See O.C.G.A. Section
48-7-38.


 


Nothing
contained in this contract shall be construed to constitute the Contractor or
any of its employees, agents, or subcontractors as a partner, employee, or
agent of the Department, nor shall either party to this contract have any
authority to bind the other in any respect, it being intended that each shall
remain an independent contractor.


 


	
  PARA
  #102 PERIOD OF CONTRACT:

  	
   

  	
  (102) 3/10/94

  



 


This contract has an effective beginning date of the 1st day of October,
2004, and shall terminate on the 30th day of September, 2005, unless terminated
earlier under other provisions of this contract.


 


	
  PARA
  # 103 DEPARTMENT AND CONTRACTOR CONTACT INFORMATION:

  	
   

  	
  (103) 3/4/03

  



 


A.                  Mailing
Addresses:


 


The mailing addresses, telephone numbers, and contact
persons listed below for the Department and the Contractor may be changed
during the term of this contract by written notification to the other party by
the Department’s division or office representatives or by the Contractor.


 


1





















 


1.                     The Department’s mailing address and telephone number for
correspondence, reports, and other matters relative to this contract, except as
otherwise indicated, are:


 


	
  Programmatic

  	
   

  	
  Fiscal Officer

  
	
   

  	
   

  	
   

  
	
  Georgia
  Department of Human Resources

  	
   

  	
  Georgia
  Department of Human Resources

  
	
  Division
  of Family and Children Services

  	
   

  	
  Division
  of Family and Children Services

  
	
  Attn:
  Amy Hale

  	
   

  	
  Attn:
  Alan Davis

  
	
  Two
  Peachtree Street, N.W., 18th Floor

  	
   

  	
  Two Peachtree Street,
  N.W., 18th Floor

  
	
  Atlanta,
  Georgia 30303-3142

  	
   

  	
  Atlanta,
  Georgia 30303-3142

  
	
  Telephone
  #: 404/657-3575

  	
   

  	
  Telephone
  #: 404/657-3304

  



 


2.                     The Contractor’s mailing address and telephone number for
correspondence, reports, and other matters relative to this contract are:


 


National Mentor Healthcare, Inc.


Attn: 2987 Clairmont Avenue


Atlanta, Georgia 30329


 


Telephone #: 404-728-1567


 


B.                    Mailing Address for Contract Payments:


 


The Contractor’s mailing address for all contract
payment checks or remittance advice (for electronic funds transfer only) is;


 


National Mentor HealthCare, Inc.

2987 Clairmont Avenue

Atlanta, Georgia 30329


 


C.                    Contract Service Delivery Sites:


 


This contract involves 6 service delivery
sites, the addresses of which are attached as Annex A, and is by
reference made a part of this contract. The Contractor may move service
delivery sites during the term of this contract with written approval of the
division or office director, provided the total cost of the contract does not
either increase or decrease.


 


	
  PARA
  #104 NONDISCRIMINATION BY CONTRACTORS AND SUBCONTRACTORS:

  	
   

  	
  (104) 4/13/99*

  



 


A.                  NONDISCRIMINATION IN EMPLOYMENT PRACTICES: The Contractor agrees to comply with federal
and state laws, rules and regulations, and the Department’s policy relative to
nondiscrimination in employment practices because of political affiliation,
religion, religious beliefs, race, color, gender, disability, age, creed,
veteran status or national origin. The Contractor may consider religion in the
hiring or appointment of any positions serving a primarily spiritual,
ministerial, or religious purpose. Under no circumstances will any government
monies, either directly, or indirectly, fund or support the employment of such
non-secular positions, or any of the non-secular programs and services that the
Contractor provides. The Contractor shall maintain on file with the Department
current financial statements; employment application forms; a list of all staff
positions, serving a primarily spiritual, ministerial, or religious purpose,
for which exemption is claimed under this paragraph; and such other records as
the Department may require to demonstrate compliance with the foregoing
requirements. Such records shall be subject to the Open Records Act; and its
exceptions. Nondiscrimination in employment practices is applicable to paid or
unpaid employees, volunteers, interns and applicants for employment and
includes actions relating to appointments, promotions, demotions, dismissals,
and other elements affecting employment/employees.


 


B.                    NONDISCRIMINATION IN CONSUMER/CUSTOMER/CLIENT AND/OR CONSUMER/CUSTOMER/CLIENT
SERVICE PRACTICES: The
Contractor agrees to comply with federal and state laws, rules and regulations,
and the Department’s policy relative to nondiscrimination in
consumer/customer/client and consumer/customer/client service practices. The
Contractor agrees that it will not discriminate against any person because of
political affiliation, religion, religious beliefs, race, color, gender,
disability, age, creed, veteran status, sexual orientation, HIV/AIDS status, or
national origin. Neither shall any individual, on any of the foregoing bases,
be excluded from participation in, denied the benefits of, or otherwise be
subjected to discrimination or harassment, under any program or activity funded
in whole or in part or supported by the Department. The foregoing shall not
prohibit the Contractor from considering these factors in providing for the
health and safety of each child in foster care. The Contractor agrees that it
will provide a safe, supportive environment for each child in state custody in accordance
with his or her best interests.


 


2





















 


The Contractor agrees that it will notify its staff,
including paid, unpaid, volunteer or intern staff or consultants, and foster
parents with whom it places children in state custody, of their ongoing
responsibility to abide by the requirements of paragraphs 104 and 105 of this
contract and all relevant Department policies and procedures. Notification of
such requirements my include, but is not limited to, the dissemination
of internal policies and procedures, official communications and organized
training.


 


C.                    COMPLIANCE WITH APPLICABLE PROVISIONS OF THE AMERICANS WITH DISABILITIES
ACT:  The Contractor agrees to comply with all
applicable provisions of the Americans with Disabilities Act (ADA) and any
relevant federal and state laws, rules and regulations regarding
employment practices toward individuals with disabilities and the
availability/accessibility of programs, activities, or services for consumers/customers/clients
with disabilities.


 


D.                   The Contractor agrees to require any subcontractor performing services
funded through this contract to comply with all provisions of the federal and
state laws, rules, regulations and policies described in this paragraph.


 


	
  PARA
  #105 GOVERNMENT-FUNDED RELIGIOUS ACTIVITIES:

  	
   

  	
  (UMCH) 9/29/03*

  



 


The Contractor agrees that it shall not engage
in religious activities including religious worship, instruction,
proselytization, or promotion, funded in whole or in part with, or supported by
government monies. However, children in state custody have a right to
voluntarily participate in religious activities and to follow their own
religious beliefs, such as attendance at worship, religious observance, and religious
study. Children who voluntarily choose to participate in religious activities
shall be afforded reasonable opportunities to do so. Under no circumstances
shall participation in religious activities be required in any way or be a
condition of involvement in the Contractor’s services or programs. See Annex
H entitled Government Funded Religious Activities Clarification.


(UMCH)
9/29/03*


 


	
  PARA
  #106 CONFIDENTIALITY OF INDIVIDUAL INFORMATION:

  	
   

  	
  (105) 8/26/86

  



 


The
Contractor agrees to abide by all state and federal laws, rules and regulations,
and the Department of Human Resources policy on respecting confidentiality of
an individual’s records. Contractor further agrees not to divulge any
information concerning any individual to any unauthorized person without the
written consent of the individual employee, consumer/customer/client. or
responsible parent or guardian.


 


	
  PARA
  #107 CONFLICT OF INTEREST:

  	
   

  	
  (106) 4/12/85

  



 


The
Contractor and the Department certify that the provisions of the Official Code
of Georgia Annotated, Section 45-10-20 through 45-10-28, as amended, which
prohibit and regulate certain transactions between certain state officials or
employees and the State of Georgia, have not been violated and will not be
violated in any respect.


 


	
  PARA
  #108 CONTRACT MODIFICATION/ALTERATION:

  	
   

  	
  (107) 4/23/98

  



 


A.                  No
modification or alteration of this agreement, except for budget revisions which
do not increase or decrease the total dollar value of the contract (except for
the addition of an equipment line item or real estate rental) which have been
approved in advance by the Department, will be valid or effective unless such
modification is made in writing and signed by both parties and affixed to this
contract as an amendment indicating the DHR contract number involved, the
original contracting parties and the original effective date of the contract
and the paragraph(s) being modified or superseded, except as stated in
subparagraph B immediately below.


 


B.                    In the event that either of the sources of reimbursement for services
under this contract (appropriations from the General Assembly of the State of
Georgia, or the Congress of the United States of America) are reduced during
the term of this contract, the Department has the absolute right to make
financial and other adjustments to this contract and to notify the Contractor
accordingly. Such adjustment(s) may require a contract amendment including, but
not limited to, a termination of the contract. The certification by the
Commissioner of the Department of the occurrence of either of the reductions
stated above shall be conclusive.


 


	
  PARA
  #109 DEPARTMENT’S RIGHT TO SUSPEND CONTRACT:

  	
   

  	
  (108) 1/21/85

  



 


The
Department reserves the right to suspend the contract/subgrant in whole or in
part under this contract provision if it appears to the Department that the
Contractor is failing to substantially comply with the quality of service or
the specified completion schedule of its duties required under this
contract, and/or to require further proof of reimbursable expenses prior to
payment thereof, and/or to require improvement, at the discretion of the
Department, in the programmatic performance or service delivery.


 


	
  PARA
  #110 SEVERABILITY:

  	
   

  	
  (109) 3/4/03

  



 


Any section, subsection, paragraph, term, condition, provision or other
part (hereinafter collectively referred to as “part”) of this Contract that is
judged, held, found, or declared to be voidable, void, invalid, illegal or
otherwise not fully enforceable shall not affect any other


 


3





















 


part of this Contract, and the remainder of this Contract shall
continue to be of full force and effect. Any agreement of the parties to amend,
modify, eliminate, or otherwise change any part of this Contract shall not
affect any other part of this Contract, and the remainder of this Contract
shall continue to be of full force and effect.


 


	
  PARA
  #111 TERMINATION:

  	
   

  	
  (110) 3/17/03*

  



 


A.               Due
to non-availability of funds.   Notwithstanding any other provision of this
contract, in the event that either of the sources of reimbursement for services
under this contract (appropriations from the General Assembly of the State of
Georgia or the Congress of the United States of America) no longer exist or in
the event the sum of all obligations of the Department incurred under this and
all other contracts entered into for this program exceeds the balance of such
contract sources, then this contract shall immediately terminate without
further obligation of the Department as of that moment. The certification by
the Commissioner of the Department of the occurrence of either of the events stated
above shall be conclusive.


 


B.                 Due to default or for cause. This contract may be terminated for cause, in whole or in part, at any
time by the Department for failure of the Contractor to perform any of the provisions
hereof.   Should the Department exercise
its right to terminate this contract under the provisions of this paragraph,
the termination shall be accomplished in writing and specify the reason and termination
date. The Contractor will be required to submit the final contract expenditure
report not later than 45 days after the effective date of written notice of
termination. Upon termination of this contract, the Contractor shall not incur
any new obligations after the effective date of the termination and shall
cancel as many outstanding obligations as possible. The above remedies are in
addition to any other remedies provided by law or the terms of this contract.


 


C.                 For Convenience. This
contract may be cancelled or terminated by either of the parties without cause;
however, the party seeking to terminate or cancel this contract must give
written notice of its intention to do so to the other party at least 60 days
prior to the effective date of cancellation or termination.


 


D.                Notwithstanding
any other provision of this paragraph, this contract may be immediately
terminated without any opportunity to cure, if any of the following events
occurs:


 


1.                    Contractor becomes insolvent or liquidation or dissolution or a sale of
the Contractor’s assets begins.


 


2.                    Contractor or any subcontractor violates or fails to comply with any
applicable provision of federal or state law or regulation.


 


3.                    Contractor or any subcontractor knowingly provides fraudulent,
misleading or misrepresentative information to any consumer/customer/client of
the Department or to the Department.


 


4.                    Contractor has exhibited an inability to meet its financial or services
obligations under this contract.


 


5.                    A voluntary or involuntary bankruptcy petition is filed by or against
the Contractor under the U.S. Bankruptcy Code or any similar petition under any
state insolvency law.


 


6.                    An assignment is made by the Contractor for the benefit of creditors.


 


7.                    A proceeding for the appointment of a
receiver, custodian, trustee, or similar agent is initiated with respect to the
Contractor.


 


8.                    The Department deems that such termination is necessary if the
Contractor or any subcontractor fails to protect or potentially threatens the
health or safety of any consumer/customer/client and/or to prevent or protect
against fraud or otherwise protect the State of Georgia’s personnel,
consumers/customers/clients, facilities, or services.


 


9.                    Contractor is debarred or suspended from performing services on any
public contracts and/or subject to exclusion from participation in the Medicaid
or Medicare programs.


 


10.              Contractor or any subcontractor violates or
fails to comply with paragraphs 104 or 105 of this contract.


 


	
  PARA
  #112 COOPERATION IN TRANSITION OF SERVICES:

  	
   

  	
  (111) 3/17/03

  



 


The
Contractor agrees upon termination of this contract, in whole or in part, for
any reason will cooperate as requested by the Department to effectuate the
smooth and reasonable transition of the care and services for
consumers/customers/clients as directed by the Department. This will include
but not be limited to the transfer of the consumer/customer/client records,
personal belongings, and funds of all consumers/customers/clients as directed
by the Department. Contractor further agrees that should it go out of business
and/or cease to operate, all original records of consumers/customers/clients
served pursuant to this contract shall be transferred by the Contractor to the
Department immediately and shall become the property of the Department.


 


	
  PARA
  #113 FORCE MAJEURE:

  	
   

  	
  (112) 3/4/03

  



 


Each
party will be excused from performance under this contract to the extent that
it is prevented from performing, in whole or in substantial part, due to delays
caused by an act of God, civil disturbance, civil or military authority, war,
court order, acts of public enemy, and such nonperformance will not be default
under this contract nor a basis for termination for cause. Nothing in this
paragraph shall be deemed to relieve the Contractor from its liability for work
performed by any subcontractor. If the services to be provided to the
Department are interrupted by a force majeure event, the Department will be
entitled to an equitable adjustment to the fees and other payments due under
this contract.


 


4





















 


	
  PARA
  #114 ACCESS TO RECORDS AND INVESTIGATION:

  	
   

  	
  (113) 3/17/03*

  



 


A.                The
state and federal government and the Department shall have full and complete
access to all consumer/customer/client records, administrative records,
financial records, pertinent books, documents, papers, correspondence,
including e-mails, management reports, memoranda, and any other records of the
Contractor and subcontractor for the purpose of conducting or reviewing audit
examinations, excerpts, and transcripts. Contractor and subcontractor record
retention requirements are six years from submission of final expenditure
report. If any litigation, claim, or audit is started before the expiration of
the six-year period, the records shall be retained until all litigations,
claims, or audit findings involving the records have been resolved.


 


B.                  The
Contractor agrees that the DHR Office of Investigative Services, upon the
request of the Commissioner or his designee, has full-authority to investigate
any allegation of-misconduct in performance of duties-arising from this
contract made against an employee of the Contractor. The Contractor agrees to
cooperate fully in such investigations by providing the Office of Investigative
Services full access to its records and by allowing its employees to be interviewed
during such investigations.


 


C.                  The
Department shall have the right to monitor and inspect the operations of the
Contractor and any subcontractor for compliance with the provisions of this
contract and all applicable federal and state laws and regulations and
Department policy, with or without notice, at anytime during the term of this
Contract. The Contractor agrees to cooperate fully with these monitoring and
inspection activities. Such monitoring and inspection activities may include,
without limitation, on-site health and safety inspections; financial and
behavioral health/clinical audits; review of any records developed directly or
indirectly as a result of this Contract; review of management systems, policies
and procedures; review of service authorization and utilization activities;
review of any other areas, activities or materials relevant to or pertaining to
this Contract; and requirements to maintain on file with the Department such
records as the Department may require to demonstrate compliance with the
provisions of this Contract. The Department will provide the Contractor with a
report of any findings and recommendations and may require the Contractor to
develop corrective action plans as appropriate. Such corrective action plans
may include requiring the Contractor to reimburse the Department, make changes
in service authorization, utilization practices, and/or any activity deemed
necessary by the Department.


 


	
  PARA
  #115 COLLECTION OF AUDIT EXCEPTIONS:

  	
   

  	
  (114) 3/1/92

  



 


The Contractor agrees that the Department may withhold net payments
(voucher deduction) equal to the amount which has been identified by an audit,
notwithstanding the fact that such audit exception is made against a prior or
current contract or subcontract. The Contractor may also repay the Department
for the total exception by check.


 


	
  PARA
  #116 SUBCONTRACTS:

  	
   

  	
  (115)3/4/03

  



 


Any subcontracts or delegation of the authority herein will be
submitted to the Department for approval prior to execution (County Boards of
Health, hereinafter referred to as “Board,” must comply with Georgia Code,
Title 31). The Contractor/Board specifically agrees to be responsible for the
performance of any subcontractor or other duties delegated and all provisions
of this contract. The Contractor/Board will ensure that the subcontractor both
understands and abides by all pertinent provisions of the contract and
regulations applicable to the subcontractor. The Contractor/Board agrees to
reimburse the Department for any federal or state audit disallowances arising
from the subcontractor’s performance or non-performance of duties under this
contract which are delegated to the subcontractor. The Department’s
division/office directors and their program officers/directors are the
Department’s approving authority for subcontracts and delegation of authority.


 


	
  PARA
  #117 PUBLICITY:

  	
   

  	
  (116) 3/4/03

  



 


A.                Contractors
must ensure that any publicity given to the program or services provided herein
identify the Department as a sponsoring agency. Publicity materials include,
but are not limited to, signs, notices, information pamphlets, press releases,
brochures, radio or television announcements, or similar information prepared
by or for the Contractor. Prior approval for the materials must be received
from the Department’s managing programmatic division/office. All media and
public information materials must also be approved by the Commissioner’s Office
of Policy and Government Services, Office of Communications. In addition, the
Contractor shall not display the Department’s name or logo in any manner,
including, but not limited to, display on Contractor’s letterhead or physical
plant, without the prior written authorization of the Commissioner of the
Department.


 


B.                  Notwithstanding
subparagraph A above, if the Contractor is a county board of health, the
Commissioner’s Office of Policy and Government Services must be notified prior
to major publicity and/or media campaigns developed by or for the
board-operated programs which identify the Department as a sponsoring agency. This
is to enable the Commissioner’s Office of Policy and Government Services to
support the effort and to respond in a timely manner to inquiries to the
Department that might result. In addition, the Contractor shall not display the
Department’s name or logo in any manner, including, but not limited to, display
on Contractor’s letterhead or physical plant, without the prior written
authorization of the Commissioner of the Department.


 


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  PARA
  #118 INVENTIONS, PATENTS, COPYRIGHTS, INTANGIBLE PROPERTY AND PUBLICATIONS:

  	
   

  	
  (117) 3/4/03

  



 


A.                Inventions and patents.  The Contractor agrees if patentable items,
patent rights, processes, or inventions are produced in the course of work
supported and funded by this contract, to report such facts in writing promptly
and fully to the Department.  The federal
agency and the Department shall determine whether protection of the invention
or discovery shall be sought. The federal agency and Department will also
determine how the rights to the invention or discovery, including rights under
any patent issued thereon, shall be allocated and administered in order to
protect the public interest consistent with Government Patent Policy.


 


B.                  Copyrights.  Except as otherwise provided in the terms and
conditions of this contract, the author or the Department is free to copyright
any books, publications, or other copyrightable materials developed in the
course of, or under this contract. 
Should any copyright materials be produced as a result of this contract,
the federal agency and the Department shall reserve a royalty-free nonexclusive
and irrevocable right to reproduce, modify, publish, or otherwise use and to
authorize others to use the work for government and departmental purposes.


 


C.                  Publications:  All publications, including pamphlets, art
work, and reports shall be submitted to the Department on disk or electronically.


 


	
  PARA
  #119 CONSULTANT/STUDY CONTRACT:

  	
   

  	
  (118) 3/4/03

  



 


A.                The
Contractor agrees not to release any information, findings, research, reports,
recommendations, or other material developed or utilized during or as a result
of this contract until such time as the information has been provided to the
Department, appropriately presented to the Board of Human Resources, and made a
matter of public record.


 


B.                  The
Contractor further agrees that any research, study, review, or analysis of the
consumers/customers/clients served under this contract by any outside
individual or organization must be conducted in conformance with Department of
Human Resources Policy 7901, Protection of Human Subjects.


 


C.                  All
products developed/collected including raw data, databases, including code
specifications, shall be the property of the Department and may be subject to
review and validation by the Department prior to completion of study.


 


	
  PARA
  #120 CONTRACTOR/SUBCONTRACTOR LICENSE
  REQUIREMENTS:

  	
   

  	
  (119) 3/17/03

  



 


A.                The
Contractor agrees to maintain any required city, county and state business
licenses and any other special licenses required, prior to and during the
performance of this contract.


 


B.                  The
Contractor is responsible to ensure that subcontractors are appropriately
licensed.


 


C.                  The
Contractor agrees that if it loses or has sanctioned any license, certification
or accreditation required by this Contract or state and federal laws, that this
contract may be terminated immediately in whole or in part.


 


	
  PARA
  #121 DRUG-FREE WORKPLACE:

  	
   

  	
  (120) 12/18/01

  



 


A.                If
Contractor is an individual, he or she hereby certifies that he or she will not
engage in the unlawful manufacture, sale, distribution, dispensation,
possession, or use of a controlled substance or marijuana during the
performance of this contract.


 


B.                  If
Contractor is an entity other than an individual, it hereby certifies that it
will comply with the Drug-Free Workplace Act of 1988 (Public Law 100-690, Title
V, Subtitle D; 41 U.S.C. 701 et seq.) and that:


 


1.                    A drug-free workplace will be provided for the
Contractor’s employees during the performance of this contract; and


 


2                       It will secure from any subcontractor hired to work in a drug-free
workplace the following written certification: As part of the subcontracting
agreement with (Contractor’s Name), (Subcontractor’s Name), certifies to the
Contractor that a drug-free workplace will be provided for the subcontractor’s
employees during the performance of this contract pursuant to paragraph 7 of
subsection B of Code Section 50-24-3”.


 


C.                  Contractor
may be suspended, terminated, or debarred if it is determined that:


 


1.                    The Contractor has made false certification hereinabove; or


 


2.                    The Contractor has violated such certification by failure to carry out
the requirements of Official Code, of Georgia Section 50-24-3.


 


6





















 


	
  PARA
  #122 FEDERAL AND DEPARTMENTAL PROHIBITIONS AND REQUIREMENTS RELATED TO
  LOBBYING:

  	
   

  	
  (121B) 4/30/01

  



 


A.     Pursuant to Section 1352 of Public Law 101-121, the Contractor agrees that:


 


1.       No federally appropriated funds have been paid or will be
paid, by or on behalf of the Contractor, to any person for influencing or
attempting to influence an officer or employee of any federal agency, a member
of Congress, an officer or employee of Congress, or an employee of a member of
Congress in connection with the awarding of any federal contract, the making of
any federal grant, the making of any federal loan, the entering into of any
cooperative agreement, and the extension, continuation, renewal, amendment, or
modification of any federal contract, grant, loan, or cooperative agreement.


 


2.       As a condition of receipt of any federal contract, grant,
loan, or cooperative agreement exceeding $100,000, the Contractor shall file
with the Department a signed “Certification Regarding Lobbying,” attached
hereto as Annex B.


 


3.                    If any funds other than federally appropriated funds have been paid or
will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, an officer or employee
of Congress, or an employee of a member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the Contractor shall
complete and submit Standard Form-LLL, “Disclosure Form to Report
Lobbying,” in accordance with its instructions, copies of which may be obtained
from the Department


 


4.                    A disclosure form will be filed at the end of each calendar quarter in
which there occurs any event that requires disclosure or that materially
affects the accuracy of the information contained in any disclosure form
previously filed by Contractor under subparagraphs (b) or (c) of this
paragraph. An event that materially affects the accuracy of the information
reported includes:


 


a.                   A cumulative increase of $25,000 or more in the amount paid or expected
to be paid for influencing or attempting to influence a covered federal action;
or


b.      A change in the person(s) or individual(s) influencing or
attempting to influence a covered federal action; or


c.      A change in the officer(s), employee(s), or member(s) contacted
to influence or attempt to influence a covered federal action.


 


Any
Contractor who makes a prohibited expenditure or who fails to file or amend the
disclosure form, as required, shall be subject to a civil penalty of not less
than $10.000 and not more than $100,000 for each such expenditure.


 


An
imposition of a civil penalty under this section does not prevent the
United States from seeking any other remedy that may apply to the same conduct
that is the basis for the imposition of such civil penalty.


 


The
Contractor shall require that the prohibitions and requirements of this
paragraph be included in the award documents for all sub awards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans, and
cooperative agreements) and that all sub recipients shall certify and disclose
accordingly.


 


B.      Contractor further agrees that in accordance with the
federal appropriations act:


 


1.                    No part of any federal funds contained in this contract shall be used,
other than for normal and recognized executive- legislative relationships, for
publicity or propaganda purposes, for the preparation, distribution or use of
any kit, pamphlet, booklet, publication, radio, television, or video
presentation designed to support or defeat legislation pending before the
Congress or any State legislature, except in presentation to the Congress or
any State legislature itself.


 


2.                    No part of any federal funds contained in this contract shall be used to
pay the salary or expenses of any grant or contract recipient, or agent acting
for such recipient, related to any activity designed to influence legislation
or appropriations pending before the Congress or any State legislature.


 


C.                  Contractor further agrees that no part of state funds
contained in this contract shall be used for the preparation, distribution or
use of any kit, pamphlet, booklet, publication, radio, television, Internet, or
video presentation designed to support or defeat legislation pending before the
General Assembly or any committee thereof, or the approval or veto of
legislation by the Governor or for any other related purposes.


 


	
  PARA
  #123 CRIMINAL RECORDS INVESTIGATIONS:

  	
   

  	
  (122A) 05/11/04

  



 


A.     The Contractor agrees that, for the filling of positions or
classes of positions having direct care/treatment/custodial responsibilities for services rendered under this contract, applicants selected for such
positions shall undergo a criminal record history investigation which shall
include a fingerprint record check pursuant to the provisions of Section 49-2-14
of the Official Code of Georgia Annotated. In order to initiate this
requirement, the Department will provide the forms which will include the
required data from the applicant. The Contractor agrees to obtain the required
information (which will include two proper sets of fingerprints on


 


7





















 


each applicant) and transmit said fingerprints directly to the Georgia
Crime Information Center, together with the fee as required by said center for
a determination made pursuant to Section 49-2-14 of the Official Code of
Georgia Annotated or any other relevant statutes or regulations.


 


B.      After receiving (the information from the Georgia Crime
Information Center or any other appropriate source, the Department will review
any derogatory information and, if the crime is one which is prohibited by duly
published criteria within the Department, the Contractor will be informed, and
the individual so identified will not be employed for the purpose of providing
services under this contract.


 


C.      The provisions of this paragraph of the contract shall not
apply to persons employed in day-care centers, group day-care homes, family
day-care homes, child-caring institutions or child care learning centers which
are required to be licensed, registered, or commissioned by the Department or
by the Georgia Department of Early Care and Learning or to personal care homes
required to be licensed, permitted, or registered by the Department.


 


	
  PARA
  #124 AIDS POLICY:

  	
   

  	
  (123) 3/4/03

  



 


A.                Contractor
agrees, as a condition to provision of services to the Department’s
consumers/customers/clients/patients, not to discriminate against any
consumer/customer/client/patient who may have AIDS or be infected with Human
Immunodeficiency Virus (HIV). The Contractor is encouraged to provide or cause
to be provided appropriate AIDS training to its employees and to seek AIDS
technical advice and assistance from the appropriate division or office of the
Department, as the Contractor deems necessary. The Contractor further agrees to
refer those consumers/customers/clients/patients requesting additional AIDS
related services or information to the appropriate county health department.


 


B.                  Notwithstanding
subparagraph A above, if the Contractor is a county board of health it agrees
to comply with the Joint Advisory Notice, entitled “Protection Against
Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency
Virus (HIV),” dated October 30, 1987, from the Department of
Labor/Department of Health and Human Services and which has been made available
to the board.  The board further agrees
that in the implementation of the Department’s programs it will follow those
standard operation procedures developed and identified by the appropriate
program division of the Department as applicable to the specific programs and
as provided to the board by the program division.


 


	
  PARA
  #125 INDEMNIFICATION:

  	
   

  	
  (124) 3/4/03

  



 


Contractor
hereby waives, releases, relinquishes, discharges and agrees to indemnify,
protect and save harmless the State of Georgia (including the State Tort Claims
Trust Fund), DHR, DOAS, their officers and employees (collectively “indemnitees”)
of and from any and all claims, demands, liabilities, loss, costs or expenses
for any loss or damage for bodily injury (including but not limited to death),
personal injury, property damage, attorneys’ fees caused by, growing out of, or
otherwise happening in connection with this Contract, due to any act or
omission on the part of Contractor, its agents, employees, subcontractors, or
others working at the direction of Contractor or on Contractor’s behalf; or due
to any breach of this Contract by contractor; (collectively, the “Indemnity
Claims”).


 


This
indemnification extends to the successors and assigns of the Contractor, and
this indemnification and release survives the termination of this Contract and
the dissolution or, to the extent allowed by law, the bankruptcy of the
Contractor.


 


If
and to the extent such damage or loss as covered by this indemnification is
covered by the State Tort Claims Fund or any other self-insurance funds
maintained by the Department of Administrative Services (collectively, the “funds”),
the Contractor agrees to reimburse the Funds for such funds paid out by the
Funds. To the full extent permitted by the Constitution and the laws of the
State of Georgia and the terms of the Funds, the Contractor and its insurers
waive any right of subrogation against the State of Georgia, the Indemnitees,
and the Funds and insurers participating thereunder, to the full extent of this
indemnification.


 


Contractor
shall, at its expense, be entitled to and shall have the duty to participate in
the defense of any suit against the Indemnities. No settlement or compromise of
any claim, loss or damage asserted against Indemnitees shall be binding upon Indemnitees
unless expressly approved by the Indemnitees.


 


	
  PARA
  #126 DEBARMENT:

  	
   

  	
  (126) 3/1/92

  



 


In
accordance with Executive Order 12549, Debarment and Suspension, and
implemented at 45 CFR Part 76, 100-510, Contractor certifies by signing Annex
C that neither it nor its principals are presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded from
participation in this contract by any federal department or agency. Contractor
further agrees that it will include the clause titled “Certification Regarding
Debarment, Suspension, Ineligibility, and Voluntary Exclusion - Lower Tier
Covered Transaction,” without modification, in all lower tier transactions and
in all solicitations for lower tier covered transactions.


 


8





















 


	
  PARA
  #127 NONSMOKING POLICY FOR CHILDREN’S SERVICES:

  	
   

  	
  (127) 3/24/95

  



 


The
Contractor agrees to comply with Public Law 103-227, also known as the
Pro-Children Act of 1994, which requires that smoking not be permitted in any
portion of any indoor facility owned or leased or contracted for by the
Contractor and used routinely or regularly for the provision of health care,
day care, early childhood development services, education or library services
to children under the age of 18. Failure to comply with the provisions of the
law may result in the imposition of a civil
monetary penalty up to $1,000.00 (for each violation and/or the imposition of
an administrative compliance order on the Contractor.


 


	
  SECTION II SPECIAL TERMS AND CONDITIONS:

  	
   

  	
  SECTION IIA

  
	
   

  	
   

  	
   

  
	
  PARA
  #201 DEPARTMENT AND CONTRACTOR AGREEMENTS:

  	
   

  	
  (201) 3/17/03

  



 


WITNESSETH:


 


WHEREAS, the Department has a
need for and desires therapeutic residential intervention services for
children;


 


AND


 


WHEREAS, the Contractor has
represented to the Department its willingness and ability to provide the
services and/or products identified herein.


 


NOW, THEREFORE, in consideration
of the mutual covenants herein set forth, it is agreed by and between the
parties hereto as follows:


 


A.     The Contractor agrees:


 


1.       That the Level of Care Application proposal, approved by the
Department, is by reference made a part of this contract.


 


2.                    To accept into care and provide therapeutic residential intervention
services (TRIS) to children referred by the Department and its local Department
of Family and Children Services offices (DFCS). 
Admission decisions will be made within seven working days of the
receipt of the completed application, as defined in the program rules,
submitted by the Department’s case manager on behalf of the child. To provide
written notice of the decision to the Department and to the case manager
whether the contractor will accept the referred child into treatment or to not
accept the referred child into treatment.


 


3.                    To maintain in current status during the term of this contract all such
licenses and certificates as may be required by the Department or professional
association or accreditation issuer for staff, facilities and programs and to
maintain compliance with the Minimum Standards for Level of Care Providers.


 


4.                    To use only such contracted service vendors who possess the appropriate
license, certificate or accreditation as may required by the Department when
providing TRIS services to children accepted under this contract.


 


5.                    To participate fully with the Department in any and all such activities
that result in rates for payment or recovery of costs from such third parties
that may be billable for any such cost for TRIS services provided under this
contract.


 


6.                    To provide the Department with information in the way of outcomes
measures, statistical reports, service narratives, client treatment and care
documentation and other such information as the Department deems necessary for
the Department’s exclusive use.


 


7.                    To accept into care and provide therapeutic residential intervention
services (TRIS), subject to the Contractor’s capacity and approved Level of
Care proposal, children referred by the Department or its local Department of
Family and Children Services offices (DFCS) and children with previous
disrupted placements referred by other providers of TRIS services. Within 72
hours of such application, Contractor will provide a written determination to
the referring agency that a child is or is not appropriately referred or placed
in the Contractor’s facility. (For Emergency Shelters Only)


 


8.                    To observe and document the behaviors of children accepted into care and
to provide the Department with recommendations for treatment whether or not
such child has assessed service level needs identified. (For Emergency Shelters
Only)


 


9.                    To develop an individual service plan for each child in care for more
than 72 hours and placed by the Department or its local Department of Family
and Children Services, including the family as appropriate, in order to assist
the Department with proper authorizations for services. (For Emergency Shelters
Only)


 


9





















 


10.              To work with assessment providers, documenting
the behaviors exhibited by children placed by the
Department or its local Department of Family and Children Services, in order to
properly assess a child’s need for service. (For Emergency Shelters Only)


 


11.     To develop an individual service plan for each child placed by
the Department or its local Department of Family and Children Services,
including the family as appropriate, in accordance with the level of care
identified for such child or children; to provide the service as described in
the individual service plan to the individual and family named in the
individual service plan; and, to document the provision of services described
in the individual service plans and delivered to the individual as contained in
these plans and in accordance with the professional standards and other such
requirements as may be designated by the Department.


 


12.     To involve the local Department of Family and Children Services
in the entire treatment planning process and ensure that the local Department
of Family and Children Services office is sent written documentation of all
treatment planning activities, including progress reports done on at least a
quarterly basis and to work as a partner with the local Department of Family
and Children Services, with the goal of achieving permanency for the child.


 


13.     To notify the Department immediately upon discovery of any
significant injury or demise of any child placed with the contractor, whether
or not the Department placed that child. To notify the Department immediately
upon discovery of any serious health or safety issues. To place on file with
the Department (with the programmatic contact) the contractor’s protocol on
child disappearance.


 


14.     To allow the Department access to pertinent records/charts upon
request and to maintain documentation for a period of six years from the date
of service.


 


15.     To allow authorized representatives of the Department access to
children placed by the Department in order to fulfill departmental case
management obligations.


 


16.     To notify the Department of any change of address, telephone
number, administrator/executive director or any other changes significantly
impacting the provider’s delivery of services.


 


17.     To notify the Department of any unplanned discharge of any child
placed by the Department at least 72 hours prior to such discharge except for
as provided by the health and safety standards defined by the Office of
Regulatory Services.


 


18.     To work with and support the Department in developing baseline
data and instituting measures and related review process that will facilitate
performance improvement in service outcomes for mission critical areas:


 


a.      Child
health and safety.


b.      Family
and community involvement.


c.      Permanency


d.      Functioning
levels


e.      Placement
stability.


f.       Reentry
to care.


 


AND


 


B.      The Department will:


 


1.       Provide training to the Contractor regarding time study, cost
report and required services documentation.


 


2.       Provide the Contractor with timely notification of any
procedural or policy change impacting service delivery, case documentation or
reporting.


 


3.       Provide service authorization documentation for each child
placed with Contractor.


 


4.       Pay provider directly or through one of its local operating
offices within 30 days of properly completed forms necessary to effect payment.


 


5.       Monitor the delivery of service and documentation of service
by contractor and issue reports to contractor about the results of that
monitoring.


 


6.       Develop measures to review performance in service outcomes for
mission critical areas.


 


7.       Provide reasonable notice to the provider prior to discharging
a child from care, changing the case manager for a child in care or temporarily
removing a child from the provider’s program.


 


10





















 


	
  SECTION III CONTRACT
  PAYMENT PROVISIONS

  	
   

  	
   

  
	
  PARA #301 DEPARTMENT
  PAYMENT TO CONTRACTOR:

  	
   

  	
  (301E) 2/23/84

  



 


The department will pay the contractor at the level of care rates
described in Annex E.  The rates per day identified in Annex E are to be claimed only if a
child is placed by the Department and is in residence in the Contractor’s
institution or in a Contractor provided community placement overnight. In the
event a child is transferred between institutions, only the claim made by the
institution where the child slept overnight will be honored. The Contractor
agrees to accept the Division’s payment rates and conditions for the services
specified in this Contract for the identified population. The Contractor agrees
and is required to pursue reimbursement from other insurers and payers from
which coverage for the consumers’ services may be provided. The Contractor has
the right and obligation to collect payment from eligible consumers for
non-covered services, co-payments, and deductibles as well as collecting
payment from third party sources for services. The contractor further agrees
not to bill any government agency other than the Department or its local Departments of Family and
Children Services for any service or any component of any service delivered to
any child placed by the Department or its local Department of Family and
Children Services under this contract. Billing to the Department or its local
Departments of Family and Children Services will be at the contracted rate
described in Annex E. This paragraph is not
intended to prohibit the contractor from billing other local, state or federal
agencies for reimbursable expenses that are not covered by the rates contained
on Annex E.


 


For a child transferring between levels and the
new level is lower: If a placement at the lower level is
not available, that child may continue at the former higher rate for thirty
(30) days upon the notification by the Contractor to the Department, if at the
end of that thirty (30) day period, a placement at the lower level is” still
not available for the child, an additional fifteen (15) day period at the
former rate for the higher level may be authorized by the Department in its
sole discretion that it is in the best interest of the child to do so. If, at
the end of the additional fifteen (15) day period or forty-five (45) days after
a child’s new level is established, no placement at the lower level is
available and the Department wishes to maintain the child in care with the
Contractor, the child’s placement may be continued at the former higher rate
provided the Contractor can document all due diligence in assisting the
Department in securing an appropriate placement for the child.


 


For a child transferring between levels and the
now level is higher: The contractor agrees that the new
rate will not be billed until after a new individual service plan has been
designed and the new level of care services have been delivered to the child.
The Contractor agrees to accept the Division’s payment rates and conditions for
the services specified in this Contract for the identified population.


 


Claiming the enhanced rate for education:
Contractors which are licensed as Child Caring Institutions and which operate a
Department of Education certified school or an accreditation agency approved by
DHR/DJJ may claim the enhanced rate for all children aged 5 years and older
placed by the Department with them each day the child is in residence with the
Contractor.


 


	
  PARA
  #302 INVOICE SUBMISSION:

  	
   

  	
  (306B) 4/8/98

  



 


The Contractor agrees to submit an invoice monthly to the local
Department of Family and Children Services Office in accordance with the fixed
rate payment schedule during the term of this contract within 10 days of
the end of the month of the invoiced month. 
Any invoice submitted more than 10 days following the contract termination
date will not be paid by the Department for service levels 1-4.


 


If the contractor is a Child Placing Agency (CPA), the contractor will
invoice separately that portion of the rate provided to the contracted
community foster home for the room, board or watchful oversight of any child
placed by the Department and that portion of the rate which is retained by the
agency. The invoice form to be used is attached to this contract as Annex F.


 


Approved level 5 and 6 service providers will mail invoices to the
address on the pre-bill in accordance with the fixed rate payment schedule attached to this contract as Annex E.


 


SECTION IV COMPLIANCE WITH STATE AND FEDERAL
LAWS, RULES, REGULATIONS AND STANDARDS:


 


	
  STATE AND FEDERAL LAWS. RULES, REGULATIONS AND
  STANDARDS:

  	
   

  	
   

  



 


	
  PARA #401 STATE AND FEDERAL
  LAWS, RULES, REGULATIONS AND STANDARDS:

  	
   

  	
  (401F) 05/11/04

  



 


Contractor agrees that all work done as part of this contract will
comply fully with all administrative and other requirements established by
applicable federal and state laws, rules and regulations, and assumes
responsibility for full compliance with all such laws, rules and regulations,
and agrees to fully reimburse the Department for any loss of funds or resources
resulting from non-compliance by the Contractor, its staff, agents, or subcontractor as revealed in any
subsequent audits.  Contractor
understands that the following items specifically apply to this contract, but
do not exclude any other applicable federal or state laws or requirements.


 


A.     Compliance with Health Insurance Portability and Accountability
Act (HIPAA):


 


It is understood and agreed
that the Department is a “covered entity” as defined by HIPAA of 1996 and the
federal “Standards for Privacy of Individually Identifiable Health Information”
promulgated thereunder at 45 CFR Parts 160 and 164. Further, it is agreed that
as a business associate of the Department that its use or disclosure of any
person’s protected health information received from or on behalf of the
Department will be governed by the Business Associate Agreement, attached
hereto as Annex G, which the
Contractor agrees to by signing and submitting with this contract. Such
Business Associate Agreement is executed and is


 


11





















 


effective simultaneously with this contract/amendment.  However, the Business Associate Agreement
will survive this contract amendment pursuant to Section E of the Business
Associate Agreement.


 


3.       45 CFR Part 74; as
used in this contract, the word Contractor is synonymous with the word
Subgrantee as used in this Code of Federal Regulations.


 


C.      Compliance with Executive
Orders Concerning Ethics:


 


The Contractor agrees to comply in all applicable respects with the
Governor’s Executive Orders concerning ethics matters, including, but not
limited to Executive Order dated January 13, 2003 (Establishing Code of
Ethics for Executive Branch Officers and Employees, including provisions
governing former officers and employees) and Executive Order dated October 1,
2003 (Providing for the Registration and Disclosure of Lobbyists Employed or
Retained by Vendors to State Agencies). In this regard, the Contractor
certifies that any lobbyist engaged to provide services has both registered and
made the disclosures required by the Executive Orders.


 


D.      Fair Labor Standards Act of
1936, as amended.


 


E.      Minimum Standards for
Level of Care Providers.


 


F.      Community Opportunities,
Accountability, and Training and Educational Services Act of 1998, Title III,
Sections 301-309.


 


G.                  Social Security Act, Title XIX, as amended;
Public Laws 89-97, 90-248, and 91-56; 42 U.S.C. 1396 et seq., as amended;
Public Law 92-223; Public Law 92-603; Public Law 93-66; Public Law 93-233;
Public Law 96-499; Public Law 97-35; Public Law 97-248; Public Law 98-369; Public
Law 99-272; Public Law 99-509; Public Law 100-93; Public Law 100-202; Public
Law 100-203; Public Law 100-360; Public Law 100-436; Public Law 100-485; Public
Law 100-647; Public Law 101-166; Public Law 101-234; Public Law 101-239; Public
Law 101-508; Public Law 101-517; Public Law 102-234; Public Law 102-170; Public
Law 102-394; Public Law 103-66; Public Law 103-112; Public Law 103-333; Public
Law 104-91; Public Law 104-191; Public Law 104-193; Public Law 104-208, 104-134;
Balanced Budget Act of 1997, Public Law 105-33; Public Law 106-113; Public Law
106-554.


 


	
  PARA
  #402 ENTIRE UNDERSTANDING:

  	
   

  	
  (403) 5/02/02

  



 


This contract, together with the annexes and all other documents
incorporated by reference, represents the complete and final understanding of
the parties to this contract. No other understanding, oral or written regarding
the subject matter of this contract, may be deemed to exist or to bind the
parties at the time of execution.


 


12





















 


	
  SECTION V:

  	
   

  	
   

  
	
  PARA
  #501 CONTRACT ANNEX INCLUSION:

  	
   

  	
  (501) 3/17/03

  



 


This contract includes annexes as listed below, which are hereto
attached:


 


	
  Annex
  A

  	
   

  	
  Service
  Delivery Sites

  
	
  Annex
  B

  	
   

  	
  Certification
  Regarding Lobbying

  
	
  Annex
  C

  	
   

  	
  Debarment
  Certification

  
	
  Annex
  D

  	
   

  	
  Contractor
  Proposal

  
	
  Annex
  E

  	
   

  	
  Rate
  Schedule

  
	
  Annex
  F

  	
   

  	
  Invoice
  –Form 526 LOC

  
	
  Annex
  G

  	
   

  	
  HIPAA
  Business Association Agreement

  
	
  Annex
  H

  	
   

  	
  Government
  Funded Religious Activities Clarification

  



 


13





















 


SIGNATURES TO CONTRACT BETWEEN
THE DEPARTMENT OF HUMAN RESOURCES


 


AND


 


National Mentor HealthCare,
Inc.


 


CONTRACTS WITH FOR PROFIT CORPORATIONS


 


IN WITNESS WHEREOF, the parties have hereunto affixed their signatures
on the dates indicated.


 


The contractor certifies by signature hereon that the named corporation
is registered with the Georgia Secretary of State to do business in the State
of Georgia and that all required reports have been filed with that office, so
as to ensure that the corporation is in good standing with the Georgia
Secretary of State.


 


	
  CONTRACTOR
  EXECUTION:

  	
   

  	
  MENTAL
  EXECUTION:

  
	
   

  	
   

  	
   

  
	
  National
  Mentor HealthCare, Inc.

  	
   

  	
   

  
	
  Name
  of Corporation

  	
  [GRAPHIC]

  	
  [ILLEGIBLE]
  Commissioner of the

  
	
   

  	
   

  	
  Department
  of Human Resources

  
	
   

  	
   

  	
   

  
	
  By:

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Title

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  The person signing on behalf of Contractor has

  	
   

  	
   

  	
   

  
	
  full power and has been properly authorized and

  empowered to enter into this Contract.

  	
   

  	
  WILLIAM L. HARRIS

  Departmental Contract Liaison

  Office of Financial Services

  Procurement/Contracts Administration

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  ***Date signed by
  Contractor

  	
   

  	
  ***Date signed by the
  Department

  



 










***Must be a date equal to or earlier than the
effective date of the contract as specified in paragraph #102 of this contract.


 


14





















ANNEX A


 


SERVICE DELIVERY
SITES


 


National Mentor Healthcare, Inc.


2987
Clairmont Avenue


Atlanta,
Georgia 30329


 


National Mentor Healthcare, Inc.


2799
Lawrenceville Hwy


Suite 201


Decatur,
Georgia 30033


 


National Mentor Healthcare, Inc.


205
Cleveland Rd.


Bogart,
Georgia 30622


 


National Mentor Healthcare, Inc.


5569
Houston Ave.


Macon,
Georgia 31206


 


National Mentor Healthcare, Inc.


7130
Hodgson Memorial Drive


Suite 203


Savannah,
Georgia 31406


 


National Mentor Healthcare, Inc.


4210–17
Columbia Road


Martinez,
Georgia 30907


 


National Mentor Healthcare, Inc.


1315
Delaunay Ave.


Suite 108


Columbus,
Georgia 31091


 


National Mentor Healthcare, Inc.


1216
Dawson Rd.


Suite 113


Albany,
Georgia 31707


 


National Mentor Healthcare, Inc.


951
Harmony Rd.


Eatonton,
Georgia 31024


 





















ANNEX B


 


CERTIFICATION REGARDING LOBBYING


 


Certification for Contracts, Grants, Loans, and
Cooperative Agreements


 


The undersigned certifies, to the best of his or her knowledge and
belief, that:


 


1.                    No federal appropriated funds have been paid or will be paid, by or on
behalf of the undersigned, to any person for influencing or attempting to
influence an officer or employee of any agency, a member of Congress, an
officer or employee of Congress or an employee of a member of Congress in
connection with the awarding of any federal contract, the making of any federal
grant, the making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment, or modification
of any federal contract, grant, loan, or cooperative agreement.


 


2.                    If any funds other than federal appropriated funds have been paid or
will be paid to any person for influencing or attempting to influence an
officer or employee of any agency, a member of Congress, an officer or employee
of Congress, or an employee of a member of Congress in connection with this
federal contract, grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-LLL, “Disclosure Form to Report
Lobbying,” in accordance with its instructions.


 


3.                    The undersigned shall require that the language of this certification be
included in the award documents for all subawards at all tiers (including
subcontracts, subgrants, and contracts under grants, loans, and cooperative
agreements) and that all sub recipients shall certify and disclose accordingly.


 


This certification is a material representation of fact upon which
reliance was placed when this transaction was made or entered into Submission
of this certification is a prerequisite for making or entering into this
transaction imposed by Section 1352, Title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of
not less than $10,000 and not more than $100,000 for each such failure.


 


	
  By

  	
      /s/
  Larry Webb

  	
   

  	
  Date

  	
  9/29/04

  	
   

  
	
  (Signature of Official Authorized to Sign)

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
							



 


16





















ANNEX C


 


CERTIFICATION
REGARDING


DEBARMENT,
SUSPENSION, INELIGIBILITY AND VOLUNTARY EXCLUSION

LOWER TIER COVERED TRANSACTION


 


(1)                The prospective lower tier participant
certifies, by submission of this proposal, that neither it nor its principals
is presently debarred, suspended, proposed for debarment, declared ineligible,
or voluntarily excluded from participation in this transaction by any Federal
department or agency.


 


(2)                Where the prospective lower tier participant
is unable to certify to any of the statements in this certification, such
prospective participant shall attach an explanation to this proposal.


 


	
  /s/ Larry Webb, Exe Dir

  	
   

  	
  /s/ Larry Webb

  	
   

  	
  9/29/04

  
	
  Name
  and Title of Authorized Representative

  	
   

  	
  Signature

  	
   

  	
  Date

  



 


INSTRUCTIONS FOR
CERTIFICATION


 


1.       By signing and submitting this proposal, the prospective lower
tier participant is providing the certification set out below.


 


2.                    The certification in this clause is a material representation of fact
upon which reliance was placed when this transaction was entered into. If it is
later determined that the prospective lower tier participant knowingly rendered
an erroneous certification, in addition to other remedies available to the
Federal Government, the department or agency with which this transaction
originated may pursue available remedies, including suspension and/or
debarment.


 


3.                    The prospective lower tier participant shall provide immediate written
notice to the person to whom this proposal is submitted if at any time the
prospective lower tier participant learns that its certification was erroneous
when submitted or has become erroneous by reason of changed circumstances.


 


4.                    The terms “covered transaction,” “debarred,” “suspended,” “ineligible,” “lower
tier covered transaction,” “participant,” “person,” “primary covered
transaction,” “principal,” “proposal,” and “voluntarily excluded,” as used in
this clause, have the meanings set out in the Definitions and Coverage sections
of rules implementing Executive Order 12549. You may contact the person to
whom this proposal is submitted for assistance in obtaining a copy of those
regulations.


 


5.                    The prospective lower tier participant agrees by submitting this
proposal that, should the proposed covered transaction be entered into it shall
not knowingly enter into any lower tier covered transaction with a person who
is debarred, suspended, declared ineligible, or voluntarily excluded from
participation in this covered transaction, unless authorized by the department
or agency with which this transaction originated.


 


6.                    The prospective lower tier participant further agrees by submitting this
proposal that it will include this clause titled “Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered
Transactions,” without modification, in all lower tier covered transactions and
in all solicitations for lower tier covered transactions.


 


7.                    A participant in a covered transaction may rely upon a certification of
a prospective participant in a lower tier covered transaction that it is not
debarred, suspended, ineligible, or voluntarily excluded from the covered
transaction, unless it knows that the certification is erroneous. A participant
may decide the method and frequency by which it determines the eligibility of
its principals. Each participant may, but is not required to, check the
Nonprocurement List (Telephone 202/245-0729).


 


8.                    Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render in good faith the
certification required by this clause. The knowledge and information of a
participant is not required to exceed that which is normally possessed by a
prudent person in the ordinary course of business dealings.


 


9.                    Except for transactions authored under paragraph 5 of these
instructions, if a participant in a covered transaction knowingly enters into a
lower tier covered transaction with a person who is suspended, debarred,
ineligible, or voluntary excluded from participation in this transaction, in
addition to other remedies available to the Federal Government, the department
or agency with which this transaction originated may pursue available remedies,
including suspension and/or debarment.


 


17





















ANNEX D


 


CONTRACTOR’S PROPOSAL ON FILE
WITH THE DEPARTMENT


 





















ANNEX E


 


LEVEL OF CARE RATE
SCHEDULE


 


	
  LEVEL OF CARE RATES

  	
   

  	
  RATE PER DAY

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Child Caring Institutions

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 1

  	
   

  	
  $

  	
  72.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 2

  	
   

  	
  $

  	
  81.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 3

  	
   

  	
  $

  	
  97.20

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 4

  	
   

  	
  $

  	
  136.89

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 4 w/Education

  	
   

  	
  $

  	
  157.50

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 5

  	
   

  	
  $

  	
  197.19

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 5 w/Education

  	
   

  	
  $

  	
  217.80

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 6

  	
   

  	
  $

  	
  298.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 6 w/Education

  	
   

  	
  $

  	
  321.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Emergency Shelters

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  $97.20, unless the child is assessed at level 4-6

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Child Placing Agencies

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 1

  	
   

  	
  $

  	
  34.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 2

  	
   

  	
  $

  	
  41.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 3

  	
   

  	
  $

  	
  82.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 4

  	
   

  	
  $

  	
  124.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 5

  	
   

  	
  $

  	
  170.00

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Level 6

  	
   

  	
  $

  	
  197.00

  	
   

  



 





















 


INVOICE


 


ANNEX F


 


Please provide written notification of any change
in address or contact person to the division of office representative.


 


Remit Checks or Remittance Advice to:


 


CONTRACTOR:


 


Attn:                                                            CONTRACT
NUMBER 427-93-


 


ADDRESS:


 


City/State/Zip:


 


CONTRACTOR’S ACCOUNT/INVOICE#:


 


 


MAIL INVOICE TO:


 


Attn:


 


 


*Attach additional sheets if needed.


 


	
  Dates of Service

  	
   

  	
  Description of Accomplishments

  	
   

  	
  Amount

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  



 


 


	
  I, the undersigned, certify that the services or
  products shown above have been provided according to the terms of the
  contract and that the payment amount claimed accurately reflects the
  contracted rate:

  	
   

  	
  Approved for Payment:

  



 


 


	
   

  	
   

  	
   

  	
   

  
	
  Contractor Signature

  	
   

  	
  DHR Program Officer

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  
	
  Date Submitted to Division

  	
   

  	
  Date Received by Division

  	
   

  



 


Rev. 3/02


 





















Annex F


 


Georgia Department of
Human Resources

LEVEL OF CARE DFCS FOSTER CARE INVOICE


 


	
  Foster Home

  	
  2. CASE WORKER NAME:

  
	
  Institution

  	
   

  
	
  o
  Emerg. Shelter

  	
  3. CHILD’S NAME:

  	
  AGE:

  	
   

  
	
  o
  Respite

  	
   

  
	
  o
  Other

  	
  4. UAS PROGRAM CODE(S)   (DFCS USE
  ONLY)                        ,                         ,

  
	
   

  	
   

  
	
   

  	
  County DFCS

  



 


 


	
  Institution

  	
  Address

  	
  City

  	
  State

  	
  Zip

  



 


 


	
  EXPENDITURES

  	
   

  	
  DESCRIPTION

  	
   

  	
  AMOUNT

  	
   

  	
  FUND SOURCE

  (DFCS

  USE ONLY)

  	
   

  
	
  PLASE ATTACH RECEIPTS)

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  FROM            TO                    Inclusive

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  PER DIEM LEVEL

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  FOR      DAYS
  @ $      PER DAY

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  CLOTHING

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  SUPPLEMENTAL SUPERVISION

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  MEDICAL

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  INCIDENTALS (List)

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  OTHER EXPENSES (List)

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  LESS: REVENUE, COPAY, INSURANCE

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
  B. GRAND TOTAL: 

  	
   

  	
  $

  	
   

  	
   

  	
   

  	
   

  
									



 


Hereby certify that the above services have been rendered and that the
total cost billed is a true reflection of the level of care rate, other costs
reflects the application of other revenues received for this child this month.


 


	
  CONTRACTOR AUTHORIZED SIGNATURE

  	
   

  	
  DATE

  	
   

  



 


Certify that this invoice has been checked and is approved for payment.


 


	
  DFCS APPROVING
  AUTHORITY SIGNATURE

  	
   

  	
  DATE

  	
   

  	
   

  



 


ITEMS 11-14 DFCS USE ONLY 11. VENDOR #              12.
CHILD’S #


 


	
  ??. EXPENDITURES

  	
   

  	
  CODE

  	
   

  	
  STATE

  	
   

  	
  CODE

  	
   

  	
  COUNTY

  	
   

  	
  CODE

  	
   

  	
  RESTRICTED

  	
   

  	
  TOTAL

  	
   

  
	
  Per Diem -
  Regular

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Per Diem -
  Special

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  AIDS Approved
  Per Diem

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  State App. Per
  Diem Waivers

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Initial Clothing

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Annual Clothing

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Clothing
  (County/R.F.)

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Supplemental
  Supervision

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Child Restraint
  Devices

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Medical Needs

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Incidentials

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Written Waiver
  Item

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  Other

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  
	
  14. TOTALS:

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  	
   

  



 


Form 526 LOC (Rev. 12-03) Original
- Accounting     Copy - Case Record Copy - Foster Patent (if desired)


 





















 


PROVIDER INSTRUCTIONS FOR
THE 526 LOC


FOSTER CARE INVOICE


 


THIS FORM IS ONLY FOR USE BY PROVIDERS APPROVED FOR LEVELS 1-4.
PROVIDERS APPROVED FOR LEVELS 5 AND 6 (FORMER MATCH INTERMEDIATE AND INTENSIVE
PLACEMENTS) WILL CONTINUE TO USE THE EXISTING MATCH PREBILL PAYMENT PROCESS.


 


Form 526 LOC serves a dual purpose. The top half serves as the
provider’s invoice with the bottom half serving as the account-coding document.
Items 1-9 are to be completed by the LOC provider. DFCS staff completes items
10-24 and other places where DFCS USE ONLY is indicated. Complete a separate
form for each child.


FOR PROVIDERS of LEVELS 1-4 SERVICES:


 


Item 1– Check the appropriate box to
indicate the appropriate type of care. If the agency is a CHILD PLACING AGENCY
only, check other and write CPA beside the other box.


 


Item 2– Enter the caseworker’s name
for the child.


 


Item 3– Enter the child’s name.


 


Item 4– DFCS use only.


 


Item 5–Enter the name of the county
DFCS office that has legal custody of the child. If this child is a Parental
Custody child referred by Mental Health, enter the county of residence for the
parents and write P.C. for parental custody.


 


Item 6– Enter the legal name and
address of the LOC provider. If there are multiple sites, also enter the site
name.


 


Item 7– For each sub item a-f enter
a description and amount per item. DO NOT ENTER THE FUND SOURCE INFORMATION.
DFCS staff will code the fund source information. If the agency is a CHILD
PLACING AGENCY the administration and per diem must be split in accordance with
federal regulations. Enter the per diem paid to the agency’s home in item a and
the administration in item f “other” with a description of CPA Administration along
with the amount. In Item g, enter the amount if any of any other revenue,
co-payments made by parents or insurance received for this child.


 


Item 8– add items 7a through 7f and
subtract item 7g. Enter this amount in item 8.


 


Item 9– Sign and date the invoice.
Mail one invoice per child to the county office that has legal custody and
place the child with your agency.


Approved Level 5 and 6 providers will continue to mail invoices to the
address on the pre-bill.


 





















ANNEX G


 


HIPAA BUSINESS
ASSOCIATE AGREEMENT


GEORGIA DEPARTMENT
OF HUMAN RESOURCES


 


This Business Associate
Agreement (hereinafter referred to as “Agreement”), effective the day and year
first written above, is made and entered into by and between the Georgia
Department of Human Resources (hereinafter referred to as “DHR”) and the
Contractor (hereinafter referred to as “Business Associate”).


 


WHEREAS, DHR is required
by the Health Insurance Portability and Accountability Act of 1996, Public Law
104-191 (“HIPAA”), to obtain satisfactory assurances that its Business
Associates will provide appropriate safeguards of Protected Health Information
(“PHI”) that a business associate may receive or create on behalf of DHR
pursuant to this Contract and to document those assurances by entering into
Business Associate Agreements with certain entities that provide functions,
activities, or services involving the use of PHI;


 


WHEREAS, Business
Associate may provide functions, activities, or services involving the use of
PHI;


 


NOW, THEREFORE, for and
in consideration of the mutual promises, covenants, and agreements contained
herein, and other good and valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, DHR and Business Associate (each individually
a ‘Party’ and collectively the ‘Parties’) hereby agree as follows:


 


A.
Terms used, but not otherwise defined, in this Agreement shall have the same
meaning as those terms in the Privacy Rule, published as the Standards for
Privacy of individually Identifiable Health Information in 45 CFR Parts 160 and
164 (“Privacy Rule”).


 


B.
Except as limited in this Agreement Business Associate may use of disclose PHI
only to extent necessary to meet its responsibilities as set forth in the
Contract provided that such user of disclosure would not violate the Privacy rule if
done by DHR.


 


C.
Unless otherwise Required by Law, Business Associate agrees:


 


1.  That it will not request, create, receive,
use or disclose PHI other than as permitted or required by this Agreement or as
required by law.


 


2.  To establish, maintain and use appropriate
safeguards to prevent use or disclosure of the PHI other than as provided for
by this Agreement.


 


3.  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 in violation of the requirements of this Agreement.


 


4.  That its agents or subbusiness Associates are
subject to the same obligations that apply to Business Associate under this
Agreement and Business Associate agrees to ensure that its agents or
subbusiness Associates comply with the conditions, restrictions, prohibitions
and other limitations regarding the request for, creation, receipt, use or
disclosure of PHI, that are applicable to Business Associate under this Agreement.


 


5.  To report to DHR any use or disclosure of PHI
that is not provided for by this Agreement of which it becomes aware. Business
Associate agrees to make such report to DHR in writing in such form as DHR may
require within twenty-four(24) hours after Business Associate becomes aware.


 


6. To
make any amendment(s) to PHI in a Designated Record Set that DHR directs or
agrees to pursuant to 45 CFR 164.526 at the request of DHR or an individual,
within five (5) business days after request of DHR or of the individual
Business Associate also agrees to provide DHR with written confirmation of the
amendment in such format and within such time as DHR may require.


 


7. To
provide access to PHI in a Designated Record Set to DHR upon request, within
five (5) business days after such request, or, as directed by DHR, to an
individual.  Business Associate also
agrees to provide DHR with written confirmation that access has been granted in
such format and within such time as DHR may require.


 


8.  To give DHR, the Secretary of the U.S.
Department of Health and Human Services (the “Secretary”) of their designees
access to Business Associate’s books and records and policies, practices or
procedures relating to the use and disclosure of PHI for or on behalf of DHR
within five (5) business days after DHR, the Secretary or their designees
request such access or otherwise as DHR, the Secretary or their designees may
require. Business Associate also agrees to make such information available for
review, inspection and copying by DHR, the Secretary or their designees during
normal business hours at the location or locations where such information is
maintained or to otherwise provide such information to DHR, the Secretary or
their designees in such form, format or manner as DHR, the Secretary or their
designees may require.


 


9. To
document all disclosures of PHI and information related to such disclosures as
would be required for DHR to respond to a request by an individual or by the
Secretary for an accounting of disclosures of PHI accordance with the
requirements of the Privacy Rule.


 


10. To
provide to DHR or to an individual, information collected in accordance with Section 3.1.
of this Agreement, above, to permit DHR to respond to a request by an
individual for an accounting of disclosures of PHI as provided in the Privacy
Rule.


 


D. Unless
otherwise required by Law, DHR agrees:


 


1.  That it will notify Business Associate of any
new limitation in DHR’s Notice of Privacy Practices in accordance with the
provisions of the Privacy Rule if, and to the extent that, DHR determines
in the exercise of its sole discretion that such limitation will affect
Business Associates use or disclosure of PHI.


 


2.  That it will notify Business Associate of any
change in, or revocation of, permission by an individual for DHR to use or
disease PHI to the extent that DHR determines in the exercise of its sole
discretion that such change or revocation will affect Business Associates use
or disclosure of PHI.


 


3.  That it will notify Business Associate of any
restriction regarding its use or disclosure of PHI that DHR has agreed to in
accordance with the Privacy Rule if, and to the extent that, DHR
determines in the exercise of its sole discretion that such restriction will
affect Business Associate’s use or disclosure of PHI.


 


E. The
Term of this Agreement shall commence on the day and year first written above,
and shall terminate when all the PHI provided by DHR to Business Associate, or
created or received by Business Associate on behalf of DHR, is destroyed or
returned to DHR, or, if it is infeasible to return or destroy PHI, protections
are extended to such information, in accordance with the termination provisions
in this Annex.


 


1.  Termination for Cause. Upon DHR’s knowledge
of a material breach by Business Associate, DHR shall either;


 


a.  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 DHR;


 


b.  Immediately terminate this Agreement if
Business Associate has breached a material term of this Agreement and cure is
not possible; or


 


c.  If neither termination nor cure is feasible,
DHR shall report the violation to the Secretary.


 


2.  Effect of Termination.


 


a.  Except as provided in paragraph (A.) (2) of
this Section, upon termination of this Agreement, for any reason, Business
Associate shall return or destroy all PHI received from DHR, or created or
received by Business Associate on behalf of DHR. This provision shall apply to
PHI that is in the possession of subbusiness Associates or agents of Business
Associate. Neither Business Associate nor its agents nor subbusiness Associates
shall retain copies of the PHI.


 


b.  In the event that Business Associate
determines that returning or destroying the PHI is not feasible. Business
Associate shall send DHR detained written notice of the specific reasons why it
believes such return or destruction is not feasible and the factual basis for
such determination, including the existence of any conditions or circumstances
which make such return or disclosure infeasible. If DHR determines, in the
exercise of its sole decretion, that the return or destruction of such PHI is
not feasible. Business Associate agrees that it will limit its further use or
disclosure of PHI only to those purposes DHR may, in the exercise of its sole discretion,
deem to be in the public interest or necessary for the protection of such PHI,
and will take such additional action as DHR may require for the protection of
patient privacy or the safeguarding, security and protection of such PHI.


 


c.  If neither termination nor cure is feasible,
DHR shall report the violation to the Secretary.


 


d.  Section E.2 of this Agreement, regarding
the effect of termination or expiration, shall survive the termination of this
Agreement.


 


F.  Interpretation. Any ambiguity in this
Agreement shall be resolved to permit DHR to comply with appleable state and
federal laws, rules and regulations, and the Privacy Rule, and any rules,
regulations, requirements, rulings, interpretations, procedures or other
actions related thereto that are promulgated, issued or taken by or on behalf
of the Secretary, provided that applicable federal laws, rules and
regulations and the laws of the State of Georgia shall supersede the Privacy Rule if,
and to the extent that, they impose additional requirements, have requirements,
that are more stringent than or provide greater protection of patient privacy or
the security or safeguarding of PHI than those HIPAA and its Privacy Rule.


 


All other terms and conditions contained in the Contract and any
amendment thereto, not amended by this Annex, shall remain in full force and
effect. The undersigned Business Associate agents, by signing this Agreement
below, that it will comply with all provisions of HIPAA and the federal “Standards
for Privacy of Individually Identifiable Health Information” promulgated
thereunder at 45 CFR Parts 160 and 164, and that it assures to DHR that it will
provide appropriate safeguards of Protected Health Information (“PHI”) as an
entity that provides functions, activities, or services involving the use of
PHI;


 


	
  For the Contractor.

  	
   

  	
  For the Commissioner of
  the Department of Human Resources:

  
	
   

  	
   

  	
   

  
	
  /s/  [ILLEGIBLE]

  	
   

  	
   

  
	
  Signature and Title of
  Contractors Authorized Representative

  	
   

  	
  Office of Financial
  Services/Procurement/Contracts Administration

  
	
   

  	
   

  	
   

  
	
  [ILLEGIBLE]

  	
   

  	
   

  
	
  Date Signed/by
  Contractor

  	
   

  	
  Date Signed by the
  Department

  



 





















ANNEX H


 


GOVERNMENT FUNDED RELIGIOUS
ACTIVITIES CLARIFICATION


 


1. The Department shall defer to the Contractor’s designation of
positions serving a primarily spiritual, ministerial, or religious purpose. (Para.
104.A.)


 


2. The Contractor shall be deemed to be in compliance with the
restrictions on the use of government monies in Paragraphs 104.A. and 105 if it
segregates such funds into a separate account and refrains from using those
funds to sponsor religious activities or to pay compensation or benefits to
persons in non-secular positions. (Paras. 104.A. and 105.)


 


3. Without changing the requirements of Paragraph 104A, the Contractor
maintains the right to employ personnel who can accept and support the
Contractor’s mission statement and who can effectively support and relate to
foster parents for whom religious beliefs are important.  Employee personnel other than those in
non-secular positions who_only incidentally interact with spiritual,
ministerial or religious programs may nevertheless be evaluated on their
ability to fulfill the functions of these positions, which evaluation may
include the ability to interact and communicate with those in non-secular
positions and consideration of all other relevant factors.  However, such incidental interaction with spiritual,
ministerial or religious programs or personnel on the part of such employee
personnel shall not be construed to constitute impermissible funding or support
of such programs or personnel. The inability or unwillingness of an employee or
prospective employee to work well with and be supportive of the Contractor’s
other personnel, including its non-secular employees, may be considered by the
Contractor. (Para. 104.A.)


 


4. The Contractor shall make available for inspection by the Department
all non-privileged legally producible records required by this Contract;
provided, however, that the private, confidential employment records of
individual employees or prospective employees shall be treated as confidential
by the Department and its personnel and shall not be disclosed to any third
party without the consent of such employee or prospective employee, and if such
records contain the mental impressions of Contractor agents, the consent of the
Contractor. (Para. 104.A.) However, it is understood that the Department is
subject to the provisions of the Georgia Open Records Act found at O.C.G.A.
§§ 50-18-70 et seq. with regard to records coming into its possession in
the normal course of business.


 


5. The phrases “consumer/customer/client,” “any person,” and “any
individual” as used in Paragraph 104.B. refer only to children in state
custody, and shall not be construed to include the potential and actual foster
families with whom the Contractor places children. (Para. 104.B.)


 


6. The word “harassment” as used in Paragraph 104.B. shall be given its
customary and ordinary meaning in law. (Para. 104.B.)


 


7. The term “government monies” as used in paragraphs 104 and 105 means
only funds received by the Contractor directly from the Department.


 


8. The Department recognizes that as a religiously-based service
provider, Contractor may from time to time engage in religious activities in
its services and programs, including religious worship, instruction, proselytization,
or promotion, and that no provision of Paragraph 105 shall be construed to
prohibit said activities. The Department clarifies that


 





















 


incidental participation in such activities by employees other than
those in non-secular positions shall not be construed to constitute
impermissible funding or support of such activities in violation of this paragraph,
but significant levels of participation in such activities will require payment
from segregated funds or other means of pro-ration to assure that the
employee’s participation is not government funded. The Department further
clarifies that residential programs may exert reasonable efforts to afford
opportunities for religious activities for foster children or to excuse foster
children from required religious activities in accordance with this paragraph.
The Department will work with the Contractor to meet or accommodate the
spiritual needs of a child when the child’s worship service, religious study,
or religious observance is not attended by the majority of the children for
whom the Contractor is providing care, or the Contractor does not have the resources
to meet the child’s religious needs. (Para. 105)


 


9. Contractor will determine the nature of contractor’s relationship
with foster parents. Should contractor enter into subcontracts with foster
parents, all subcontractor requirements of Paragraph 116 under the contract
will apply. Subcontractor requirements will not apply to foster parents
considered as agents, volunteers, or compensated or uncompensated staff members
of contractor, but the anti-discrimination clauses as herein clarified will
apply.


 


10. The Department recognizes that compliance with paragraphs 104 and
105 may require Contractor to engage in substantial revisions of its operating
policies and procedures. Accordingly, while Contractor is expected to make best
efforts to come into compliance as soon as possible, full compliance shall not
be required until October 3, 2004, provided the Contractor commences its
good faith compliance efforts with reasonable promptness.


 


11. All services provided by parties contracting with, funded in whole
or in part by, or acting on behalf of the Department of Human Resources or its
divisions, including individual foster parents, child welfare agencies, child
caring institutions and child-placing institutions as defined in O.C.G.A.
§ 49-5-3, shall be performed without discrimination or harassment based
upon a child’s religion, religious beliefs, race, color, national origin, age,
disability, creed, political affiliation, gender, sexual orientation, or
HIV/AIDS status. This provision, and contractual terms related to this
provision, are intended to acknowledge the Department’s commitment to see that
no child in its custody is taunted, verbally or physically assaulted, or
otherwise ridiculed for reasons based on sexual orientation or for any other
reason. Nothing in this provision or in the contractual terms related to this
provision is intended to create or recognize sexual orientation as a new
protected class or to confer rights and privileges based on sexual orientation
beyond what is required by law.


 


12. It is understood that should controlling provisions of the federal
or state constitutions be subjected to narrowing interpretation by decisions of
the United States Supreme Court or Georgia Supreme Court issued hereafter that
the provisions of the LOC contract shall be revised to be consistent with then
existing law.


 


13. Nothing in this contract shall be interpreted or applied in a
manner that violates the constitutional rights of the Contractor, its employees
agents or subcontractors including the foster families with whom it places
children in state custody or to cause the Department to violate any legally
binding constitutional or statutory provisions, including the Open Records Act.