Within this context, we will continue to fulfill the following objectives:

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1 MEMORANDUM OF AGREEMENT BETWEEN THE TOHONO O ODHAM DEPARTMENT OF HEALTH AND HUMAN SERVICES, DIVISION OF BEHAVIORAL HEALTH AND CENPATICO OF ARIZONA, INC. dba CENPATICO INTEGRATED CARE Purpose: Cenpatico of Arizona, Inc. dba Cenpatico Integrated Care ( Cenpatico ) is the Regional Behavioral Health Authority ( RBHA ) serving eligible members in Yuma, LaPaz, Graham, Greenlee, Cochise, Santa Cruz, Pinal and Pima Counties. Cenpatico is contracted with the Arizona Department of Health Services/Division of Behavioral Health Services (ADHS/DBHS) and funded through the Arizona Health Care Cost Containment System (AHCCCS). Whereas, the Tohono O odham Nation ( Nation ) wishes to receive all eligible healthcare services (Covered Services) approved by ADHS/DBHS and AHCCCS through Cenpatico; the Nation agrees to allow Cenpatico and its subcontracted providers to enter onto the Nation s lands and provide all Covered Services that are available to all eligible adults and children ( Members ). This document serves as a basic guide that allows for an inclusive, collaborative service approach for the Nation s members who are jointly served by the Tohono O'odham Nation Department of Health and Human Services, Division of Behavioral Health ( TODHHS ) and Cenpatico s contracted providers. Goals and Objectives: The system-wide goal is to increase the array of Behavioral Health Services to the O odham both inside and outside the exterior boundaries of the Nation s reservation by working together in an atmosphere of mutual respect, dignity and joint responsibility. Within this context, we will continue to fulfill the following objectives: 1.) Promote a coordinated, collaborative effort to assess behavioral health needs and service gaps by: Meeting at least quarterly for joint planning and problem solving; Refining the information sharing process which tracks the progress and maximizes the services available to mutually served individuals. Work jointly and collaboratively with TODHHS to implement the proposed plan to increase access to Cenpatico services on the Nation (Attachment A). The plan may be modified as agreed upon by both parties. 2.) Promote access and flexibility of Behavioral Health Services to accommodate individuals both inside out outside the exterior boundaries of the Nation s reservation by: Increasing the availability of services through the Cenpatico system; Educate staff at the Nation, Cenpatico and Cenpatico s contracted providers about Behavioral Health Services available at the prospective agency. 3.) Promote a belief in the process of wellness/healing/recovery by: Verifying that the person/family receiving services is actively involved in all aspects of care; 1

2 Ensuring a comprehensive team is developed for each person that includes family and community members as applicable in addition to Behavioral Health staff using a collaborative decision-making process; Ensuring effective coordination between Cenpatico, Cenpatico s contracted agencies and TODHHS; Continuing to develop assessments and treatment plans that promote the use of evidence-based practices; and Inviting all appropriate TODHHS staff to be part of the member s Treatment Team, subject to the member s desires, when persons are jointly served by TODHHS and a Cenpatico contracted provider. TODHHS and Cenpatico staffs will work closely together to uphold the guidelines presented in this document and advance the shared vision and mission of TODHHS and Cenpatico related to Behavioral Health Service delivery. In order to fulfill the foregoing objectives, Cenpatico will ensure the following: 1) All of Cenpatico s contracted providers located within the exterior boundaries of the Nation s reservation shall provide quarterly reports of activities conducted, as outlined in Attachment A, to the Executive Director of TODHHS and to the Nation s Chairman. 2) Cenpatico will provide to the Executive Director of TODHHS and to the Nation s Chairman copies of all inspection reports generated by Cenpatico upon inspection of a contracted provider located within the exterior boundaries of the Nation s reservation with due regard for the provisions of the Health Insurance Portability and Accountability Act of 1996, as amended (HIPAA). 3) Cenpatico will provide to the Executive Director of TODHHS and to the Nation s Chairman copies of all disciplinary reports generated by Cenpatico against a contracted provider located within the exterior boundaries of the Nation s reservation with due regard for the provisions of the HIPAA. 4) Cenpatico will not contract with a provider located within the exterior boundaries of the Nation s lands without the prior approval of the Nation, and Cenpatico shall cease contracting with a provider located within the exterior boundaries of the Nation s reservation upon notice by the Nation that the provider no longer has the Nation s approval. 5) An authorized representative of Cenpatico shall attend at least one session of the Tohono O odham Legislative Council s Health and Human Services Committee per year in order to discuss issues relating to this Agreement and services provided to the Nation s members under this Agreement. The following outlines the various ways TODHHS and Cenpatico will coordinate and collaborate in Behavioral Health Service delivery. Eligible Members: Nation s members who are AHCCCS eligible through either Title XIX (Medicaid) or Title XXI (KidsCare) and have behavioral health needs or members who have been determined to have a serious mental illness are eligible to receive services through Cenpatico. In order to receive services, a member will need to complete a Behavioral Health Assessment with a Cenpatico provider and be enrolled in the Behavioral Health System. Crisis services do not require 2

3 enrollment. Coordinating services with TODHHS is critical during the referral process and throughout service delivery. Once enrolled, members are afforded all rights under ADHS/DBHS rules which include access to Cenpatico Member Services and Grievance and Appeals staff for assistance in problem resolution. The TODHHS Grievance Process is also available to members. Information Sharing: All sharing of Protected Health Information (PHI) will be subject to the provisions of the HIPAA, and any other applicable federal law. Cenpatico will work with the Nation to establish Business Associate Agreements (BAA), if necessary, to allow specific PHI under HIPAA to be shared on mutually served individuals to maximize coordination of care between service systems. Availability of Services: Cenpatico in collaboration with TODHHS will work to increase the availability of a comprehensive and coordinated array of behavioral health services for eligible members as outlined by the ADHS/DBHS Covered Behavioral Health Service Guide. This guide can be found at This includes the availability of services for children, adults with serious mental illness and adults with substance abuse/dependence and general mental health disorders. Services available from Cenpatico contracted providers include, but are not limited to: Treatment Services Rehabilitation Services Medical Services Support Services Crisis Intervention Services Inpatient Services; Hospitalization Residential Services Day Programs Residential Treatment Case Management Services Pharmacy-Psychotropic Medication Respite Care Therapy and counseling services (family, group, individual, etc.) Medically Necessary Transportation Substance Abuse Prevention & Treatment Prevention & Suicide Prevention All AHCCCS covered medical services Provision of Crisis Services on the Tohono O odham Nation: Cenpatico will verify that all crisis services are available and accessible to all O odham members inside or outside the exterior boundaries of the Nation s reservation, within Cenpatico service areas. Cenpatico will work in collaboration with the Nation s first responders, community stakeholders, and TODHHS to develop a Crisis Response Protocol that will serve as a guide to crisis responders while on the Nation s lands. Crisis services include, but are not limited to, access to a 24/7/365 crisis line, over-the-phone crisis stabilization, and crisis mobile team onsite assessments/stabilization. Neither Cenpatico nor its contracted providers have the authority to remove an O odham member from the Nation s lands without consent of the individual, whether at a time of crisis or not in crisis. Training: 3

4 All current and newly hired personnel who provide services to the Nation s members will complete cultural competency training. Training will include American Indian cultural competency, as well as Tohono O odham History & Culture, as provided by a trainer designated by TODHHS. Additional training topics will be identified through joint planning sessions consisting of agreed upon topics to enhance service delivery. Sessions will be jointly prepared, conducted, and evaluated whenever possible. Professional development training, both online and live in-person, will continue to be made available to TODHHS staff. Research: In addition to compliance with the provisions of HIPAA, Cenpatico and its contracted providers agree to abide by the provisions of Title 17, Chapter 8 of the Tohono O odham Code (the Nation s Research Code) when applicable. 17 T.O.C. Ch. 8 defines Research as: the use of systematic methods to gather and analyze information for the purpose of proving or disproving a hypothesis, evaluating concepts or practices or otherwise adding to knowledge and insight in a particular discipline or field of knowledge or to demonstrate or investigate theories, techniques or practices. For the purpose of this Chapter, research includes but is not limited to the following: (1) Basic and clinical research. (2) Behavioral studies. (3) Anthropological studies. (4) Community based participatory research. (5) Practice based research. (6) Cultural or historical research. (7) Feasibility and other studies designed to develop, test and evaluate basic data in all phases of environmental and public health. Changes in development, testing, or evaluation must be pre-approved by the Tohono O odham Nation Institutional Review Board ( IRB ). (8) Research on plants, animals, water, land, air, or weather. Summary: This Memorandum of Agreement grants permission for Cenpatico and its contracted providers to deliver mutually agreed upon services to the Nation s members living both within and outside of the exterior boundaries of the Nation s reservation in conjunction with prioritized needs. Each participating agency/entity will verify that all staff/contractors are familiar with and adhere to these guidelines in working with all jointly served Nation s members. This Agreement is effective on October 1, This memorandum of agreement may be terminated by either party at any time upon not less than thirty days prior written notice to the other party. This letter will be reviewed and revised as necessary by agreement of the undersigned. Sovereign Immunity: 4

5 Nothing in this Agreement shall be construed as an implied or express waiver of the sovereign immunity of the Tohono O odham Nation in any forum or jurisdiction. IN WITNESS WHEREOF, this Agreement has been executed and approved by the parties and persons whose signatures appear below: Cenpatico Integrated Care By: Terry Stevens, Chief Executive Officer EIN: Date: Tohono O odham Nation By: Edward Manuel, Chairman Date: Approved as to form: By: Laura Berglan, Acting Attorney General Date: 5