ORDER NO. 31014
CORRECTIONAL HEALTHCARE MANAGEMENT AGREEMENT FOR INMATE
MEDICAL SERVICES
Came to be heard this the 22nd day of September, 2008, with a motion made by
Commissioner Letz, seconded by Commissioner Oehler. The Court unanimously
approved by a vote of 4-0-0 to:
Approve the Agreement with Correctional Healthcare Management to provide inmate
medical services effective October 1, 2008, and authorize the County Judge to sign same.
!. ~~v~y
~.a
CONIlVIISSIONERS' COURT AGENDA REQUEST
PLEASE FURNISH ONE ORIGINAL AND TEN COPIES OF THIS REQUEST
AND DOCUMENTS TO BE REVIEWED BY THE COURT.
MADE BY: W.R Hierholzer OFFICE: Kerr County Sherifi's Office
MEETING DATE: September 22, 2008 TIME PREFERRED:
SUBJECT:
Consider, discuss and take appropriate action regazding the agreement with Correctional Healthcare
Management to provide inmate medical services effective October 1, 2008.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: SheriffHierholzer
ESTIMATED LENGTH OF PRESENTATION: 5 minutes
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in accordance with Title 5, Chapter 551 and
552, Government Code, is as follows:
Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday.
THIS REQUEST RECEIVED BY:
THIS REQUEST RECEIVED ON:
All Agenda Requests will be screened by the County Judge's Office to determine if adequate information has been
prepazed for the Court's formal consideration and action at time of Court Meetings. Your cooperation will be
appreciated and contribute towards your request being addressed at the earliest opportunity. See Agenda Request
Rules Adopted by Commissioners' Court.
September 22, 2008
TO: Kerr County Judge Pat Tinley and
Kerr County Commissioners' Court
FROM: Sheriff W.R. Hierholzer
RE: Agreement with Correctional Healthcare Management
Consider, discuss and take appropriate action regarding the agreement
with Correctional Healthcare Management to provide inmate medical
services effective October 1, 2008.
#31014
AGREEMENT FOR INMATE HEALTH CARE SERVICES
AT KERR COUNTY, TEXAS
Effective October 1, 2008 through September 30, 2009
This Agreement for Inmate Health Services (hereinafter, the "AGREEMENT") entered into by
and between the County of Kerr, a political subdivision in the State of Texas, (hereinafter, the
"COUNTY") acting by and through its duly elected COMMISSIONER'S COURT and/or
SHERIFF (hereinafter, "SHERIFF"), and Correctional Healthcare Management, (hereinafter,
"CHM") a Colorado corporation.
RECITALS
WHEREAS, the COUNTY is charged by law with the responsibility for administering,
managing, and supervising the health care delivery system of the Kerr County Jail, 400
Clearwater Paseo, Kerrville, Texas 78028 (hereinafter, "JAIL"); and
WHEREAS, the objective of the COUNTY is to provide for the delivery of quality health care
to the INMATES and DETAINEES of the JAIL (hereinafter, "JAIL POPULATION"), in
accordance with applicable law; and
WHEREAS, CHM is in the business of administering correctional health care services and
desires to administer such services on behalf of the COUNTY to the JAIL POPULATION under
the terms and conditions hereof.
NOW THEREFORE, in consideration of the covenants and promises hereinafter made, the
parties hereto agree as follows:
DEFINITIONS
CONTRACT YEAR -The initial, and any successive, twelve (12) month period beginning
with the effective date of the AGREEMENT.
COUNTY INMATES/DETAINEES - An INMATE/DETAINEE held under the jurisdiction of
the COUNTY or SHERIFF. COUNTY INMATES/DETAINEES may be housed in the
JAIL or in another jurisdiction's correctional facility. However, COUNTY
1NMATES/DETAINEES housed in another jurisdiction are not covered by the provisions
of this AGREEMENT unless CHM administers health care services at the other
jurisdiction's facility and is specifically set forth below.
COVERED PERSONS - An INMATE/DETAINEE of the JAIL who is: (1) part of the JAIL's
MADP; and (2) FIT FOR CONFINEMENT; and (3)(a) incarcerated in the JAIL; or (b)
on work release status and is indigent. NOTE: COVERED PERSONS include OUT-OF-
COUNTY INMATES/DETAINEES for purposes of delivery of basic health care
services, however, the cost of certain services provided to OUT-OF-COUNTY
INMATES/DETAINEES are born by the COUNTY as set forth in Section 5.0.
Kerr County Texas/CHM Agreement Page 1 of 20
DETAINEE - An adult or juvenile individual whose sentence has not yet been adjudicated and
is being held as a pre-trial detainee or other individual held in lawful custody.
FIT FOR CONFINEMENT - A determination made by an CHM authorized physician and/or
health-trained JAIL staff that an INMATE/DETAINEE is medically stable and has been
medically cleared for acceptance into the JAIL. Such determination shall only be made
after resolution of any injury or illness requiring immediate transportation and treatment
at a hospital or similar facility.
CHM CHIEF MEDICAL OFFICER - CHM's Chief physician who is vested with certain
decision making duties under this AGREEMENT.
INMATE - An adult or juvenile individual who is being incarcerated for the term of their
adjudicated sentence.
MONTHLY AVERAGE DAILY POPULATION (MADP) -The average number of
INMATES/DETAINEES housed in the JAIL on a daily basis for the period of one
month. The MADP shall include, but separately list, OUT-OF-COUNTY
INMATES/DETAINEES. The MADP shall be figured by summing the daily population
for the JAIL and OUT-OF-COUNTY INMATES/DETAINEES (as determined by a
count performed at the same time each day) for each day of the month and dividing this
sum by the total number of days in the month. JAIL records shall be made available to
CHM upon request to verify the MADP. Persons on work release and not indigent, home
confinement, housed outside of the JAIL, and parolees and escapees shall not be
considered part of the JAIL's MADP.
NCCHC -The National Commission on Correctional Health Care.
OUT-OF-COUNTY INMATE/DETAINEE - An INMATE/DETAINEE under the jurisdiction
of another county or state,being housed in the JAIL.
SPECIALTY SERVICES -Medical services that require physicians to be licensed in a
specialty such as obstetrics, gynecology, or dermatology or any other specialized field of
medicine.
ARTICLE I
HEALTH CARE SERVICES
1.0 SCOPE OF SERVICES. CHM shall administer health care services and related
administrative services at the JAIL according to the terms and provisions of the
AGREEMENT. The costs of the various health care services shall be born by
CHM or the COUNTY as set forth in this Article.
1.1 GENERAL HEALTH CARE SERVICES. CHM will arrange and bear the cost of
the following health care services:
Kerr County Texas/CHM Agreement Page 2 of 20
1.1.1 ASSESSMENT. Health assessment of a COVERED PERSON as soon as
possible, but no later than 14 calendar days after the
INMATE/DETAINEE'S arrival at the JAIL. The health assessment shall
follow current NCCHC guidelines.
1.1.2 REGULARLY SCHEDULED SICK CALL. A qualified healthcare
professional shall conduct sick calls for COVERED PERSONS on a
timely basis and in a clinical setting. A nurse practitioner or physician
assistant will be available to see COVERED PERSONS at least once per
week.
1.1.3 TB SCREENING. CHM shall arrange and bear the cost of TB
(Tuberculosis) screening for all INMATES who have been confined in the
JAIL for more than 7 days. Testing shall occur on or before the 7t" day
after the initial day of confinement.
1.2 AMBULANCE SERVICE. CHM shall arrange and bear the cost of emergency
ambulance services for COVERED PERSONS. Costs associated with CHM's
provision of ambulance services shall be subject to the financial limitations listed
in Section 1.18.
1.3 BODY CAVITY SEARCHES/COLLECTION OF PHYSICAL EVIDENCE.
CHM HEALTH CARE STAFF will not perform body cavity searches, nor collect
physical evidence (blood, hair, semen, saliva, etc.), except within guidelines
established by the NCCHC. If CHM HEALTH CARE STAFF collect physical
evidence, the COUNTY shall be responsible for arranging any testing and bear
the cost of collection and testing the collected evidence. After collecting
evidence, CHM HEALTH CARE STAFF shall turn the specimen over to the
SHERIFF or acourt-designated representative for completion of chain-of-custody
evidence.
1.4 DENTAL. CHM shall arrange and bear the cost of oral screening (as defined by
NCCHC guidelines) of all COVERED PERSONS. CHM shall arrange and bear
the cost of dental services for COVERED PERSONS only if CHM's CHIEF
MEDICAL OFFICER determines that such care is medically necessary. If the
dental services cannot be rendered on-site, CHM shall arrange and bear the cost of
off-site dental services. Costs for dental services provided off-site shall be subject
to the financial limitations listed in Section 1.18.
1.5 ELECTIVE MEDICAL CARE - NOT COVERED. CHM shall not be
responsible for the provision or cost of any elective care. In the event a member
of the JAIL POPULATION requires elective care, the INMATE/DETAINEE or
COUNTY shall be responsible for all costs. Elective medical care shall be
defined as care which, if not provided, would not, in the sole opinion of CHM's
CHIEF MEDICAL OFFICER, cause the INMATE/DETAINEE'S health to
deteriorate or cause harm to the INMATE/DETAINEE'S well being. Decisions
Kerr County Texas/CHM Agreement Page 3 of 20
concerning elective medical care shall be consistent with the applicable American
Medical Association (AMA) Standards.
1.6 HOSPITALIZATION. CHM will arrange and bear the cost of hospitalization for
a COVERED PERSON who, in the opinion of the treating physician and/or
CHM's CHIEF MEDICAL OFFICER, requires hospitalization. All costs
associated with the hospitalization of a COVERED PERSON shall be subject to
the financial limitations listed in Section 1.18.
1.7 LONG TERM CARE -NOT COVERED. CHM shall not be responsible for the
provision or cost of any long term care facility services. In the event that a
member of the JAIL POPULATION requires skilled care, custodial care or other
services of a long term care facility, the COUNTY shall bear the cost.
1.8 MEDICAL EQUIPMENT-NOT COVERED. CHM shall not be responsible for
the provision or cost of any medical equipment. In the event that medical
equipment is required for the JAIL, the COUNTY shall bear the cost.
1.9 MEDICAL SUPPLIES-CHM shall provide and bear the cost of all medical
supplies (alcohol prep pads, syringes, etc.) required for the administration of the
medical unit.
1.10 MEDICAL WASTE. CHM shall bear the cost of removing and properly
disposing of medical waste material generated while fulfilling its duties under this
AGREEMENT in accordance with all applicable state laws and OSHA-regulated
standards.
1.1 l MENTAL HEALTH -NOT COVERED. CHM shall not be responsible for the
provision or cost of any mental health services. The COUNTY shall be
responsible for the provision or cost of mental health services for the JAIL
POPULATION.
1.12 OFFICE SUPPLIES. CHM shall be responsible for providing office supplies and
a fax machine as required for the administrative operations of the medical unit.
1.13 PATHOLOGY/RADIOLOGY SERVICES. CHM shall arrange and bear the cost
of all pathology and radiology services (also referred to as laboratory and x-ray
services) for COVERED PERSONS. CHM shall arrange on-site pathology and
radiology services to the extent reasonably possible. To the extent pathology and
radiology services are required and cannot be rendered on-site, CHM shall make
appropriate off-site arrangements for rendering such care. CHM will arrange and
coordinate with the Sheriff's office the transportation for the provisions of such
services off-site. All costs associated with CHM's provision of
pathology/radiology services shall be subject to the financial limitations listed in
Section 1.18.
Kerr County Texas/CHM Agreement Page 4 of 20
1.14 PHARMACY SERVICES. CHM shall provide monitoring of pharmacy usage as
well as development of a preferred drug list. Except as provided below, CHM
shall bear the cost of all prescription and non-prescription over-the-counter
medications prescribed by a duly licensed CHM physician, physician assistant, or
nurse practitioner for a COVERED PERSON. EXCEPTION: CHM shall only
bear the cost of CHM physician approved non-prescription over-the-counter
medication issued to COVERED PERSONS from OUT-OF-COUNTY and the
COUNTY shall bear the cost of all prescription medications issued to COVERED
PERSONS from OUT-OF-COUNTY.
1.14.1 GENERAL. Prescribing, dispensing, and administering of medication
shall comply with all State and Federal laws and regulations and all
medications shall be dispensed under the supervision of a duly authorized,
appropriately licensed or certified health care provider.
1.14.2 LIMITS. CHM's maximum liability for costs associated with the
provision of psychotropic medications and/or prescription medications
related to the treatment of Acquired Immune Deficiency Syndrome
("AIDS"), Human Immuno-deficiency Virus ("HIV"), Hepatitis C and
Biologicals shall be $14,000.000 (fourteen thousand dollars) in the
aggregate per CONTRACT YEAR. Psychotropic medications and
medications related to the treatment of AIDS, HIV, Hepatitis C and
Biologicals shall be defined in accordance with the Physician's Desk.
1.14.3 COUNTY REBATE. Should the costs associated with CHM's provision
of psychotropic medications and/or prescription medications related to the
treatment AIDS, HIV, Hepatitis C and Biologicals not exceed $14,000.00
in the aggregate in any CONTRACT YEAR, CHM shall reimburse
COUNTY at a rate of fifty percent (50%) of the difference between the
actual cost to CHM for these services and the $14,000.000 aggregate cap.
1.15 PREGNANT COVERED PERSONS. CHM shall arrange and bear the cost of
health care services for any pregnant COVERED PERSON in accordance with
NCCHC standards and this AGREEMENT, but CHM shall not arrange or bear
the cost of any health care services for infants.
1.16 SPECIALTY SERVICES. In the event it is determined that a COVERED
PERSON requires SPECIALTY SERVICES, CHM shall arrange and bear the
cost of such services. CHM's authorized physician will make such determination
and refer COVERED PERSONS for SPECIALTY SERVICES when, in the
physician's professional opinion, it is deemed medically necessary. CHM's
authorized personnel will make a recommendation and obtain approval from the
SHERIFF's office for SPECIALTY SERVICES prior to making arrangements for
such services. CHM shall arrange on-site SPECIALTY SERVICES to the extent
reasonably possible. To the extent SPECIALTY SERVICES are required and
Kerr County Texas/CHM Agreement Page 5 of 20
cannot be rendered on-site, CHM shall make appropriate off-site arrangements for
rendering such care. In the event that SPECIALTY SERVICES are rendered off-
site but do not require hospitalization, CHM will arrange and bear the cost only if
the CHM CHIEF MEDICAL OFFICER approves such SPECIALTY SERVICES.
Costs for such off-site services shall be subject to the financial limitations listed in
Section 1.18.
1.17 VISION CARE -NOT COVERED. CHM shall not be responsible for the
provision of eyeglasses or any other vision services other than care for eye
injuries or diseases. In the event that any COVERED PERSON requires vision
services, including an ophthalmologist's services, the COUNTY shall bear the
cost of such vision or eye care services.
1.18 FINANCIAL LIMITATIONS. CHM's maximum liability for costs associated
with the provision of off-site medical or other healthcare services which includes,
but is not limited to emergency room visits, outpatient and inpatient hospital
services, ambulance transports, off-site specialty services, pathology and
radiology services, off-site dental visits, and any costs incurred in providing
services under Section 6.1 of this Agreement, shall be $56,000.00 (fifty-six
thousand dollars and 0/100) in the aggregate per CONTRACT YEAR. Any
expenses incurred or to be incurred for medical and other health services
described above, in excess of $56,000.00 in the aggregate per CONTRACT
YEAR shall be the responsibility of the COUNTY. CHM will continue to
provide utilization management and extend all provider discounts to the
COUNTY should the aggregate limit be met.
1.18.1 COUNTY REBATE. Should the costs associated with the provision of
off-site medical or other healthcare services listed above not exceed
$56,000.00 in the aggregate in any CONTRACT YEAR, CHM shall
reimburse COUNTY at a rate of fifty percent (50%) of the difference
between the actual cost to CHM for these services and the $56,000.000
aggregate cap.
ARTICLE II
HEALTH CARE STAFF
2.0 STAFFING HOURS. CHM shall provide medical and support personnel
(hereinafter "HEALTH CARE STAFF") necessary to render the health care
services contemplated in Article I as set forth below:
2.0.1 A total of 40 hours every week of Licensed Vocational Nurse services to
be assigned by CHM.
2.0.2 A total of 40 hours per week of Emergency Medical Technician services
to be assigned by CHM.
Kerr County Texas/CHM Agreement Page 6 of 20
2.0.3 A total of to 2 hours per week of Physician Extender (Physician
Assistant/Nurse Practitioner) services to as assigned by CHM, excluding
CHM corporate holidays and paid time off (PTO) for vacation or illness.
2.0.4 Additional hours may be provided if mutually agreed upon by both parties
in writing, with at least 24 hours advanced notice;
2.0.5 CHM shall provide an on-call physician extender and/or nurse 24 hours
per day and 7 days per week.
2.0.6 The JAIL will be provided the total amount of hours listed in sections
2.0.1 through 2.0.5. Said hours may be re-allocated and subject to change
as determined by mutual agreement of the SHERIFF and CHM, but shall
in all respects be consistent with the medical recommendations of CHM's
licensed physician.
2.1 STAFFING LEVELS WAIVER. Based on actual staffing needs as affected by
medical emergencies, riots, increased or decreased INMATE/DETAINEE
population, and other unforeseen circumstances, certain increases or decreases in
staffing requirements may be waived as agreed to by the SHERIFF and CHM.
2.2 LICENSURE, CERTIFICATION, AND REGISTRATION OF HEALTH CARE
STAFF. All HEALTH CARE STAFF shall be licensed, certified or registered, as
appropriate, in their respective areas of expertise pursuant to applicable state law
and as required by NCCHC guidelines. (If Required by NCCHC Accreditation.)
2.3 STAFFING CHANGES. CHM shall not make HEALTH CARE STAFF changes
without prior notice to the SHERIFF.
2.4 STAFF SCREENING. Prior to placement the SHERIFF shall screen CHM's
proposed HEALTH CARE STAFF, employees, agents and/or subcontractors
providing services at the JAIL to insure they do not constitute a security risk. The
SHERIFF shall have final approval of CHM's HEALTH CARE STAFF,
employees, agents and/or subcontractors in regards to security/background
clearance.
2.5 SATISFACTION WITH HEALTH CARE STAFF. In recognition of the
sensitive nature of correctional services, if the SHERIFF becomes dissatisfied
with any member of the HEALTH CARE STAFF, the SHERIFF shall provide
CHM written notice of such dissatisfaction and the reasons therefore. Following
receipt of such notice, CHM shall use commercially reasonable efforts to resolve
the dissatisfaction. If the problem is not resolved to the satisfaction of the
SHERIFF within ten (10) business days following CHM's receipt of the notice,
CHM shall remove the individual from providing services at the JAIL within a
reasonable time frame considering the effects of such removal on CHM's ability
to deliver health care services and recruitment/hiring of an acceptable
Kerr County Texas/CHM Agreement Page 7 of 20
replacement. The SHERIFF reserves the right to revoke the security clearance of
any CHM HEALTH CARE STAFF at any time.
ARTICLE III
ADMINISTRATIVE SERVICES
3.0 HEALTH EDUCATION AND TRAINING. CHM shall conduct an ongoing
health education and training program for the COUNTY Deputies and Jailers in
accordance with the needs mutually established by the COUNTY and CHM.
3.1 QUARTERLY REPORTS. CHM shall submit quarterly health care reports to the
SHERIFF, or his designee, concerning the overall operation of the health care
services program rendered pursuant to this AGREEMENT and the general health
of the JAIL POPULATION.
3.2 QUARTERLY MEETINGS. CHM shall meet quarterly, or as soon thereafter as
possible, with the SHERIFF, or his designee, concerning procedures within the
JAIL and any proposed changes in health-related procedures or other matters,
which both parties deem necessary.
3.3 MEDICAL RECORDS MANAGEMENT. CHM shall provide the following
medical records management services:
3.3.1 MEDICAL RECORDS. CHM shall maintain, cause or require the
maintenance of complete and accurate medical records for COVERED
PERSONS who have received health care services. The medical records
shall be kept separate from the COVERED PERSON'S confinement
record. A complete original of the applicable medical record shall- be
available to accompany each COVERED PERSON who is transferred
from the JAIL to another location for off-site services or transferred to
another institution. CHM will keep medical records confidential and shall
not release any information contained in any medical record except as
required by published JAIL policies, by a court order or by applicable law.
Upon termination of this AGREEMENT, all medical records shall be
delivered to and remain with the SHERIFF, as property of the SHERIFF'S
office.
3.3.2 COMPLIANCE WITH LAWS. Each medical record shall be maintained
in accordance with the Health Insurance Portability and Accountability
Act of 1996 ("HIPAA"), and any other applicable state or federal privacy
statute or regulation.
3.3.3 RECORDS AVAILABILITY. CHM shall make available to the
SHERIFF or COUNTY, unless otherwise specifically prohibited, at the
SHERIFF'S or COUNTY's request, all records, documents and other
Kerr County Texas/CHM Agreement Page 8 of 20
papers relating to the direct delivery of health care services to the Jail
Population hereunder.
ARTICLE IV
PERSONS COVERED UNDER THIS AGREEMENT
4.0 GENERAL. Except as otherwise provided in this AGREEMENT, CHM shall
only be required to arrange for services under this AGREEMENT to be provided
to COVERED PERSONS.
4.1 EMERGENCY MEDICAL CARE FOR JAIL EMPLOYEES AND VISITORS.
CHM shall contact emergency medical services and/or provide on-site first
response emergency medical care as required for JAIL employees, contractors
and visitors to the JAIL. The medical treatment shall be limited to the extent
reasonably necessary to stabilize and facilitate the individual's referral to a
medical facility or personal physician.
4.2 TB SCREENING FOR JAIL EMPLOYEES. At the request of the SHERIFF,
CHM shall arrange and bear the cost of TB (tuberculosis) screening for JAIL
EMPLOYEES
0
4.3 RELEASE FROM CUSTODY. The COUNTY acknowledges and agrees that
CHM is responsible for the payment of costs associated with services rendered to
COVERED PERSONS as set forth in this AGREEMENT only when such persons
are in the custody of, or under the jurisdiction of, the JAIL. In no event shall
CHM be responsible for payment of any costs associated with any services
rendered to any individual after said individual is released from the custody of, or
no longer under the jurisdiction of, the JAIL including, but not limited to,
releasees, parolees and escapees. Furthermore, in no event shall CHM be
responsible for payment of costs associated with any medical services rendered to
a COVERED PERSON when said COVERED PERSON is injured outside the
JAIL facility during transport to or from the JAIL.
ARTICLE V
PERSONS NOT COVERED OR PARTIALLY COVERED UNDER THIS AGREEMENT
5.0 OUT-OF-COUNTY INMATES/DETAINEES. CHM shall only be responsible
for arranging sick call, over-the counter medications, medical supplies and
medical waste services for OUT-OF-COUNTY INMATES/DETAINEES. The
cost of all prescription medication and all other health care expenses shall be paid
by the agency responsible for the OUT-OF-COUNTY INMATE/DETAINEE,
including those services listed in Article I of this AGREEMENT and all other
medically-related expenses associated with OUT-OF-COUNTY
INMATES/DETAINEES.
Kerr County Texas/CHM'Agreement Page 9 of 20
5.1 COUNTY INMATES/DETAINEES HOUSED IN OTHER JURISDICTIONS
OR OUTSIDE THE JAIL. CHM shall not be responsible for arranging the
medical care or treatment for COUNTY INMATES/DETAINEES housed in other
counties or jurisdictions. The COUNTY or SHERIFF or other agency with legal
responsibility for the medical care of such persons shall be responsible for all
medical expenses associated with the care and treatment of COUNTY
INMATES/DETAINEES removed from the JAIL, including, but not limited to
the services listed in Article I of this AGREEMENT and any other medically-
related expenses associated with said INMATES/DETAINEES, unless the
INMATE/DETAINEE is housed in a facility where CHM provides
INMATE/DETAINEE health care services. CHM shall not be responsible for
arranging the medical care or treatment for COUNTY INMATES/DETAINEES
housed outside the JAIL (i.e. non-indigent work release
INMATES/DETAINEES).
5.2 INJURIES PRIOR TO INCARCERATION, FIT FOR CONFINEMENT AND
ESCAPED INMATES/DETAINEES. CHM shall not be responsible for the cost
of providing off-site medical care for injuries incurred by an
INMATE/DETAINEE prior to incarceration at the JAIL or during an escape„
including, but not limited to, medical services provided to any
INMATE/DETAINEE prior to the INMATE/DETAINEE'S booking and
commitment into the JAIL. If an INMATE/DETAINEE is injured during an
escape attempt, CHM shall arrange and bear the cost for any necessary medical
care; however, CHM shall apply all costs associated with rendering such care to
the financial limitations listed in Section 1.18. In addition, CHM shall not be
responsible for the cost of any medical treatment or health care services necessary
to medically stabilize any arrested person presented at intake by an arresting
agency with a life threatening injury or illness or in immediate need of emergency
medical care. CHM shall provide such care as is medically necessary until the
arrested person can be transported to a medical care facility by the arresting
agency or their designee. The arresting authority or the COUNTY shall bear the
cost of, and be responsible for, all reasonable and necessary medical services or
health care services of the individual until such time as the arresting authority can
present a medically stable individual that is FIT FOR CONFINEMENT. To the
extent CHM is billed for medical services provided to an individual who is not
FIT FOR CONFINEMENT the COUNTY shall reimburse CHM for all such
costs. CHM shall not charge an additional fee simply to examine an individual to
determine if he is suitably FIT FOR CONFINEMENT.
ARTICLE VI
COST OF SERVICES NOT COVERED UNDER THIS AGREEMENT
6.0 SERVICES NOT LISTED. Both parties understand and agree that there will be
costs incurred for health care related services as outlined in Articles I, II and III
above. CHM shall not be responsible for any expenses not specifically covered
Kerr County Texas/CHM Agreement Page 10 of 20
under Articles I, II and III of this Agreement. In the event that any of the health
care services not covered by CHM under Articles I, II and III, or any services that
are not listed within this AGREEMENT, are required for a member of the JAIL
POPULATION as a result of the medical judgment of a physician or CHM
authorized personnel, CHM shall not be responsible for arranging such services
and the cost of such services shall be billed directly to the COUNTY.
6.1 SERVICES BEYOND THE SCOPE OF THE AGREEMENT. Both parties
further understand and agree that there are certain occurrences, both beyond the
control and within the control of the parties, that may result in health care
expenses which are outside the scope of the normal operation of a correctional
facility and, therefore, outside the contemplated scope of services under this
AGREEMENT. While both parties will act in good faith and endeavor to reduce
the possibility of such occurrences, in the unlikely event of an occurrence such as
an Act of God, riot, explosion, fire, food poisoning, epidemic illness outbreak or
any other catastrophic event, or an event caused by the action or inaction of the
COUNTY or SHERIFF or their employees, agents or contractors, which results in
medical care for the JAIL POPULATION, JAIL staff, visitors, or contractors,
CHM shall apply the costs associated with such an event, including any overtime
staffing, to the financial limitations listed in Section 1.18. Notwithstanding the
above, CHM shall be responsible for medical costs associated with such an event
only if such an event was caused solely by CHM.
ARTICLE VII
COUNTY'S DUTIES AND OBLIGATIONS
7.0 COMPLIANCE WITH HIPAA. The COUNTY, JAIL, and SHERIFF -and
their employees, agents and subcontractors shall comply with the Health
Insurance Portability and Accountability Act of 1996 (hereinafter "HIPAA") to
the extent it is applicable. The COUNTY and the SHERIFF shall implement
policies and/or procedures in compliance with HIPAA.
7.1 COMPREHENSIVE MEDICAL/MENTAL HEALTH CARE. CHM shall
identify to the SHERIFF those members of the JAIL POPULATION with medical
or mental health conditions which may be worsened as a result of being
incarcerated at the JAIL or which may require extensive care while incarcerated.
After review of the circumstances, and when security risks permit, the SHERIFF
shall make every effort to have those inmates released or transferred on their own
recognizance.
7.2 RECORD ACCESS. During the term of this AGREEMENT, and for a reasonable
time following the termination of this AGREEMENT, the SHERIFF shall provide
CHM, at CHM's request, the COUNTY, JAIL and/or SHERIFF'S records
(including medical records) relating to the provision of health care services to the
JAIL POPULATION, including records maintained by hospitals, and other
outside health care providers involved in the care or treatment of the JAIL
Kerr County Texas/CHM Agreement Page ] 1 of 20
POPULATION (to the extent the COUNTY, JAIL or SHERIFF has control of, or
access to, such records). CHM may request such records in connection with the
investigation of, or defense of, any claim by a third party related to CHM's
conduct or to prosecute a claim against a third party. Any such information
provided by the SHERIFF to CHM that the SHERIFF considers confidential shall
be kept confidential by CHM and shall not, except as may be required by law, be
distributed to any third party without prior written approval by the SHERIFF.
7.3 USE OF INMATES/DETAINEES IN THE PROVISION OF HEALTH CARE
SERVICES. INMATES/DETAINEES of the JAIL shall not be employed or
otherwise engaged or utilized by either CHM or the SHERIFF in rendering any
health care services to the JAIL POPULATION, provided however, that
INMATES/DETAINEES may be used in positions not involving the rendering of
health care services directly to the JAIL POPULATION and not involving access
to JAIL POPULATION records in accordance with NCCHC standards.
7.4 SECURITY OF THE JAIL FACILITY AND CHM. CHM and the COUNTY
understand that adequate security services are necessary for the safety of the
agents, employees, and subcontractors of CHM, as well as for the security of the
JAIL POPULATION and SHERIFF'S staff, consistent with a correctional setting.
The SHERIFF shall provide security sufficient to enable CHM, its HEALTH
CARE STAFF, employees, agents and/or subcontractors to safely provide the
health care services described in this AGREEMENT. CHM, its HEALTH CARE
STAFF, employees, agents and/or subcontractors shall follow all security
procedures of the SHERIFF while at the JAIL or other premises under the
SHERIFF's direction or control. However, any CHM HEALTH CARE STAFF,
employee, agent and/or subcontractor may, at any time, refuse to provide any
service required under this AGREEMENT if such person feels, in their sole
discretion, that the current safety services are insufficient. CHM shall not be
liable for any loss or damages resulting from CHM's HEALTH CARE STAFF,
employees, agents and/or subcontractors failure to provide medical services due
to insufficient security services.
7.5 SHERIFF'S POLICIES AND PROCEDURES. CHM, its HEALTH CARE
STAFF, employees, agents and/or subcontractors shall operate within the
requirements of the COUNTY'S and/or SHERIFF'S posted Policies and
Procedures, which directly relate to the provision of medical services.
7.5.1 A complete set of said Policies and Procedures shall be maintained by the
COUNTY to be made available for inspection at the Jail, and CHM may
make a reasonable number of copies of any specific section(s) it wishes
using the SHERIFF'S photocopy equipment and paper.
7.5.2 Any Policy or Procedure that may impact the provision of health care
services to the JAIL POPULATION which has not been made available to
Kerr County Texas/CHM Agreement Page 12 of 20
CHM shall not be enforceable against CHM unless otherwise agreed upon
by both parties.
7.5.3 Any modification of the posted Policies and Procedures shall be timely
provided to CHM. CHM, its HEALTH CARE STAFF, employees, agents
and/or subcontractors shall operate within the requirement of a modified
Policy or Procedure after such modification has been made available to
CHM.
7.6 DAMAGE TO EQUIPMENT. CHM shall not be liable for loss of or damage to
equipment and supplies of CHM, its agents, employees or subcontractors if such
loss or damage was caused by the sole negligence of the COUNTY and/or
SHERIFF's employees.
7.7 SECURE TRANSPORTATION. The SHERIFF shall provide security as
necessary and appropriate in connection with the transportation of a member of
the JAIL POPULATION to and from off-site services including, but not limited
to, SPECIALTY SERVICES, hospitalization, pathology and radiology services as
requested by CHM. CHM shall coordinate with the SHERIFF's office for
transportation to and from the off.-site services provider or hospital.
7.8 OFFICE EQUIPMENT. SHERIFF shall provide use of COUNTY-owned office
equipment and all necessary utilities (including telephone and fax line service) in
place at the JAIL health care facilities. At the termination of this AGREEMENT,
CHM shall return to the COUNTY possession and control of all COUNTY-
owned medical and office equipment. At such time, the office equipment shall be
in good working order, reasonable wear and tear excepted.
7.9 NON-MEDICAL CARE OF JAIL POPULATION. It is understood that the
SHERIFF shall provide for all the non-medical personal needs and services of the
JAIL POPULATION as required by law. CHM shall not be responsible for
providing, or liable for failing to provide, non-medical services to the JAIL
POPULATION including, but not limited to: daily housekeeping services, dietary
services, building maintenance services, personal hygiene supplies and services
and linen supplies.
7.10 JAIL POPULATION INFORMATION. In order to assist CHM in providing the
best possible health care services to COVERED PERSONS, the SHERIFF shall
provide, as needed, information pertaining to the COVERED PERSON that CHM
and the SHERIFF mutually identify as reasonable and necessary for CHM to
adequately to perform its obligations under this AGREEMENT.
ARTICLE VIII
Kerr County Texas/CHM Agreement Page 13 of ZO
COMPENSATION/ADJUSTMENTS
8.0 ANNUAL AMOUNT/MONTHLY PAYMENTS. The annual amount to be paid
by the COUNTY to CHM under this AGREEMENT is $298,245.54 (two hundred
ninety-eight thousand, two hundred forty-five dollars and 54/100) for a period of
12 (twelve) months. Each monthly payment shall be at $24,853.80 (twenty four
thousand, eight hundred fifty-three dollars and 80/100). The first monthly amount
is to be paid to CHM on the 1St day of _October, 2008 for services administered in
the month of October, 2008. Each monthly payment thereafter is to be paid by
the COUNTY to CHM before or on the 1St day of the month of the month of
service. If a subsequent contract encompassing these services is agreed to by both
parties, the monthly amount will be pro rated per day.
8.1 NEGOTIATED ANNUALIZED AMOUNT OF INCREASE UPON RENEWAL.
Upon each annual or contractual renewal of the CONTRACT YEAR of this
AGREEMENT, the base annual amount to be paid by the COUNTY to CHM
upon renewal shall be the annual amount of the current CONTRACT YEAR, plus
a minimum increase based on the average Consumer Price Index for medical
services for the prior twelve (12) month period, plus an additional increase
negotiated between the parties no less than 30 days prior to the end of the
CONTRACT YEAR.
8.2 ADJUSTMENT FOR MONTHLY AVERAGE DAILY POPULATION. If the
JAIL's MADP is greater than 180, the compensation payable to CHM by the
COUNTY for that month shall be increased by a per diem rate of $0.66 for each
INMATE/DETAINEE.
8.3 CHM reserves the right to evaluate and recommend staffing changes to be
mutually agreed upon by both parties.
ARTICLE IX
TERM AND TERMINATION
9.0 TERM. The term of this AGREEMENT shall be One (1) year from October 1,
2008 at 12:00 a.m. through September 30, 2009 at 11:59 p.m. This
AGREEMENT shall automatically renew for additional one year periods on
MONTH DATE of each subsequent year with increases pursuant to Section 8.1,
unless this AGREEMENT is terminated or notice of termination is given, as set
forth in this Article.
9.1 TERMINATION FOR LACK OF APPROPRIATIONS. It is understood and
agreed that this AGREEMENT shall be subject to annual appropriations by the
Commissioner's Court of the COUNTY.
9.1.1 Recognizing that termination for lack of appropriations may entail
substantial costs for CHM, the COUNTY and the SHERIFF shall act in
Kerr County Texas/CHM Agreement Page 14 of 20
good faith and make every effort to give CHM reasonable advance notice
of any potential problem with funding or appropriations.
9.1.2 If future funds are not appropriated for this AGREEMENT, and upon
exhaustion of existing funding, the COUNTY and SHERIFF may
terminate this AGREEMENT without penalty or liability, by providing a
minimum of thirty (30) days advance written notice to CHM.
9.2 TERMINATION DUE TO CHM'S OPERATIONS. The COUNTY reserves the
right to terminate this AGREEMENT immediately upon written notification in the
event that CHM discontinues or abandons operations, is adjudged bankrupt or is
reorganized under any bankruptcy law, or fails to keep in force any required
insurance policies. Both parties agree that termination under this provision will
be considered without cause.
9.3 TERMINATION FOR CAUSE. The AGREEMENT may be terminated for cause
under the following provisions:
9.3.1 TERMINATION BY CHM. Failure of the COUNTY and/or SHERIFF to
comply with any provision of this AGREEMENT shall be considered
grounds for termination of this AGREEMENT by CHM upon sixty (60)
days advance written notice to the COUNTY specifying the termination
effective date and identifying the "basis for termination." The COUNTY
shall pay for services rendered up to the date of termination of the
AGREEMENT. Upon receipt of the written notice, the COUNTY shall
have ten (10) days to provide a written response to CHM. If the
COUNTY provides a written response to CHM which provides an
adequate explanation for the "basis for termination" and the COUNTY
cures the "basis for termination" to the satisfaction of the CHM, the sixty
(60) day notice shall become null and void and this AGREEMENT will
remain in full force and effect. Termination under this provision shall be
without penalty to CHM.
9.3.2 TERMINATION BY COUNTY. Failure of CHM to comply with any
provision of this AGREEMENT shall be considered grounds for
termination of this AGREEMENT by the SHERIFF or the COUNTY who
shall provide sixty (60) days advanced written notice specifying the
termination effective date and identifying the "basis for termination." The
COUNTY shall pay for services rendered up to the date of termination of
the AGREEMENT. Upon receipt of the written notice CHM shall have
ten (10) days to provide a written response to the COUNTY. If CHM
provides a written response to the COUNTY which provides an adequate
explanation for the "basis of termination," or cures the "basis for
termination" to the satisfaction of the SHERIFF, the sixty (60) day notice
shall become null and void and this contract will remain in full force and
Ken County Texas/CHM Agreement Page 15 of 20
effect. Termination under this provision shall be without penalty to the
SHERIFF or the COUNTY.
9.4 TERMINATION WITHOUT CAUSE. Notwithstanding anything to the contrary
contained in this AGREEMENT, the SHERIFF, the COUNTY or CHM may,
without prejudice to any other rights it may have, terminate this AGREEMENT
for their convenience and without cause by giving ninety (90) days advance
written notice to the other party.
9.5 COMPENSATION UPON TERMINATION. If any of the above termination
clauses are exercised by any of the parties to this AGREEMENT, CHM shall be
paid by the COUNTY for all services rendered by CHM up to the date of
termination of the AGREEMENT regardless of the COUNTY'S failure to
appropriate funds.
ARTICLE X
LIABILITY AND RISK MANAGEMENT
10.0 INSURANCE COVERAGE. CHM shall, at its sole cost and expense, procure
and maintain during the term of this AGREEMENT, the following coverage and
limits of insurance:
10.0.1 MALPRACTICE/PROFESSIONAL LIABILITY. Malpractice/
Professional Liability insurance in an amount not less than $1,000,000 per
occurrence and $3,000,000 in the aggregate.
10.0.2 COMPREHENSIVE GENERAL LIABILITY. Comprehensive General
Liability insurance in an amount not less than $1,000,000 per occurrence
and $3,000,000 in the aggregate.
10.0.3 WORKER'S COMPENSATION. Worker's Compensation coverage as
required by applicable State law.
10.1 END^vRSEMENTS. The Comprehensive General Liability policy shall contain
additional endorsements naming the JAIL, COUNTY and SHERIFF as an
additional insured with respect to liabilities arising out of the performance of
services under this AGREEMENT.
10.2 PROOF OF INSURANCE. CHM shall provide the COUNTY proof of
professional liability or medical malpractice coverage for CHM's HEALTH
CARE STAFF, employees, agents and subcontractors, for the term services are
provided under this AGREEMENT. CHM shall promptly notify the SHERIFF, in
writing, of each change in coverage, reduction in policy amounts or cancellation
of insurance coverage. If CHM fails to provide proof of adequate insurance
within a reasonable time under the circumstances, then the COUNTY shall be
Kerr County Texas/CHM Agreement Page 16 of 20
entitled to terminate this AGREEMENT without penalty to the COUNTY or the
SHERIFF pursuant to the terms of Article VIII.
10.3 INDEMNIFICATION. CHM shall only be responsible for claims resulting from
CHM's negligence while performing its duties under this AGREEMENT. If a
claim is brought against the COUNTY, JAIL or SHERIFF relating to CHM's
negligent performance of its duties under this AGREEMENT, the COUNTY,
JAIL or SHERIFF shall promptly notify CHM of such claim. CHM shall take all
steps necessary to promptly defend and protect the COUNTY, JAIL and
SHERIFF including the retention of defense counsel. However, CHM shall not
be responsible for any claims arising out of: (1) the COUNTY, JAIL or
SHERIFF or their employees' or agents' intentionally preventing any persons
from receiving medical care ordered by CHM its HEALTH CARE STAFF,
employees, agents, or subcontractors; or (2) the negligence of the COUNTY,
JAIL or SHERIFF or their employees or agents in promptly presenting an ill or
injured person to CHM for treatment if it should have been obvious to a non-
medical individual that the person was in serious need of immediate medical
attention; or (3) the COUNTY, JAIL or SHERIFF or their employees' or agents'
breach of this AGREEMENT.
10.4 HIPAA. CHM, the COUNTY, JAIL, and SHERIFF and their employees, agents
and subcontractors shall fully comply with, and shall implement all necessary
policies and/or procedures in order to comply with, the requirements of the
HIPAA as it applies to the services provided under this AGREEMENT. Each
party to this Agreement shall be responsible for any liability arising from its own
conduct under this subsection in regard to compliance with HIPAA. Neither party
agrees to insure, defend or indemnify the other in regard to claims of violations of
HIPAA.
10.5 SURVIVABILITY. The obligations under this Article X shall survive the
termination of this AGREEMENT.
ARTICLE XI
MISCELLANEQUS
11.0 INDEPENDENT CONTRACTOR STATUS. It is mutually understood and
agreed, and it is the intent of the parties hereto that an independent contractor
relationship be and is hereby established under the terms and conditions of this
AGREEMENT. Nothing in this AGREEMENT shall be construed to create an
agency relationship, an employer/employee relationship, a joint venture
relationship, or any other relationship allowing the COUNTY or SHERIFF to
exercise control or direction over the mariner or methods by which CHM, its
employees, agents or subcontractors perform hereunder, or CHM to exercise
control or direction over the manner or methods by which the COUNTY or the
SHERIFF, and their employees, agents or subcontractors perform hereunder,
other than as provided in this AGREEMENT. CHM assumes all financial
responsibility for the employees of CHM, such as workers compensation,
Kerr County Texas/CHM Agreement Page 17 of 20
unemployment insurance, wages, withholding taxes, social security, sales and
other taxes that may be directly or indirectly related to the services to be provided
under this AGREEMENT.
11.1 SUBCONTRACTING. In order to discharge its obligations hereunder, CHM
may engage certain physicians as independent contractors rather than employees
("Contract Professionals"). CHM shall not engage any Contract Professional that
does not meet the applicable professional licensing requirements and CHM shall
exercise administrative supervision over such Contract Professionals as necessary
to insure the strict fulfillment of the obligations contained in this AGREEMENT.
As the relationship between CHM and these Contract Professionals will be that of
independent contractor, CHM will not be considered or deemed to be engaged in
the practice of medicine. Services provided by Contract Professionals under this
AGREEMENT shall be provided in a manner reasonably consistent with the
independent medical judgment the Contract Professional is required to exercise.
11.2 EQUAL EMPLOYMENT OPPORTUNITY. CHM will not discriminate against
any employee or applicant for employment because of race, color, religion, sex,
ancestry, national origin, place of birth, marital status, sexual orientation, age or
handicap unrelated to a bona fide occupational qualification of the position or
because of status as a disabled veteran or Vietnam-Era veteran. CHM will
distribute copies of its commitment not to discriminate to all persons who
participate in recruitment, screening, referral and selection of job applicants, and
to prospective job applicants.
11.3 ENTIRE AGREEMENT. This AGREEMENT constitutes the entire agreement of
the parties and is intended as a complete and exclusive statement of the promises,
representations, negotiations, discussions and agreements that have been made in
connection with the subject matter hereof. This AGREEMENT may be amended
at any time, but only with the written consent of all parties.
11.4 WAIVER OF BREACH. The waiver of either party of a breach or violation of
any provision of this AGREEMENT shall not operate as, or be construed to be, a
waiver of any subsequent breach of the same or other provision hereof.
11.5 OTHER CONTRACTS AND THIRD-PARTY BENEFICIARIES. The parties
acknowledge that CHM is neither bound by or aware of any other existing
contracts to which either the SHERIFF or the COUNTY are a party and which
relate to the providing of health care to INMATES/DETAINEES at the Jail. The
parties agree that they have not entered into this AGREEMENT for the benefit of
any third person or persons, and it is their express intention that this
AGREEMENT is for their respective benefits only and not for the benefits of
others who might otherwise be deemed to constitute third-party beneficiaries
thereof.
Kerr County Texas/CHM Agreement Page 18 of 20
11.6 SEVERABILITY. In the event that any one or more provisions of this
AGREEMENT shall, for any reason, be held to be invalid, illegal or
unenforceable in any respect, such invalidity, illegality or unenforceability shall
not affect any other provision of this AGREEMENT and this AGREEMENT shall
be construed and enforced as if such invalid, illegal or unenforceable provision
had never been contained herein.
11.7 FORCE MAJEURE. In case performance of any terms or provisions hereof shall
be delayed or prevented because of compliance with any law, decree or order of
any governmental agency or authority of local, State or Federal governments or
because of riots, war, terrorism, explosions, acts of civil or military authority, acts
of public enemy, public disturbances, lack of adequate security escorts, strikes,
lockouts, differences with workers, earthquakes, fires, floods, Acts of God or any
other reason whatsoever which is not reasonably within the control of the party's
whose performance is interfered with and which, by the exercise of reasonable
diligence, said party is unable to prevent; the party so suffering may, at its option,
suspend, without liability, the performance of its obligations hereunder during the
period such cause continues.
11.8 ASSIGNMENT. No party to this AGREEMENT may assign or transfer this
AGREEMENT, or any part thereof, without the written consent of the other
parties.
11.9 NOTICES. Any notice of termination permitted under this AGREEMENT shall
be in writing and shall be deemed delivered when delivered in person or by
certified mail, return receipt requested, addressed as follows:
If for CHM: If for COUNTY:
Correctional Healthcare Management, Inc County Attorney Pat Tinley
Legal Counsel Kerr County Courthouse
6200 South Syracuse Way, Suite 440 700 Main Street
Greenwood Village, Colorado 80111 Kerrville, TX 78028
Sheriff W.R. Hierhoizer
Kerr County Sheriff s Office
400 Clearwater Paseo
Kerrville, TX 78028
Such address may be changed from time to time by either party by providing
written notice to the other in the manner set forth above.
Any notice of changes mutually agreed upon in the manner of services can be
provided via facsimile transmission as follows:
If for CHM: If for COUNTY:
Kerr County Texas/CHM Agreement Page 19 of 20
(303) 706-9068
Such facsimile may be changed from time to time by either party by providing
written notice via certified mail as provided above.
11.10 GOVERNING LAW. This AGREEMENT shall be governed by and construed in
accordance with the laws of the State of Texas without regard to the conflicts of
laws or rules of any jurisdiction.
11.11 COUNTERPARTS. This AGREEMENT may be executed in several
counterparts, each of which shall be considered an original and all of which shall
constitute but one and the same instrument.
11.12 TITLES OF PARAGRAPHS. Titles of paragraphs are inserted solely for
convenience of reference and shall not be deemed to limit, expand or otherwise
affect the provisions to which they relate.
IN WITNESS WHEREOF, the parties have caused this AGREEMENT to be executed in their
official acts by their respective representative, each of whom is duly authorized to execute the
same.
AGREED TO AND ACCEPTED AS STATED ABOVE:
County of Kerr, Texas
Correctional Healthcare Management,
Inc
B
D O By:
TITLE ~,~.~-w~,,~ Dol
~ Titl
Date: ~ ~ ~ - ~ is
Date: ~/ I ~~~
Kerr County Texas/CHM Agreement Page 20 of 20
This i
1, 20U8 through
Inc.
NOW
herein
TO THE AGREEMENT FOR INMATE HEALTH SERVICES AT
KERR COUNTY, TEXAS
(Effective date October 1, 2009)
to the Agreement for Inmate Health Services at Kerr County, Texas
30, 2009 (hereinafter "AGREEMENT") between Correctional Healthcare
and Kerr County, Texas (hereinafter the "COUNTY").
IN CONSIDERATION of the foregoing facts, the mutual covenants and
other good and valuable consideration (the receipt and sufficiency'. of which
the I, Parties agree that beginning on October 1, 2009 and for the duration of the
October
hereby
phs 8.0 and ~.0 of the AGREEMENT shall be deleted and amended to state as follows:'
8.0 UAL AMOUNT/MONTHLY PAYMENTS. The annual amount to be paid by the C UNTY to
C under this AGREEMENT is $308,952.55 (Three Hundred Eight Thousand N' Hundred
Fi Two Dollars and fifty-five cents) for a period of 12 (twelve) months. Each month payment
shall be at $25,746.05 (Twenty-Five Thousand Seven Hundred Forty-Six Dollars and eve cents).
The first monthly amount is to be paid to CHM on the 1St day of October, 2009 r services
adm' istered in the month of October, 2009. Each monthly payment thereafter is to be id by the
CO TY to CHM before or on the 1St day of the month of the month of service. If a ubsequent
conti}act encompassing these services is agreed to by both parties, the monthly amount ill be pro-
ratedll, per day.
9.0 TERM. The term of this AGREEMENT shall be one (1) year from October 1, 2009 at 2:00 a.m.
through September 30, 2010 at 11:59 p.m. This AGREEMENT shall automatically renew for
additional one year periods on October 1st of each subsequent year with increases ursuant to
Sectipn 8.1, unless this AGREEMENT is terminated or notice of termination is given, as t forth in
this Article.
Exce 't for the provi ions, amended by this document, all other provisions of the Agreement shall remain ' full force
and a ect and unch ged.
IN TNESS WHE OF, the parties have caused this Amendment to be executed in their names or their fficial
acts `their respecti~+e representatives, each of whom is duly authorized to execute the same.
AGREED TO ANDI ACCEPTED AS STATED ABOVE:
Correctional Healthcare Management. Inc.
Title: iCounty Judge
t
Date:'',; ~.~s-~~~Z~O ~3
By:
Doug Goetz
Title: Chief Executive Officer
Date:
Kerr County Adult Facilities Texas/CHM Amendment
Page 1 of 1