MEMORANDUM OF UNDERSTANDING (MOU) BETWEEN

BEHAVIORAL HEALTH SERVICES, INC.

dba BEHAVIORAL HEALTH SERVICES - FAMILY HEALTH CENTER

AND

ACME TREATMENT CENTER

/

This Memorandum of Understanding (MOU) is entered into by the above parties and shall commence on
the date of execution by both parties and shall continue unless otherwise terminated. Either party, however,
may modify, amend, or terminate this MOU with 30 days written notice.

The purpose of this agreement is to formalize a partnership and working relationship, and to identify and
stipulate the type and extent of services to be provided by Behavioral Health Services - Family Health
Center (BHS-FHC) and Acme Treatment Centers for mutual clients. .

I. PURPOSE

The purpose of the partnership is collaborate in providing more comprehensive services and
increase access to care for clients/patients with substance use disorder which the agencies share in
common.

II. GOALS

The goals of the partnership are:

1) To coordinate the service referral process for clients/patients of BHS-FHC and Acme,
ensuring the non-duplication of services.

2) Provide clients with access to medication-assisted therapy, and medical services not
currently provided by the referring agency.

3) Develop a collaborative and cross-agency model to discuss and co-manage mutual patients
in order to improve the delivery of care for complex patients with substance use disorder
(SUD).

III. SERVICES PROVIDED

Behavioral Health Services - Family Health Center will:

I ) Accept referrals from Acme of patients in need of primary medical care, physical exams
required for enrolling in SUD services, and MAT services not currently provided by Acme.
BHS-FHC will identify a contact person for Acme case management staff to work with that
will facilitate timely care coordination for services including but not limited to scheduling
primary care appointments, TB clearance, medical clearance for entry into substance use
treatment, evaluation for appropriateness of and management of Medication Assissted
Treatment (MAT) within the scope BHS-FHC provides MAT if a BHS-FHC medical
provider finds that MAT is appropriate and prescribes such..
 Services will be through one of two pathways:
A. Acme Patients may choose to designate BHS-FHC as their preferred primary
care provider, in which case their medical care will be managed by BHS. SUD
care will continue to be co-managed through an integrated approach where the
case manager will communicate with Acme staff any ongoing SUD and medical
care needs. Acme reserves the right to be the primary agency for SUD services
and case management as it pertains to SUD care.
B. Patient who do not elect to designate BHS-FHC as their preferred site for
primary care will obtain physical exam clearance and MAT services on an as
needed basis. The case manager at BHS-FHC will be responsible for the
following steps to assist with medical follow-up for issues that are identified at
the time of the physical exam:
a. The case manager at BHS-FHC will notify the patient of recommended
medical follow up.
b. The case manager at BHS-FHC will facilitate the communication of
recommended medical follow up to the patient’s chosen primary care
provider, if the patient has such and is willing to sign a release of
information allowing that communication.
c. The case manager at BHS-FHC will assist the patient in identifying an
appropriate primary care resource in the area to which they intend to
reside and communicate follow up recommendations to such, if the
patient is willing to sign a release of information allowing that
communication
d. The case manager at BHS-FHC will also communicate follow-up care
needs to Acme staff who will assist in supporting the client in obtaining
appropriate follow-up.
2) Provide primary medical care services as deemed necessary and appropriate for referred
patients of Acme. Including providing appointments for history and physical exams within
30 days of referral.
3) Maintain confidentiality of patient information shared between the two agencies in
accordance with HIPAA, 42 CFR Part 2, and other relevant state and federal privacy and
security laws and regulations. BHS-FHC will agree to provide timely access to medical
records regarding diagnosis and treatment for continuum of care purposes no longer than
7 business days from the date of request from Acme to assist in providing follow-up
care.
4) Provide roundtrip transportation services for Acme-referred patients to the BHS-FHC from
Acme program(s) in accordance with a mutually agreed-upon schedule.
5) BHS-FHC will be solely liable for all services provided by it and its health care
professionals.

Acme will:

1) Refer patients to BHS-FHC who are in need of primary medical care and/or
behavioral health services not currently provided by Acme. Will keep track of all
referred patients.
2) Acme will assign a case manager for all referred patients to communicate across-
agencies as needed with BHS-FHC clinical team or case manager in order to
identify and jointly resolve barriers to medical or MAT services.
3) Maintain confidentiality of patient information shared between the two agencies in
accordance with HIPAA, 42 CFR Part 2, and other relevant state and federal
 privacy and security laws and regulations. Acme will agree to provide timely access
to medical records regarding diagnosis and treatment for continuum of care purposes
no longer than 7 business days from the date of request from BHS-FHC to assist in
providing follow-up care.

IV. ADDITIONAL PROVISIONS

1. To the extent that referred patients receive services from BHS-FHC, such individuals
are considered patients of Acme for substance use treatment.
2. Acme and BHS-FHC reserve the right to enter into arrangements with other providers,
whether for the same of similar services, if such party deems it necessary.
3. Clients retain the right to see whomever they choose. However, both parties agree to
provide only services not offered by the other Agency.

V. COMPENSATION

This MOU formalizes a cooperative agreement for making referrals providing services to
mutual clients/patients. There will be no compensation or payment to either party by the
other under this agreement.

VI. COMPLIANCE WITH LEGAL REQUIREMENTS

BHS-FHC and Acme shall comply with all applicable federal, state and local laws
including specifically regulations in 42 CFR Part 2 and 4,CFR Parts 160-164 (also known
as HIPAA) and shall abide by all mandated statutes for the protection of patient/client
confidentiality. Both parties agree to serve program participants without regard to color,
creed, religion, race, ethnicity, gender, gender identity, sexual orientation, nationality,
and/or physical or mental disability.

VII. INDEMNIFICATION AND INSURANCE

BHS-FHC and Acme shall mutually agree to defend, hold harmless, and indemnify the
other and their officers, agents, and employees from any and all liabilities including, but
not limited to any claims from death, sickness, or other personal injury or injury to
property, including without limitation all consequential damages, for any cause
whatsoever arising from or connected with its service hereunder, except if it resulting
from the negligence of their agents, and/or employees.

Each party will ensure that it and its employees providing services pursuant to the referral
are covered by a professional liability insurance policy providing sufficient coverage
against professional liabilities which may occur as a result of the services provided to
referred patients.

BHS-FHC will be solely liable for services provided by it and its employees/contractors
and Acme will not be liable for any damages arising from any acts or omissions in
connection with the services provided by BHS-FHC.

VIII. OPERATIONAL AND PROCEDURAL DETAIL

Any and all operational and procedural detail that is mutually agreed to by BHS-FHC and
Acme, and deemed necessary to be put in writing, may be attached to this MOU as
Appendix A.

IX. NOTICES

All notices or correspondence related to this MOU should be directed to:

 BEHAVIORAL HEALTH SERVICES - FAMILY HEALTH CENTER
Michael Ballue, Director, Family Health Services
15519 Crenshaw Boulevard Telephone: 424-456-
8933
Gardena, CA 90249-4525 FAX: 323-757-
2068

Acme
John Doe Telephone: 999-999-9999
President and CEO FAX: 999-999-9999
1122 Boogiewoogie Ave
Los Angeles , CA 90000

VIII. EXECUTION OF MEMORANDUM OF UNDERSTANDING

The parties agree that:

1) This MOU shall be reviewed annually. Any amendments or modifications to this MOU
shall be executed in writing by both parties.
2) This MOU shall commence on the date of execution by both parties.
3) This MOU reflects the entire agreement between the parties with respect to the subject
matter hereof and supersedes all written statements, understandings
other prior oral or correspondence.
4) The persons signing and executing this MOU have been fully authorized to execute this
document.

BEHAVIORAL HEALTH SERVICES, INC.

Name: Debbie Levan, MPH, CCEP, CHC Date

Title: Chief Compliance Officer

Name: John Doe, MBA, MPH Date

Title: President &CEO