THE DEPARTMENT OF BEHAVIORAL HEALTH AND

DEVELOPMENTAL SERVICES (DBHDS)

1220 BANK STREET

RICHMOND, VA 23219

REQUEST FOR PRE-QUALIFICATION

(RFPQ) NUMBER: 720-5237

ISSUE DATE: May 4, 2026

TITLE: Sexually Violent Predator Evaluations

CONTRACT TYPE: Requirements

COMMODITY CODE(S):

94876 Psychologists/Psychological and Psychiatric Services 91867 Human Services Consulting (To Include Mental Health Consulting Services) 95271 Rape and Sexual Assault Prevention

ISSUING AGENCY:

Commonwealth of Virginia Department of Behavioral Health and Developmental Services

Using Agency and/or location(s) where work will be performed: DBHDS/Commonwealth of Virginia-Statewide

Electronic Sealed Proposals Will Be Received Until August 4, 2026 AT 2:00 PM, local prevailing time, For Furnishing The Goods/Services Described Herein.

If an applicant has questions about the solicitation, questions shall be emailed to Nicholas Sloane, Procurement Officer II at nick.sloane@dbhds.virginia.gov. Nicholas Sloane is the single point of contact for this procurement. Communication, regarding this solicitation, with anyone else may result in disqualification of the Applicant(s).

PREQUALIFICATION CONFERENCE: A prequalification conference will be held on Friday, June 5, 2026 at 1:00 PM via Microsoft Teams (Reference Section VII.A herein)

Note: This public body does not discriminate against faith-based organizations in accordance with the Code of Virginia, § 2.2-4343.1 or against a bidder or applicant because of race, religion, color, sex, national origin, age, disability, sexual orientation, gender identity, political affiliation, or veteran status or any other basis prohibited by state law relating to discrimination in employment. Faith-based organizations may request that the issuing agency not include subparagraph 1.e in General Terms and Condition C. Such a request shall be in writing and explain why an exception should be made in that invitation to bid or request for proposal.

TABLE OF CONTENTS

SECTION PAGE

Glossary 3

I. PURPOSE 5

II. BACKGROUND 5

III. LICENSE, CERTIFICATION, AND EXPERIENCE 5

IV. STATEMENT OF NEEDS 5

V. SPECIFIC PROPOSAL INSTRUCTIONS 8

VI. VETTING PROCESS 8

VII. PREQUALIFICATION CONFERENCE 9

VIII. APPROVAL OR DENIAL OF APPLICANT 9

ATTACHMENTS – pages 10-17

A. Applicant Data Sheet B. State Corporation Commission Form

C. Proprietary/Confidential Information Identification D. Business Associate Agreement

ACRONYM/KEY TERM MEANING/DEFINITION

Professional Services

Work performed by an independent contractor within the scope of the practice of Accounting, actuarial services, architecture, land surveying, landscape architecture, law, dentistry, medicine, optometry, pharmacy, professional engineering, and the services of an economist procured by the State Corporation Commission.

Request for Prequalification (RFPQ)

A procedure to prequalify products or vendors and limit consideration of bids or proposals to only those products or vendors which have been prequalified.

DSBSD Department of Small Business and Supplier Diversity

DUNS #

The Dun & Bradstreet D-U-N-S Number is a unique nine-digit identifier for businesses.

SOSA Sex Offender Screening and Assessment

GLOSSARY

Sexually Violent Offense means any felony under (i) former §18-54, former §18.12-44, subdivision 5 of §18.2- 31, §18.2-61, 18.2-67.1, or 18.2-62; (ii) §18.2-48, (iii) 18.2-63, 18.2-64.1, or 18.2-67.3; subdivision 1 of §18.2-31 where the abduction was committed with intent to defile the victim; (iv) §18.2-32 when the killing was in the commission of, or attempt to commit rape, forcible sodomy, or inanimate or animate objects sexual penetration; (v) the laws of the Commonwealth for a forcible sexual offense committed prior to July 1, 1981, where the criminal behavior is set forth in §18.2-67.1 or 18.2-67.2; or (vi) conspiracy to commit or attempt to commit any of the above offenses.

Sexually Violent Predator (SVP) is defined by Virginia Code §37.2-900 as “any person who (i) has been convicted of a sexually violent offense or has been charged with a sexually violent offense and is URIST pursuant to §19.2-

169.3 and (ii) because of a mental abnormality or personality disorder, finds it difficult to control his predatory behavior which makes him likely to engage in sexually violent acts.

Commitment Review Committee (CRC) is established by the Code of Virginia §37.2-904 under the supervision of the Director of the Department of Corrections to screen, evaluate, and make recommendations regarding prisoners in the custody of the Department of Corrections or defendants charged with sexually violent offenses who have been found URIST for the purposes of civil commitment as Sexually Violent Predator.

Commissioner-Designated Independent SVP Evaluator is licensed psychiatrists and licensed clinical psychologists who are skilled in the diagnosis, treatment, and risk assessment of sex offenders.

COV means the Code of Virginia. https://law.lis.virginia.gov/vacode

DBHDS means the Virginia Department of Behavioral Health and Developmental Services.

www.dbhds.virginia.gov

VADOC means the Virginia Department of Corrections. www.vadoc.virginia.gov

DSBSD means the Virginia Department of Small Business Supplier Diversity. www.sbsd.virginia.gov

ECO Evaluations means Emergency Custody Order evaluations. These are forensic evaluations for the purpose of an SVP civil proceeding that are completed by the Commissioner-designated independent evaluator to provide information relevant to each of the conditional release statutory requirements for the court.

OAG means the Virginia Office of the Attorney General. https://www.oag.state.va.us/

OSVPS means the DBHDS Office of Sexually Violent Predator Services.

SVP evaluations forensic evaluations for the purpose of a civil proceeding that are completed by the Commissioner-designated independent SVP Evaluators that provide information relevant to each of the statutory commitment criteria for the court.

Testing or Assessment is the systematic application of objective, projective, or other screening or evaluative instruments for the purpose of documenting and describing some aspect of an individual’s personality, behavior, or functioning as well as risk assessment information.

VCBR refers to the Virginia Center for Behavioral Rehabilitation, the secure SVP civil commitment facility operated by the DBHDS.

SVP Annual Review (AR) Evaluations forensic evaluations for the purpose of civil proceedings that are completed by evaluators employed by the VCBR Forensic Department and also by Commissioner-designated SVP evaluators when contracted by the VCBR Forensic Department. These reports provide information relevant to whether persons found to Sexually Violent Predators by the court and civilly committed to VCBR– hereafter, respondents – continue to meet SVP criteria and, if so, continue to need secure inpatient treatment/civil commitment or meet criteria for conditional release.

Pursuant § 37.2-912, if a respondent is assessed as continuing to meet SVP criteria, then the evaluator conducting the SVP Annual Review evaluation must address appropriateness for conditional release. This is done by addressing whether each of the following criteria is met:

(i) The respondent does not need secure inpatient treatment but does need outpatient treatment or monitoring to prevent their condition from deteriorating to the degree that they would need secure inpatient treatment.

(ii) Appropriate outpatient supervision and treatment are reasonably available.

(iii) There is significant reason to believe that the respondent, if conditionally released, would comply with the conditions specified.

(iv) Conditional release will not present an undue risk to public safety.

Defendant means any person charged with a sexually violent offense who is deemed to be an unrestorably incompetent defendant pursuant to § 19.2-169.3 and is referred for commitment review pursuant to this chapter.

Respondent means the person who is subject of a petition filed under §37.2 - 900 through 37.2-921

I. PURPOSE:

The purpose of this solicitation is to Prequalify Psychologists and Psychiatrists to establish a Qualified Contractor’s List (QCL) in the event for future solicitations to provide SVP, ECO and Annual Review Evaluations for DBHDS.

II. BACKGROUND:

The DBHDS Commissioner designates SVP evaluators to conduct evaluations of persons, either offenders or detainees, convicted of, or charged with a Sexually Violent Offense, as defined by the COV. These evaluations are conducted throughout the Commonwealth of Virginia, either in a local jail, a VADOC correctional institution, or one of the DBHDS mental health facilities. https://law.lis.virginia.gov/vacode/title37.2/.

III. LICENSE, CERTIFICATION & EXPERIENCE: The Contractor shall:

1. Possess a current Virginia license or be eligible for licensure by the Virginia Department of Health Professions as a Psychiatrist or Clinical Psychologist to practice medicine and psychiatry or psychology in the Commonwealth of Virginia. Contractors that are license eligible should obtain licensure in Virginia within their respective field within one year of contract award.

2. Possess certification as a Virginia Sex Offender Treatment Provider (CSOTP) or documentation of training in the evaluation and treatment of sexual offenders that is at a minimum an approved equivalent to Virginia’s CSOTP requirements as stated in the Commonwealth of Virginia Regulations Governing the Certification of Sex Offender Treatment Providers, Page 5 18VAC125-30-40 and 18VAC125-30-50, Section B..

3. Demonstrate experience in the following areas throughout the duration of the resulting contract:

a. Diagnosing personality disorders and other mental abnormalities.

b. Evaluating sexually violent individuals.

c. Conducting forensic-type evaluations for the courts.

d. Providing expert testimony to the courts in forensic-type cases.

4. Be knowledgeable in the area of evidence-based sex offender treatment.

IV. STATEMENT OF NEEDS:

A. SVP AND ECO EVALUATIONS REQUIREMENTS: The Contractor shall:

1. Confirm, within one (1) business day of contact from the Agency, the ability to accept or decline an SVP or ECO evaluation by the deadline specified by the OSVPS consistent with the time frames mandated in the COV and by the courts. The Agency will provide the deadline at the point of contact.

a. The frequency of referrals for an evaluator depends on the number of cases reviewed for civil commitment, the number of emergency custody orders issued, and the number of SVP evaluators under contract at a given time.

b. The contractor should complete a minimum of four (4) evaluations per year unless otherwise approved by the Purchasing Agency to conduct less. Repeated refusals of evaluations may lead to contract cancellation (reference Section VIII. Paragraph 2).

2. Prepare for evaluation interviews by reviewing relevant available records to a degree sufficient for conducting the assigned evaluation.

a. SVP evaluation records are housed at the VADOC Headquarters, located at 6900 Atmore Drive, Richmond, VA 23225.

i. If found URIST, all available records with the exception of the Virginia Criminal Information

Network (VCIN) report will be provided by OSVPS. Evaluators will need to contact the DOC Sex Offender Screening and Assessment (SOSA) Unit to coordinate viewing the VCIN.

b. Available ECO evaluation records will be sent by the OSVPS after confirmation of referral acceptance

i. The contractor might be required to contact supervising officers to obtain additional records.

3. Travel to the institution or location housing the prisoner or defendant if a virtual option is not available.

4. Interview and test the prisoner or defendant in accordance with the requirements of the instruments used, consistent with the ethics of the profession of the evaluator and to the degree necessary for completing the assigned evaluation to a high professional standard.

a. Provide any tests specified by OSVPS. Evaluators may select additional tests as deemed appropriate in their professional judgment.

b. Interviews may be conducted by video, based on the facility resources. Evaluators shall coordinate interviews directly with the facility.

c. Conduct collateral interviews with family members, or persons related to, or known to the prisoner or defendant. ECO evaluations require contact with supervising officers.

5. Follow the templates for reports provided by the OSVPS. Evaluators may add information as needed but shall not drop any required item from the template. Complete evaluation reports in accordance with evidence-based practice and accepted clinical standards.

a. Email SVP evaluations to the OSVPS and the CRC.

b. Email ECO evaluations to the OSVPS.

6. Meet an evaluation assigned deadline. Evaluators will be informed of this deadline at the time the referral is made. Deadlines are in large part determined by COV and are not negotiable.

7. Make themself available to the OAG for case consultation, testimony, and other services as deemed necessary by the OAG. Communication regarding these services includes but is not limited to phone calls, emails, and subpoenas.

8. Provide addendums or other written clarification if requested by the CRC, OAG, or OSVPS. The addendum or written clarification shall be provided by the date specified by the requesting entity.

9. Ensure any documents related to any SVP cases or evaluations are stored per security requirements.

Records held by the evaluator shall be maintained in a locked file, separate from all other records, and specifically designated for this purpose. On a case-by-case basis, DBHDS, in its sole discretion, reserves the right to inspect how files are stored. Reference Attachment D. Business Associate Agreement.

10. Provide consultation services for OSVPS on specific cases or other issues related to SVPs.

11. Provide redacted evaluations to OSVPS within 14 calendar days for the purpose of peer review upon request.

B. VCBR ANNUAL REVIEW EVALUATION REQUIREMENTS: The Contractor shall:

1. Confirm within one (1) business day of referral their ability to complete, or decline, an SVP Annual

Review evaluation by the deadline specified by the VCBR Forensic Department, consistent with the time frames mandated in the Code of Virginia and the processing needs of the Forensic Department.

a. By statute, SVP Annual Review evaluations have a mandated deadline which is 60 days prior to the annual review hearing date. The completed SVP Annual Review evaluation report shall be delivered to the VCBR Forensic Department not later than three (3) business days prior to the statutorily mandated deadline. Evaluators will be informed of the date the report must be received by the VCBR Forensic Department.

b. The frequency of referrals for an evaluator depends upon the number of SVP Annual Review evaluations needed by the VCBR Forensic Department during a particular month, the workloads of SVP forensic evaluators on staff at VCBR, and the number of SVP evaluators under contract at a given time.

2. Prepare for the interviews required for SVP Annual Review evaluations by reviewing available records.

These records may be reviewed on-site at the VCBR, located at 4901 East Patrick Highway, Burkeville, VA 23922; or they may be provided to the evaluators electronically. Evaluators should call the VCBR to set up an appointment regarding the best method to receive records and set up a time to interview the respondent.

3. Afford respondents being evaluated for AR evaluations the opportunity to participate in a face-to-face clinical interview. Evaluators may travel to VCBR for these interviews or complete them by video.

4. Consult with the respondent’s therapist to gather additional information, in any form the evaluator considers to be appropriate. For example, the evaluator may choose to consult with the therapist in person when the evaluator comes to the VCBR to interview the respondent; or the evaluator may elect to conduct consultation by telephone or email if the therapist is willing and able to do so. Collateral interviews or consultation with other VCBR staff is not mandatory and is left to the discretion of the evaluator.

5. Follow the report structure contained in the template when providing reports provided by the VCBR Forensic Department. Evaluators may add to the template but shall not drop any required item from the template. Evaluators have discretion as to which dynamic risk factors listed in the SVP Annual Review evaluation report template are relevant to the case at hand. Factors that are not deemed relevant do not have to be cited or discussed. If the evaluator considers other risk factors and considerations to be important, those should be discussed in the section for other risk factors. If the evaluator considers other protective factors to be important, those should be discussed in the section addressing protective factors.

6. Include actuarial data from the Static-99R if applicable in AR evaluations. Evaluators are not required to conduct other tests or measures. The evaluator has discretion about using additional tests or measures. If such testing is conducted the evaluator shall incorporate test findings into his or her discussion of diagnoses, risk and protective factors, recommendations, and/or suitability for conditional release, when relevant and appropriate.

7. Reserve availability to the Office of the Attorney General (OAG) upon completion of an AR evaluation for case consultation, testimony, and other services as deemed necessary by the OAG.

8. Provide a written response to any request for an addendum or clarification to the AR evaluation to the Forensic Department by the date specified by the Forensic Director. These occasions are expected to be quite infrequent and typically related to some event or change of condition that occurs after the submission of the report that the evaluator may consider relevant to his or her opinions or recommendations.

9. Review treatment records for the period of time from when the AR evaluation was submitted to the date of any hearings (hearings are often continued or occur many weeks or months after the report is submitted) so that they are able to provide up-to-date information to the court. A written update (usually no more than one or two pages) is generally not needed but may be requested by the OAG if a lengthy period has passed between evaluation date and hearing date and will be reimbursed at the agreed upon rate.

10. Ensure respondent records are stored per security requirements. Records held by the evaluator shall be maintained in a locked file, separate from all other records, and specifically designated for this purpose.

On a case-by-case basis, the Agency, in its sole discretion, reserves the right to inspect how files are stored. Reference Attachment D. Business Associate Agreement.

11. Be informed of the assigned deadline for the AR evaluation at the time the referral is made. Deadlines are in large part determined by Code of Virginia the processing needs for the VCBR Forensic Department and are not negotiable. SVP reports are to be delivered to the Forensic Department no later than three days prior to the 60-day deadline. The Forensic Department will inform the evaluator of the date the report must be received by the department.

a. SVP Annual Review evaluation reports are due to the court, Office of Attorney General (OAG), and the respondent’s attorney no later than 60 days prior to the scheduled date of the annual review hearing.

This is called the 60-day deadline. The Forensic Department handles this distribution after the report is received from the evaluator.

C. PURCHASING AGENCY REQUIREMENTS:

The Purchasing Agency will:

1. Upon contract execution, designate an individual(s) as an authorized representative, the Contract Administrator (CA), to administer all services performed in conjunction with an awarded contract(s).

DBHDS will provide the CA’s contact information to the Contractor upon contract execution.

V. SPECIFIC PROPOSAL INSTRUCTIONS:

Proposals should be as thorough and detailed as possible so that the DBHDS may properly evaluate your capabilities to provide the required goods/services. Applicants are required to submit the following items as a complete proposal:

1. A written narrative statement to include company background information, including size, number of employees, and annual volume of business.

2. Documentation to verify the Applicant is:

a. Currently licensed (or license eligible) as a Psychiatrist or Clinical Psychologist to practice medicine and psychiatry or psychology in the Commonwealth of Virginia.

b. Currently Certified as a Virginia Sex Offender Treatment Provider (CSOTP); or documentation of training in the evaluation and treatment of sexual offenders that is at a minimum an approved equivalent to Virginia’s CSOTP requirements.

c. Knowledgeable in the area of evidence-based sex offender treatment.

d. Experienced in the following:

i. Diagnosing personality disorders and other mental abnormalities.

ii. Evaluating sexually violent individuals.

iii. Conducting forensic-type evaluations for the courts.

iv. Providing expert testimony to the courts in forensic-type cases.

3. Work Samples – A minimum of two (2) completed sex offender evaluations completed within the last year. All Personally Identifiable Information/ Protected Personal Information shall be redacted.

4. Description of the Applicant’s method for dealing with problems and complaints presented by the

Department of Behavioral Health and Developmental Services employees detailing at what point the problem would escalate to the next level of supervision/management.

5. Attachments

Attachment A – Applicant Data Sheet Attachment B – State Corporation Commission Form Attachment C – Proprietary/Confidential Information Identification Attachment D – Business Associate Agreement

VI. VETTING PROCESS: DBHDS will use the information/documents, referenced in Section V., provided by the applicant, to determine if the applicant is qualified. The process includes vetting by DBHDS, VADOC and OAG. During the vetting process, the applicant shall communicate solely with the Agency’s Procurement Office only for all matters related to this solicitation.

VII. PREQUALIFICATION CONFERENCE: A preproposal conference will not be held.

A. OPTIONAL PREQUALIFICATION CONFERENCE: An optional prequalification conference will be held on June 5, 2026 at 1:00 PM. The purpose of this conference is to allow potential applicants an opportunity to present questions and obtain clarification relative to any facet of this solicitation.

While attendance at this conference will not be a prerequisite to submitting for qualification, applicants who intend to submit for qualification are encouraged to attend. Bring a copy of the solicitation with you.

Any changes resulting from this conference will be issued in a written addendum to the solicitation.

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VIII. APPROVAL OR DENIAL OF APPLICANT: DBHDS will notify the applicant once the vetting process has been completed. The notification will let the applicant know DBHDS’ determination of approval or denial.

The following is a list of reasons why an applicant may be denied. This is not an all-inclusive list of reasons.

Each applicant’s information/documents will be reviewed independently. If the applicant is approved, they will be notified before DBHDS issues the resulting solicitation. If the applicant is not approved, they will have the opportunity to correct any deficiencies (depending on the reason for rejection) and respond to any future RFPQ that DBHDS may issue. These deficiencies may include:

1. Unable to qualify as an SVP expert per the OSVPS, DOC SOSA Unit, OAG or by a court.

2. Does not agree to cooperate with general rules of conduct and/or logistics for performing any type of

SVP report (SVP, ECO, or Annual Review).

3. Does not agree to conform to the overall formatting requirements for SVP reports.

4. Work samples demonstrate a clear bias or lack of KSA’s to produce comprehensive SVP, ECO, or AR reports.

5. Unable to successfully pass a background check (i.e., criminal history beyond traffic violations).

6. History of fraternization and/or any issues with visitation or entry into VADOC or DBHDS facilities.

7. History of substantial noncompliance with the terms and conditions of prior contracts with a public body without good cause.

8. Currently debarred pursuant to an established debarment procedure from bidding or contracting by any public body, agency of another state or agency of the federal government.

9. History of statements in professional environments, including but not limited to court transcripts, that allude to bias for or against DBHDS and/ or SVP legislation.

THE DEPARTMENT OF BEHAVIORAL HEALTH AND

DEVELOPMENTAL SERVICES

1220 BANK STREET

RICHMOND, VA 23219

NOTE TO APPLICANT:

The following attachments must be completed, signed (when applicable) and submitted with your proposal. Failure to submit a complete proposal may result in you not receiving qualification.

ATTACHMENT A Applicant Data Sheet ATTACHMENT B State Corporation Commission Form ATTACHMENT C Proprietary/Confidential Information Identification ATTACHMENT D Business Associate Agreement

ATTACHMENT A: APPLICANT DATA SHEET

The applicant must have the capability and capacity in all respects in order to fully satisfy all of the contractual requirements.

APPLICANT/COMPANY NAME:

COMPANY ADDRESS:

YEARS IN BUSINESS: ___ year(s) ___ months (providing this type of service) eVA VENDOR ID#:

DSBSD CERTIFICATION #:

DSBSD CERTIFICATION TYPE & EXPIRATION:

DUNS#:

PERFORMANCE/DELIVERY DATE:

_____ earliest firm delivery/performance start date after receipt of order (ARO)

ARE YOU A SUBSIDIARY FIRM?

YES NO

If yes, list the name and location of your parent affiliation:

CONTRACTOR’S REPRESENTATIVE:

The Contractor shall assign one (1) representative to be in contact with DBHDS for any questions regarding your proposal; as well as any contract that may result from this solicitation. The Contractor’s representative shall handle and resolve all issues including, but not limited to billing and reporting.

Representative’s Name:

Representative’s Telephone:

Representative’s Email:

ATTACHMENT B: STATE CORPORATION COMMISION FORM

Virginia State Corporation Commission (SCC) registration information.

The Applicant:

is a corporation or other business entity with the following SCC identification number: ______________ is not a corporation, limited liability company, limited partnership, registered limited liability partnership, or business trust is an out-of-state business entity that does not regularly and continuously maintain as part of its ordinary and customary business any employees, agents, offices, facilities, or inventories in Virginia (not counting any employees or agents in Virginia who merely solicit orders that require acceptance outside Virginia before they become contracts, and not counting any incidental presence of the applicant in Virginia that is needed in order to assemble, maintain, and repair goods in accordance with the contracts by which such goods were sold and shipped into Virginia from applicant’s out-of-state location) is an out-of-state business entity that is including with this proposal an opinion of legal counsel which accurately and completely discloses the undersigned applicant’s current contacts with Virginia and describes why those contacts do not constitute the transaction of business in Virginia within the meaning of § 13.1-757 or other similar provisions in Titles 13.1 or 50 of the Code of Virginia.

**NOTE** >> Check the following box if you have not completed any of the foregoing options but currently have pending before the SCC an application for authority to transact business in the Commonwealth of Virginia and wish to be considered for a waiver to allow you to submit the SCC identification number after the due date for proposals (the Commonwealth reserves the right to determine in its sole discretion whether to allow such waiver):

ATTACHMENT C: PROPRIETARY/CONFIDENTIAL INFORMATION IDENTIFICATION

Trade secrets or proprietary information submitted by an Applicant shall not be subject to public disclosure under the Virginia Freedom of Information Act; however, the Applicant must invoke the protections of § 2.2-4342F of the Code of Virginia, in writing, either before or at the time the data or other material is submitted. The written notice must specifically identify the data or materials to be protected including the section of the proposal in which it is contained, as well as the page numbers, and must state the reasons why protection is necessary. The proprietary or trade secret material submitted must be identified by some distinct method such as highlighting or underlining and must indicate only the specific words, figures, or paragraphs that constitute trade secret or proprietary information. In addition, a summary of proprietary information submitted shall be submitted on this form. The classification of an entire proposal document, line item prices, and/or total proposal prices as proprietary or trade secrets is not acceptable. If, after being given reasonable time, the Applicant refuses to withdraw such a classification designation, the proposal will be rejected.

Name of Firm/Applicant: ______________________________, invokes the protections of § 2.2-4342F of the Code of Virginia for the following portions of my proposal submitted on __________ (Date).

Signature:

Title:

DATA/MATERIAL TO BE PROTECTED SECTION # & PAGE # REASON WHY PROTECTION IS

NECESSARY

ATTACHMENT D: BUSINESS ASSOCIATE AGREEMENT

Contract Number: 720-5237

PRIVACY AND SECURITY OF PROTECTED HEALTH INFORMATION

THIS BUSINESS ASSOCIATE AGREEMENT is made as of ___________, by the Department of Behavioral Health and Developmental Services (herein referred to as “Covered Entity”), with an office at 1220 Bank Street, Richmond, VA 23219 and ___________________- (here in referred to as “Business Associate”), a corporation, department or other entity with office at _________________________________________.

This BUSINESS ASSOCIATE AGREEMENT (herein referred to as the “Agreement”) constitutes a non-exclusive agreement between the Covered Entity, which administers health services, and the Business Associate named above.

The parties wish to enter into an Agreement that addresses the requirements of the HIPAA Privacy and Security Rules.

NOW THEREFORE, the parties, intending to be legally bound, agree as follows:

I. Definitions: As used in this contract, the terms below will have the following meanings:

a. Business Associate shall generally have the same meaning as the term “business associate” at 45CFR160.103, and in reference to the party to this agreement, shall mean.

b. Covered Entity shall generally have the same meaning as the term “covered entity” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean Department of Behavioral Health and Developmental Services.

c. Protected Health Information (PHI): Any information that is created or received by a Covered Entity that relates to the past, present, or future physical or mental health or condition of an individual, limited to the information created or received by Business Associate from or on behalf of Covered Entity.

d. HIPAA Rules shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.

II. Obligations and Activities of Business Associate:

a. Business Associate agrees to not use or disclose Protected Health Information other than as permitted or required by the Agreement or as required by law.

b. Business Associate agrees to use appropriate safeguards and comply with Subpart C of 45 C.F.R. Part 164 to prevent use or disclosure of the Protected Health Information other than as provided for by this Agreement.

c. Business Associate agrees to report to Covered Entity any use or disclosure of the Protected Health Information not provided for by this Agreement of which it becomes aware, including breaches of unsecured protected health information, as required at 45 C.F.R. 164.410.

d. In accordance with 45 C.F.R. 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit protected health information on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information.

e. Report to the Covered Entity any security incident of which it becomes aware.

f. Business Associate shall notify the Covered Entity of a breach of unsecured PHI on the first day on which such breach is known by Business Associate or an employee, officer or agent of Business Associate other than the person committing the breach, or as soon as possible following the first day on which Business Associate or an employee, officer or agent of Business Associate other than the person committing the breach should have known by exercising reasonable diligence of such breach. Notification shall include, to the extent possible, the identification of each individual whose unsecured PHI has been or is reasonably believed by the Business Associate to have been, accessed, acquired, used or disclosed during the breach.

Business Associate shall also provide the Covered Entity with any other available information at the time Business Associate makes notification to the Covered Entity or promptly thereafter as information becomes available. Such additional information shall include (i) a brief description of what happened, including the date of the breach; (ii) a description of the types of unsecured PHI that were involved in the breach; (iii)any steps the Business Associate believes individuals should take to protect themselves from potential harm resulting from the breach; and (iv) a brief description of what Business Associate is doing to investigate the individuals, and protect against any future breaches. For purposes of this paragraph, unsecured PHI means protected health information that is not rendered unusable, unreadable, or indecipherable to unauthorized persons through the use of a technology or methodology specified by the U.S. Secretary of Health and Human Services.

g. Business Associate agrees to provide access, at the request of Covered Entity to Protected Health Information to Covered Entity or, as directed by Covered Entity, to an Individual in order to meet the requirements under 45 CFR 164.524.

h. Business Associate agrees to make internal practices, books, and records, including policies and procedures and Protected Health Information, available to the Secretary of the U.S. Department of Health and Human Services for the purpose of determining compliance with the HIPAA Rules.

i. Business Associate agrees to document and provide to Covered Entity such disclosures of Protected Health Information and information as would be required for Covered Entity to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

j. Make any amendment(s) to Protected Health Information in a designated record set as directed or agreed to by the covered entity pursuant to 45 C.F.R. 164.526 or take other measures as necessary to satisfy covered entity's obligations under 45 C.F.R. 164.526.

III. General Use and Disclosure Provisions

a. Business Associate may only use or disclose Protected Health Information as provided in the underlying

Agreement

b. Business Associate may use or disclose Protected Health Information as required by law.

c. Business Associate agrees to make uses and disclosures and requests for Protected Health Information consistent with Covered Entity’s minimum necessary policies and procedures.

d. Business Associate may not use or disclose Protected Health Information in a manner that would violate

Subpart E of 45 CFR Part 164 if done by covered entity, except for the specific uses and disclosures set forth below.

e. Business Associate may disclose Protected Health Information for the proper management and administration of the Business Associate, provided that disclosures are required by law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law orfor the purpose for which it was disclosed to the person, and the person notifies the Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

IV. Obligations of Covered Entity

a. Covered Entity shall notify Business Associate of any limitations in its notice of privacy practices of

Covered Entity in accordance with 45 CFR 164.520, to the extent that such limitation may affect Business Associate’s use or disclosure of Protected Health Information.

b. Covered Entity shall notify Business Associate of any changes in, or revocation of, permission by Individual to use or disclose Protected Health Information, to the extent that such changes may affect Business Associate’s use or disclosure of Protected Health Information.

c. Covered Entity shall notify Business Associate of any restriction to the use or disclosure of Protected Health Information that Covered Entity has agreed to in accordance with 45 CFR 164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of Protected Health Information.

V. Permissible Request by Covered Entity:

a. Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under the Privacy Rule if done by Covered Entity.

VI. Termination:

Either party may terminate this Agreement immediately if it determines that the other party has violated a material term of this Agreement. This Agreement shall remain in effect unless terminated for cause with immediate effect, or until terminated by either party with not less than thirty (30) days prior written notice to the other party, which notice shall specify the effective date of the termination; provided, however, that any termination shall not affect the respective obligations or rights of the parties arising under this Agreement before the effective date of termination.

VII. Effect of Termination:

Upon termination of this Agreement for any reason, Business Associate shall return or destroy all Protected Health Information received from Covered Entity or created or received by Business Associate on behalf of Covered Entity. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of Business Associate. Business Associate shall retain no copies of the Protected Health Information. In the event that Business Associate determines that returning or destroying the Protected Health Information is infeasible, Business Associate shall provide to Covered Entity notification of the conditions that make return or destruction of Protected Health Information infeasible. Upon agreement that return or destruction of Protected Health Information is infeasible, Business Associate shall extend the protections of this Agreement to such Protected Health information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as Business Associate maintains such Protected Health Information.

VIII. Amendment:

Upon the enactment of any law or regulation affecting the use or disclosure of PHI, or the publication of any decision of a court of the United States or of this state relating to any such law, or the publication of any interpretive policy or opinion of any governmental agency charged with the enforcement of any such law or regulation, the parties shall work in good faith to amend this Agreement in such manner as is necessary to comply with such law or regulation. If the parties are unable to agree on an amendment within thirty (30) days thereafter, either of them may terminate this Agreement by written notice to the other.

EACH PARTY has caused this Agreement to be properly executed on its behalf as of the date first above written

CONTRACTOR:

PURCHASING AGENCY: Department of Behavioral Health and Developmental Services

BY: BY:

PRINTED NAME: PRINTED NAME:

TITLE: TITLE:

DATE: DATE: