HomeMy WebLinkAboutCONSENT HCA Professional Serices JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh Peters, County Administrator
FROM: David Fortino
DATE: October 27, 2025
SUBJECT: HCA PROFESSIONAL SERVICES CONTRACT AMENDMENT for
MOUD/MAUD in Jails
STATEMENT OF ISSUE:
This HCA Contract Amendment for MOUD/MAUD will continue to provide access to medication, and
services for individuals with substance use disorders among the inmate population of the Jefferson County
Jail.
ANALYSIS:
This Amendment extends funding for MOUD/MAUD medications,program staff and supplies, and release
and reentry coordination. This funding expands the substances use disorder services provided in the jail.
FISCAL IMPACT:
The HCA Contract prior maximum contract amount $179,073.00. Amount of increase $304,720. Total
Maximum compensation$483,793.00
RECOMMENDATION:
Approve HCA PROFESSIONAL SERVICES CONTRACT AMENDMENT for MOUD/MAUD in Jails and
delegate the authority to sign off on behalf of the county to Chief of Corrections David Fortino.
REVIEWED BY:
1)4,e4. 0//q3
Jo Peters, County Administrator Date
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Washington State Healthcare Authority Contract No: K8167-1
Contract For: PROFESSIONAL SERVICES CONTRACT for MOUD?MAUD m Jaas Term: 1 year
COUNTY DEPARTMENT: Jefferson County Sheriffs Office
Contact Person: David Fortino
Contact Phone: 360-344-9743
Contact email: dfortino@co.}efferson.wa us
AMOUNT: S483,793.00 PROCESS: Exempt from Bid Process
Revenue: N/A Cooperative Purchase
Expenditure: NIA Competitive Sealed Bid
Matching Funds Required: NiA Small Works Roster
Sources(s) of Matching Funds , Vendor List Bid
vFund 4 001-180-000 _ RFP or RFQ
Munis OrglObj 001-180-000 ✓ Other: State Grant
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: E N/A:E _�f'"�«•rj '— — — /C �/tea.
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: E N/A: l l
Signature D`ate
STEP 3: RISK MANAGEN1F NT REVIEW (will be added electronicaII:1/4 through Lasert ehe):
Electronically approved by Risk Management on 10/14/2025.
P4o PnaallValpTpIrNoGv eAT aOt m VLO(olb ds11 e ctronically through Laserfiche):
Original contract expired 06/30/2025. Amendment No.1 extends the contract
date. Case law cautions against executing amendments on expired
contracts. In this case, JCSO has been waiting for the amended contract
from HCA for months. Low risk given HCA unlikely to complain. Risk
Management decision.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
Docusign Envelope ID:080C55A3-41F1-4D98-82CB-945E2BBB3072
Washington State CONTRACT HCA Contract No.: K8167
Health Care Authority AMENDMENT Amendment No.: 01
THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority and the
party whose name appears below, and is effective as of the date set forth below.
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
Jefferson County Sheriffs Office Jefferson County Jail
CONTRACTOR ADDRESS CONTRACTOR CONTRACT MANAGER
81 Elkins Road Name: Chief David Fortino
Port Hadlock, WA 98339 Email: dfortino(aco.jefferson.wa.us
AMENDMENT START DATE CONTRACT END DATE
July 1, 2025 June 30, 2026
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE TOTAL MAXIMUM COMPENSATION
$179,073 $304,720 $483,793
WHEREAS, HCA and Contractor entered into Contract K8167 for to develop and implement, or
expand, the Medication for Opioid Use Disorder(MOUD) and Medications for Alcohol Use Disorder
(MAUD) in Jails program, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.4, Amendments,
to extend the Contract term, increase funding, and incorporate a revised and restated Statement of
Work;
THEREFORE, the parties agree the Contract is amended as follows:
1. Section 2, Definitions, two (2) new, defined terms are added, and incorporated in alphabetical
order, as follows:
"Medications for Alcohol Use Disorder" or "MAUD" means a medical treatment approach that
uses FDA-approved medications to help individuals with Alcohol Use Disorder(AUD) reduce or
stop their opioid use and improve their overall health and well-being.
"Medications for Opioid Use Disorder" or"MOUD" means a medical treatment approach
that uses FDA-approved medications to help individuals with Opioid Use Disorder (OUD)
reduce or stop their opioid use and improve their overall health and well-being.
2. Section 3.2, Term, subsection 3.2.1, is amended to extend the Contract term as follows:
3.2.1 The initial term of the Contract will commence on December 1, 2024, and continue
through June 30, 2026, unless terminated sooner as provided herein.
3. Section 3.3, Compensation, subsection 3.3.1 is amended to reflect the $304,720 increase in
funding, the maximum compensation is as follows:
3.3.1 The parties have determined the cost of accomplishing the work herein will not exceed
$483,793, inclusive of all fees, taxes, and expenses. Compensation for satisfactory
performance of the work will not exceed this amount unless the parties agree to a
higher amount through an amendment.
HCA Contract No. K8167-01 Page 1 of 14
Docusign Envelope ID.080C55A3-41F1-4D98-82CB-945E2BBB3072
4. Section 3.4, Invoice and Payment is revised to make minor updates and incorporate additional
detail regarding cost reimbursement payment requirements. Section 3.4, Invoice and
Payment, now reads as follows:
3.4 INVOICE AND PAYMENT
3.4.1 In order to receive payment for services or products provided to a state agency,
Contractor must register with the Statewide Payee Desk at https://ofm.wa.gov/it-
systems/statewide-vendorpayee-services/receivinq-payment-state.
3.4.2 Invoices must describe and document to the HCA Contract Manager's
satisfaction a description of the work performed, the progress of the project, and
fees. All invoices and deliverables will be approved by the HCA Contract
Manager prior to payment. Approval will not be unreasonably withheld or delayed.
3.4.3 If expenses are invoiced, invoices must provide a detailed breakdown of each
type. Expenses of$50 or more must be accompanied by a receipt.
3.4.4 Invoices must be submitted using the A-19 Invoice Voucher form to
rachel.meadeAhca.wa.gov with the HCA Contract number in the subject line of
the email. Invoices must include the following information, as applicable:
a. The HCA Contract number;
b. Contractor name, address, phone number;
c. Description of services;
d. Date(s) of delivery;
e. Net invoice price for each item;
f. Applicable taxes;
g. Total invoice price; and
h. Any available prompt payment discount.
3.4.5 HCA will return incorrect or incomplete invoices for correction and reissue.
Payment will be considered timely if made within thirty (30) calendar days of
receipt of properly completed invoices.
3.4.6 Upon expiration of the Contract, any claims for payment for costs due and
payable under this Contract that are incurred prior to the expiration date must be
submitted by the Contractor to HCA within sixty (60) calendar days after the
Contract expiration date. HCA is under no obligation to pay any claims that are
submitted sixty-one (61) or more calendar days after the Contract expiration date
("Belated Claims"). HCA will pay Belated Claims at its sole discretion, and any
such potential payment is contingent upon the availability of funds.
5. Section 3.7, Incorporation of Documents and Order of Precedence, is amended to reflect the
changes made with this amendment and now reads as follows:
3.7 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE
Each of the documents listed below is by this reference incorporated into this Contract.
In the event of an inconsistency, the inconsistency will be resolved in the following
order of precedence:
HCA Contract No. K8167-01 Page 2 of 14
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3.7.1 Applicable Federal and State of Washington statutes and Regulations;
3.7.2 Recitals;
3.7.3 Special Terms and Conditions;
3.7.4 General Terms and Conditions;
3.7.5 Attachment 1(s) Statement(s) of Work; and
3 7.6 Any other provision, term or material incorporated herein by reference or
otherwise incorporated.
6. A new Attachment 1-A, Statement of Work, is added to prevent redundancy between the
previous Attachment 1(s), Statement(s) of Work, while also incorporating updates. In the event
of an inconsistency the revised and restated Attachment 1-A, Statement of Work, shall
supersede all previous Attachment 1-A(s) Statement(s) of Work.
The revised and restated Attachment 1-A, Statement of Work is attached hereto and by this
reference is incorporated into the Contract
7. A new Attachment 2, MOUD & MAUD in Jails Program Monthly Progress Report, is added for
Contractor's use in meeting the requirements of Attachment 1-A. Statement of Work, Section
3, Reporting. The new Attachment 2, MOUD & MAUD in Jails Program Monthly Progress
Report, is attached hereto and by this reference is incorporated into the Contract.
8. A new Attachment 3, MOUD Monthly Data Collection Spreadsheet, is added for Contractor s
use in meeting the requirements of Attachment 1-A, Statement of Work, Section 3, Reporting.
The new Attachment 3, MOUD Monthly Data Collection Spreadsheet, is by this reference
incorporated into the Contract.
9. This Amendment is effective July 1, 2025, ("Effective Date").
10. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the
Contract.
11. All other terms and conditions of the Contract remain unchanged and in full force and effect
The parties signing below warrant that they have read and understand this Amendment and have authority to
execute the Amendment. This Amendment will be binding on HCA only upon signature by both parties.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Chief David Fortino
Chief of Corrections ,
N SJGN,;T'uR PRINTED NAME AND TITLE DATE SIGNED
" ° LAndria Howerton
..4,... ,,� y ...,,, ... 1 10/2/2025
fPotty Cnntracts Administratnr
Approved as to orm only:
ii , ,(A-/� for 10/14/2025
Philip Hunsucker,Chief Civil Deputy Prosecuting Attorney
HCA Contract No K8167-01 Page 3 of 14
Docusign Envelope ID:080C55A3-41F1-4D98-82CB-945E2BBB3072
ATTACHMENT 1-A
Statement of Work
July 1, 2025 -June 30, 2026
1. PURPOSE
Support a comprehensive treatment program for incarcerated individuals with Opioid Use Disorder
(OUD) and Alcohol Use Disorder(AUD), beginning with screening upon entry and ending with
seamless transition to the care in the community, with use of Medications for Opioid Use Disorder
(MOUD) and Medications for Alcohol Use Disorder(MAUD) at its core.
This Contract supports RCW 71.24.599: Opioid use disorder—City and county jails—Fundinq.
(wa.gov).
Health Equity - This program also intends to address inequities in treatment and recovery services
by providing medically necessary treatment to incarcerated individuals. Programs should
understand cultural barriers and provide culturally appropriate services. Additionally, this program
intends to identify stigma and educate to ensure ongoing collaboration and openness to change.
2. WORK EXPECTATIONS
Contractor shall ensure funds are responsibly used towards the Opioid Use Disorder(OUD) and
Alcohol Use Disorder(AUD) treatment programs in the jail and provide the community standard of
care, including, at a minimum, the following core components:
2.1. General Standard of Care
2.1.1. 2020 ASAM National Practice Guideline for the Treatment of Opioid Use Disorder,
2.1.2. Guidelines for Managing Substance Withdrawal in Jails;
2.1.3. For American Indian/Alaska Native (Al/AN) individuals receiving Medications for
Opioid Use Disorder(MOUD) and/or Medications for Alcohol Use Disorder (MAUD)
services, Contractor, shall coordinate with the individual's Indian Health Care
Provider (IHCP) to ensure the IHCP can participate in treatment and discharge
planning, including continuity of care in the nearest IHCP clinically appropriate
setting for all Al/AN individuals participating in the program.
2.2. Intake
2.2.1. Screen all newly admitted individuals for risk of acute withdrawal from opioids and
alcohol upon intake.
2.2.2. MOUD, MAUD, and other medications which support the relief of withdrawal
symptoms, such as clonidine, anti-emetics, anti-diarrheals, and analgesics must be
offered to individuals at no charge to the individual.
2.2.3. Offer initiation of MOUD treatment to individuals who are physically dependent on
opioids, may have withdrawal symptoms or have disclosed recent use and
anticipate withdrawal.
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2.2.4. Offer treatment for withdrawal with benzodiazepines to individuals entering the
facility who are physically dependent on alcohol, if clinically appropriate.
2.2.5. Continue MOUD and MAUD for individuals who are already taking these
medications upon entering the facility.
2.2.6. Continue the individual on the same medication at the same dose unless ordered
otherwise by the prescriber based on clinical need, and as documented in the
individual's medical record, unless one of the following exceptions is applicable:
2.2.6.1. Injectable long-acting naltrexone may be converted to an equivalent oral
dose until just prior to release at which time the injectable form shall be
restarted.
2.2.6.2. Injectable long-acting buprenorphine may be converted to an equivalent
oral dose until just prior to release at which time the injectable form shall
be restarted.
2.2.6.3. Oral buprenorphine may be converted to any of the three formulations
available; film, tablet with naloxone, or tablet without naloxone.
2.2.6.4. If the individual is not pregnant, methadone may be transitioned to
buprenorphine if the Contractor is not a licensed Opioid Treatment
Program (OTP) and the nearest OTP is not within reasonable driving
distance from the jail or there is no OTP within reasonable distance of
the individual's release residence.
2.2.6.5. Though MOUD/MAUD may not be discontinued on a policy or
administrative basis because of the presence of other illicit or controlled
substances, administration of the community-based MOUD or MAUD
may be adjusted if clinically necessary due to pharmacologic risks of
drug-to-drug interaction.
2.2.7. Screen for OUD and AUD without physical dependence (i.e. without a risk of acute
withdrawal) after intake, as long as the delay does not impair the ability to begin
treatment prior to release.
2.2.8. Educate individuals on treatment choices and the process for continuation of
access to MOUD during incarceration and upon release.
2.2.9. Make available and offer treatment using some formulation of methadone,
buprenorphine, and naltrexone based on a mutually agreed-upon plan between the
prescriber and the individual, with the following exceptions or caveats:
2.2.9.1. The Contractor may decline to offer methadone if the Contractor is not a
licensed OTP, and the nearest OTP is not within reasonable driving
distance from the jail or there is no OTP within reasonable distance of
the individual's release residence.
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2.2.9.2. If there is no available buprenorphine provider in the community to
which the individual will release, the Contractor must still offer
buprenorphine (tapered over several days) if opioid withdrawal is
clinically indicated.
2.2.9.3. If withdrawal is not clinically indicated and the only reason for
considering discontinuation of buprenorphine is the lack of an available
buprenorphine provider in the community to which the individual will be
released, the decisions when or if buprenorphine should be
discontinued prior to release should be made based on the following:
a. A plan mutually agreed-upon between the individual and the
prescriber;
b. The length of time the individual is expected to remain in the jail;
c. The risks of opioid misuse or overdose during the incarceration; and
d. The individual's willingness to receive a dose of an extended-release
injectable buprenorphine just prior to release which will provide a
safe tapered withdrawal for the individual.
2.2.9.4. Provide naltrexone in oral formulation while the individual is
incarcerated. Offer injectable long-acting naltrexone or buprenorphine
as an option prior to release.
2.2.9.5. Offer oral buprenorphine without naloxone while the individual is
incarcerated but must discharge the individual on a formulation of
buprenorphine with naloxone unless there is a clinical reason not to do
so. E.g., the individual is discharged on injectable buprenorphine, the
individual is allergic to naloxone.
2.2.10. Contractor shall not facilitate forced opioid withdrawal, including withdrawal using a
tapering dose of buprenorphine or methadone, unless the individual provides an
informed refusal of treatment or the individual elects MOUD treatment with
naltrexone, in which case withdrawal is clinically required.
2.2.10.1. In such case, Contractor may use other medications (e.g., clonidine,
anti-emetics, anti-diarrheals, analgesics, etc.) in place of buprenorphine
or methadone if the individual chooses or as adjuncts to these
medications, but they may not be the only withdrawal treatment
available.
2.2.10.2. Initiation of buprenorphine or methadone, whether for induction of
treatment or for withdrawal, may not be delayed for administrative
reasons, e.g., unavailability of a prescriber, beyond when they are
clinically indicated to be started.
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Docusign Envelope ID.080C55A3-41F1-4D98-82CB-945E2BBB3072
2.2.11. Provide immediate evaluation to individuals at risk for, or in, opioid or alcohol
withdrawal who refuse treatment by a medical or mental health prescriber or a
licensed mental health professional at the masters' level or higher, to determine if
they have decision-making capacity.
2.2.11.1. If they do not, they must be transported to a community hospital and
may not return to the jail until they are clinically safe to return to the jails
AND have regained decision-making capacity.
2.3. During Incarceration
2.3.1. Offer initiation of MOUD/MAUD to individuals with unidentified OUD/AUD and/or if
treatment was not offered at intake. E.g., individuals with OUD but without physical
dependence, individuals with AUD who underwent withdrawal, etc.
2.3.2. Educate individuals on treatment choices and the process for continuation of
access to MOUD/MAUD during incarceration and upon release.
2.3.3. Administer methadone and buprenorphine daily or more frequently.
2.3.4. Contractor shall not use alternate-day or"balloon" dosing of buprenorphine.
2.3.5. Offer counseling to individuals for their OUD/AUD if they are expected to remain in
jail for longer than one month.
2.3.6. Provide MOUD/MAUD regardless of the individual's willingness to participate in
counseling.
2.4. Release
Contractor must accomplish the following prior to each individual's release from jail:
2.4.1. Complete release planning and reentry coordination as soon as possible after
admission to ensure an effective plan is in place prior to release or in the event of
an unexpected release of an individual who needs continued treatment and
services.
2.4.2. Provide at least two (2) doses of naloxone (e.g., Narcan®) and training on how to
administer the medication to all individuals with OUD.
2.4.3. Schedule the first community appointment with a treatment facility for continuation
of MOUD or MAUD.
2.4.4. Provide in hand, upon release, and at no cost to the individual, sufficient doses of
MOUD and/or MAUD to bridge, or sustain treatment for, the individual until the
scheduled MOUD/MAUD follow-up appointment at the selected community
treatment facility. This does not apply to individuals treated with injectable
MOUD/MAUD.
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2.4.4.1. If an individual is at risk of being released directly from court, inform
them prior to going to court that they may request to be transported
back to the jail by staff to receive these medications prior to going home.
2.4.4.2. In situations where a follow-up appointment upon release cannot be
made, e.g., after-hours bail-out, give the individual enough medication to
last until the next available appointment at the community treatment
facility. If the appointment date is unknown, give the individual a 30-day
supply at minimum.
2.4.4.3. In situations where medications cannot be provided upon release, e.g.,
unscheduled release at a time when medical staff are not present in jail,
Contractor must ensure the following:
a. The individual is informed that they may either return to the jail in the
morning to receive bridge medications; or
b. If no medical staff are present the following day, call in a prescription
for the same bridging medication to a local pharmacy, at no cost to
the individual.
2.4.5. Assist Medicaid-eligible individuals to sign up for Medicaid or assist individuals
whose Medicaid coverage has been terminated to reestablish coverage.
2.4.6. For any individual with Medicaid coverage, work cooperatively with the individual's
Managed Care Organizations (MCO)to facilitate re-entry benefits and continued
treatment with a community partner, including but not limited to allowing the MCO's
agent timely access to the jail and the individual.
2.5. Contract Management
2.5.1. Ensure operation specific tools, such as job descriptions, policies and procedures,
and statements of work, are developed, and staff are adequately trained, to ensure
consistent and appropriate practice.
2.5.2. Attend monthly meetings with HCA Contract Manager to discuss Contract
requirements, compliance, and problem-solving. Attend additional meetings as
required or deemed necessary by the HCA Contract Manager.
2.5.3. Contractor shall cooperate with periodic site visits by the HCA DBHR program
administrator or designee and make all relevant records and personnel available.
3. REPORTING
Contractor shall complete performance monitoring activities, including the submission of timely
and accurate data reports to the HCA Contract Manager, utilizing the HCA provided templates.
Further evaluation, including on- and off-site data collection may be conducted by HCA or an
HCA-designated third party. Reporting shall include, but is not limited to, the following:
HCA Contract No. K8167-01 Page 8 of 14
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3.1. Monthly Progress Reports
3.1.1. Due no later than the 10th day of the month following the month in which the
services being reported were provided.
3.1.2. See Attachment 2, MOUD & MAUD in Jails Program Monthly Progress Report.
3.2. Monthly Data Collection Spreadsheet
3.2.1. Due no later than the 10th day of the month following the month in which the
services being reported were provided.
3.2.2. See Attachment 3, MOUD Monthly Data Collection Spreadsheet.
3.3. Data Collection Format
Contractor shall provide the required reports via Managed File Transfer(MFT).
3.3.1. HCA anticipates shifting the data collection format at least in part from MFT to the
Program Data Acquisition Management and Storage (PDAMS) system prior to the
end date of this Contract.
3.3.1.1. Contractor shall continue to collect data via MFT method until notified
otherwise by the HCA Contract Manager in writing.
3.3.1.2. HCA Contract Manager shall notify Contractor of this change no less
than ten (10) Business Days before implementing the new collection
format.
4. COST REIMBURSEMENT
The payment format for this Contract is established as cost reimbursement. Reports and receipts
must be submitted monthly with each A-19 invoice, as identified in this section and in Contract
Section 3.4, Invoice and Payment.
4.1. Allowable Expenses
Funding provided under this Contract must be used to support a MOUD/MAUD program
prior to the implementation of the Medicaid Reentry Waiver and the ability to bill Medicaid for
reimbursable services. If Contractor's status changes Contractor must notify the HCA
Contract Manager to negotiate an amendment to this Contract.
Contractor shall submit a written request to the HCA Contract Manager prior to the purchase
of any items not included in the list below. Requests must be submitted no less than fifteen
(15) Business Days prior to purchasing and HCA approval must be granted, in writing, prior
to purchasing.
The following is a list of allowable expenses:
4.1.1. Program Staff
4.1.1.1. Nurses;
4.1.1.2. Medical assistants;
4.1.1.3. Health Care Providers;
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4.1.1.4. Prescribers;
4.1.1.5. Correctional staff;
4.1.1.6. Clerical and/or administrative staff for program reporting and
administration; and
4.1.1.7. Other program staff as needed.
4.1.2. MOUD, MAUD, and Medications
4.1.2.1. FDA approved Medications for Opioid Use Disorder:
a. Buprenorphine, including long-acting, injectable buprenorphine;
b. Methadone; and
c. Naltrexone.
4.1.2.2. FDA approved Medications for Alcohol Use Disorder(MAUD).
4.1.2.3. Naloxone for Contractor and Contractor staff.
4.1.3. Program Supplies
4.1.3.1. Technology:
a. Tablets;
b. Phones;
c. Security;
d. Internet or wi-fi enhancements to allow for telehealth; and
e. Other supplies if approved by the HCA Contract Manager as
outlined in Section 4.1, Allowable Expenses.
4.1.3.2. MOUD and MAUD Program Staff Office Needs:
a. Desk;
b. Chair;
c. Computer; and
d. Phone.
4.1.4. Release and Reentry
4.1.4.1. Transportation for participating individuals upon release to facilitate
treatment services such as first community appointment, picking up
prescriptions, safe place facilities, etc.
4.1.4.2. Release kit items such as:
a. Naloxone;
b. Gift cards;
c. Clothing and shoes;
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d. Personal hygiene items; and
e. Phones.
4.2. Monthly Estimated Costs
The estimated monthly cost reimbursement is as follows:
4.2.1. July 1, 2025—June 30, 2026
Monthly Estimated Cost Number of Months Total Costs
$25,393 12 $304,720
4.2.2. Adjustments revising twenty-five percent (25%) or more of the Monthly Estimated
Costs as identified in this section 4.2 must be submitted to the HCA Contract
Manager or designee for approval in writing, via email, at least fifteen (15) Business
Days prior to expending the adjusted funds.
4.2.3. HCA written approval must be granted prior to expending funds.
4.3. Invoicing
Invoices must be submitted in conjunction with the monthly reports identified in Section 3,
Reporting, and as follows:
4.3.1. Invoices shall be due no later than the 10th day of the month following the month in
which the expenses being invoiced were expended; and
4.3.2. As outlined in Contract Section 3.4, Invoice and Payment.
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ATTACHMENT 1
MOUD & MAUD in Jails Program Monthly Progress Report
Please give a sentence or two in response to each prompt below. These are not yes or no questions
but rather guidance on what is needed for program compliance. It is important to share that funding is
being spent in accordance with program requirements, that the funding is needed, and that the
program is successful.
Please plan to discuss your program and bring innovative ideas to each monthly HCA partner
meeting.
1. Key information
Contractor Name:
Month Reporting on:
Project Manager(s):
Contract Funding Start: July 1, 2025
Contract Funding End: June 30, 2026
2. How are funds spent for this program?
This section may be the same each month.
2.1. Staff:
2.2. Medications:
2.3. Subcontractors:
2.4. Naloxone:
2.5. Release Kits:
2.6. Other:
3. Narrative Progress Report
Include meeting the standard of care, barriers, solutions, Training and Technical Assistance
(TTA), successes, who is providing each step, what tools are being used, etc.
3.1. Screening or assessments for OUD and AUD and for risk of acute withdrawal.
3.2. How are withdrawals being treated?
3.3. Continuing or inducing MOUD or MAUD.
3.4. Release plan and reentry coordination, including:
3.4.1. Schedule first community follow-up appointment; and
3.4.2. Bridge medication upon release.
4. Successes
Including program or individual participant successes.
5. Challenges
Include both challenges faced and what solutions are being considered.
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Docusign Envelope ID:080055A3-41 F1-4D98-82CB-945E2BBB3072
6. How many individuals were screened for alcohol use disorder?
7. How many individuals began, or were continued on, Medications for Alcohol Use Disorder
(MAUD)?
8. Which MAUDs are being offered and which one is being chosen the most often?
HCA Contract No. K8167-01 Page 13 of 14
Docusign Envelope ID:080C55A3-41F1-4D98-82CB-945E2BBB3072
ATTACHMENT 3
MOUD Monthly Data Collection Spreadsheet
The current Contract Attachment 3, MOUD Monthly Data Collection Spreadsheet, including any and all
modifications, is incorporated herein by reference. Any questions regarding the use or purpose of this
form may be submitted to the HCA Contract Manager.
HCA Contract No. K8167-01 Page 14 of 14