HomeMy WebLinkAboutWashington State Healthcare Authority Residential Substance Abuse Treatment - 042026 JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh Peters, County Administrator
FROM: David Fortino
DATE: 4ri( X, got& '
SUBJECT: HCA Grant Contract for the Residential Substance Abuse Treatment Program
STATEMENT OF ISSUE:
This Agreement with the HCA for Residential Substance Abuse Treatment allows for work to continue that
has helped address behavioral health and substance use disorders among the inmate population of the
Jefferson County Jail.
ANALYSIS:
This contract continues the Residential Substance Abuse Treatment program at the Jefferson County Jail that
provides an opportunity for incarcerated individuals in our community to engage in inpatient treatment
services locally, and gain a head start on their road to recovery.
FISCAL IMPACT:
The HCA Grant Contract Provides $148,221 along with $49,407 in matching county funds.
RECOMMENDATION:
Approve Contract- Washington State Healthcare Authority—Residential Substance Abuse Treatment in
Prisons and Jails and delegate the authority to sign off via Docusign on behalf of the county to Chief of
Corrections David Fortino.
REVIEWED BY:
Jos eters, County Administrator Date
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Washington Sate Healthcare Authority Contract No: K8843
Contract For: Residential Substance Abuse Treatment in Prisons and Jails Term: 1 year
COUNTY DEPARTMENT: Jefferson County Sheriffs Office
Contact Person: David Fortino
Contact Phone: 360-344-9743
Contact email: dfortino@co.jefferson.wa.us
AMOUNT: $148,221 PROCESS: ^ Exempt from Bid Process
Revenue: NIA Cooperative Purchase
Expenditure: N/A Competitive Sealed Bid
Matching Funds Required: $49,407 Small Works Roster
Sources(s)of Matching Funds 13056400-410458 _ Vendor List Bid
Fund # 001-180-000 RFP or RFQ
Munis Org/Obj o0t-180-000 ✓ Other: State Grant
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: 1—J N/A:i l
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: El N/A: /,?3//v .?�e
Signature Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 4/6/2026.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 4/1/2026.
reviewed and approve by jbl on 04-01-2026
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: 7610O50E-05AA -44CA-9566-AC5O58O7C0AA
Washington State~ INTERAGENCY AGREEMENT
for
Health Care uthority Residential Substance Abuse HCA Contract Number: K8843
Treatment for State Prisoners
THIS AGREEMENT is made by and between Washington State Health Care Authority (HCA) and Jefferson
County Sheriff Department, (Contractor), pursuant to the authority granted by Chapter 39.34 RCW.
CONTRA CTOR NAME CONTRACTOR DOING BUSINESS AS (DBA)
Jefferson County Sheriff Department Jefferson County
CONTRA CTOR ADDRESS I Street City State Zip Code
79 Elkins Road Port Hadlock WA 98339-9700
CONTRA CTOR CONTRACT MANAGER CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS
David Fortino 360-344-97 43 dfortino@co.jefferson.wa.us
HCA PROGRAM HCA DIVISION/SECTION
Adult Substance Use Disorder Division of Behavioral Health and Recovery
HCA CONTRACT MANAGER NAME AND TITLE HCA CONTRACT MANAGER ADDRESS
Rachel Brandhorst,
Health Care Authority
626 8th Avenue SE
Department of Justice Grants Administrator P.O. Box 42730
Olympia, WA 98504-2730
HCA CONTRACT MANAGER TELEPHONE HCA CONTRACT MANAGER E-MAIL ADDRESS
360- 725-1889 rachel.brandhorst@.hca.wa.gov
CONTRA CT START DATE CONTRACT END DATE TOTAL MAX IMUM CONTRA CT AMOUNT
October 1 , 2025 September 30, 2026 $148,221
PURPOSE OF CONTRACT:
Residential Substance Abuse Treatment (RSAT) for State Prisoners - Contractor shall provide residential
substance use disorder (SUD) treatment to incarcerated individuals and prepare participants for successful
community reintegration through aftercare and wrap around services.
The parties signing below warrant that they have read and understand this Contract, and have authority to
execute this Contract. This Contract will only be binding upon signature by both parties. The parties may execute
this contract in multiple counterparts, each of which is deemed an original and all of which constitute only one
agreement. E-mail (electronic mail) transmission of a signed copy of this contract shall be the same as delivery
of an original.
CONTRA CTOR SIGNATURE PRl~TED NAME AND TITLE
David Fortino
Chief of Corrections
DATE SIGNED
/24/2026
PRINTED NAME AND TITLE
Andria Howerton
HCA Deputy Contracts Administrator
DATE SIGNED
4/27/2026
Washington State
Health Care Authority
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1. DEFINITIONS
"Authorized Representative" means a person to whom signature authority has been delegated in
writing acting within the limits of the person's authority.
"Business Days" means Monday through Friday, 8:00 a.m. to 5:00 p.m., Pacific Time, except for
holidays observed by the state of Washington.
"Confidential Information" means information that may be exempt from disclosure to the public or
other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other state or
federal statutes or regulations. Confidential Information includes, but is not limited to, any information
identifiable to an individual that relates to a natural person's health, finances, education, business,
use or receipt of governmental services, names, addresses, telephone numbers, social security
numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and any
other identifying numbers, law enforcement records, HCA source code or object code, or HCA or
State security information.
"Contract" or "Agreement" means the entire written agreement between HCA and the contractor,
including any exhibits, documents, or materials incorporated by reference. MContract and
Agreement may be used interchangeably.
"Contractor" means Jefferson County Sheriff Department, its employees and agents. Contractor
includes any firm, provider, organization, individual or other entity performing services under this
Agreement. It also includes any Subcontractor retained by Contractor as permitted under the terms
of this Agreement.
"Data" means information disclosed, exchanged or used by Contractor in meeting requirements
under this Agreement. Data may also include Confidential Information as defined in this Contract.
"Health Care Authority" or "HCA" means the Washington State Health Care Authority, any
division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully
representing HCA.
"Information and Communication Technology" or "ICT" means information technology and other
equipment, systems, technologies, or processes, for which the principal function is the creation,
manipulation, storage, display, receipt, or transmission of electronic data and information, as well as
any associated content. Examples include computers and peripheral equipment; information kiosks
and transaction machines; telecommunications equipment; customer premises equipment;
multifunction office machines; software; applications; websites; videos; and electronic documents.
"Services" means all work performed or provided by Contractor pursuant to this Contract.
"Statement of Work" or "SOW" means a detailed description of the work activities the Contractor is
required to perform under the terms and conditions of this Contract, including the deliverables and
timeline, and is included as Attachment 1.
"Subcontractor" means a person or entity that is not in the employment of the Contractor, who is
performing all or part of the business activities under this Agreement under a separate contract with
Contractor. The term "Subcontractor" means Subcontractor(s) of any tier.
"Subrecipient" shall have the meaning given in 45 C.F.R. 75.2, or any successor or replacement to
such definition, for any federal award from HHS; or 2 C.F.R. 200.93, or any successor or
replacement to such definition, for any other federal award.
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2. STATEMENT OF WORK
Contractor will furnish the necessary personnel, equipment, material and/or service(s) and otherwise
do all things necessary for or incidental to the performance of work set forth in Attachment 1(s),
Statement(s) of Work.
3. PERIOD OF PERFORMANCE
Subject to its other provisions, the period of performance of this Contract will commence on October
1, 2025, and be completed on September 30, 2026, unless terminated sooner or extended upon
written agreement between the parties.
4. PAYMENT
Compensation for the work provided in accordance with this Agreement has been established under
the terms of RCW 39.34.130. The parties have determined that the cost of accomplishing the work
herein will not exceed $148,221. Payment for satisfactory performance of the work will not exceed
this amount unless the parties mutually agree to a higher amount. Compensation for Services will be
based on the terms set forth in Attachment 1(s), Statement(s) of Work.
5. BILLING PROCEDURE
5.1. Contractor must submit accurate invoices to the following address for all amounts to be paid by
HCA via e-mail to: rachel.brandhorst(a�hca.wa.gov, and include the HCA Contract number in
the subject line of the email.
5.2. Invoices must describe and document to HCA's satisfaction a description of the work
performed, the progress of the project, and fees. If expenses are invoiced, invoices must
provide a detailed breakdown of each type. Any single expense in the amount of$50.00 or
more must be accompanied by a receipt in order to receive reimbursement. All invoices will be
reviewed and must be approved by the Contract Manager or designee prior to payment.
A. Documentation must include an A-19 form submitted to the HCA Contract Manager, in
accordance with the deliverable descriptions and payment amounts as outlined in
Attachment 1, Statement of Work, Section 4, Deliverables Table.
5.3. Contractor must submit properly itemized invoices to 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. Payment terms and any available prompt payment discount.
5.4. Contractor will return incorrect or incomplete invoices for correction and reissue. The
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Agreement number must appear on all invoices, bills of lading, packages, and correspondence
relating to this Agreement.
5.5. Payment will be considered timely if made within thirty (30) calendar days of receipt of properly
completed invoices. Payment will be directly deposited in the bank account or sent to the
address Contractor designated in this Agreement.
5.6. Upon expiration or termination any claims for payment for costs due and payable under this
Agreement that are incurred prior to the expiration date must be submitted by Contractor within
forty-five (45) calendar days after the expiration date. There will be no obligation to pay any
claims that are submitted forty-six (46) or more calendar days after the expiration date
("Belated Claims"). Belated Claims will be paid at HCA's sole discretion, and any such potential
payment is contingent upon the availability of funds.
6. ACCESSIBILITY
6.1. Requirements and Standards
Each Information and Communication Technology(ICT) product or service furnished under this
Contract shall be accessible to and usable by individuals with disabilities in accordance with the
Americans with Disabilities Act(ADA) and other applicable Federal and State laws and policies,
including OCIO Policy 188, et seq. For purposes of this clause, Contractor shall be considered
in compliance with the ADA and other applicable Federal and State laws if it satisfies the
requirements (including exceptions) specified in the regulations implementing Section 508 of
the Rehabilitation Act, including the Web Content Accessibility Guidelines (WCAG)2.1 Level
AA Success Criteria and Conformance Requirements (2008), which are incorporated by
reference, and the functional performance criteria.
6.2. Documentation
Contractor shall maintain and retain, subject to review by HCA, full documentation of the
measures taken to ensure compliance with the applicable requirements and functional
performance criteria, including records of any testing or simulations conducted.
6.3. Remediation
If the Contractor claims that its products or services satisfy the applicable requirements and
standards specified in this Section and it is later determined by HCA that any furnished product
or service is not in compliance with such requirements and standards, HCA will promptly inform
Contractor in writing of noncompliance. Contractor shall, at no additional cost to HCA, repair or
replace the non-compliant products or services within the period specified by HCA. If the repair
or replacement is not completed within the specified time, HCA may cancel the contract,
delivery, task order, or work order, or purchase line item without termination liabilities or have
any necessary changes made or repairs performed by employees of HCA or by another
contractor, and Contractor shall reimburse HCA for any expenses incurred thereby.
6.4. Indemnification
Contractor agrees to indemnify and hold harmless HCA from any claim arising out of failure to
comply with the aforesaid requirements.
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7. AGREEMENT CHANGES, MODIFICATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such amendments are not
binding unless they are in writing and signed by an Authorized Representative of each party.
8. SUBCONTRACTING
Neither the Contractor nor any Subcontractor shall enter into subcontracts for any of the work
contemplated under this Agreement without obtaining HCA's prior written approval. HCA shall have
no responsibility for any action of any such Subcontractors.
9. SUBRECIPIENT
If the Contractor is a Subrecipient (as defined in 45 C.F.R. 75.2 and 2 C.F.R. 200.93) of federal
awards, then the Contractor shall:
9.1. Comply with 2 C.F.R. 200.501 and 45 C.F.R. 75.501; and
9.2. Overpayments
If it is determined by HCA, or during the course of a required audit, that Contractor has been
paid unallowable costs under this or any program agreement, Contractor will refund the full
amount to HCA. In the event that overpayments or erroneous payments have been made to
the Contractor under this Contract, HCA will provide written notice to Contractor and Contractor
will refund the full amount to HCA within thirty (30) calendar days of the notice. If the Contractor
disagrees with HCA's actions under this section, then it may invoke the dispute resolution
provisions of Section 13, Disputes.
10. ASSIGNMENT
The work to be provided under this Agreement, and any claim arising thereunder, is not assignable
or delegable by either party in whole or in part, without the express prior written consent of the other
party, which consent will not be unreasonably withheld.
11. CONTRACT MANAGEMENT
The Contract Manager for each of the parties, named on the face of this Contract, will be responsible
for and will be the contact person for all communications and billings regarding the performance of
this Agreement. Either party must notify the other party within thirty (30) days of change of Contract
Management. Changes in Contract Management shall require an amendment.
12. DISALLOWED COSTS
The Contractor is responsible for any audit exceptions or disallowed costs incurred by its own
organization or that of its Subcontractors.
13. DISPUTES
In the event that a dispute arises under this Agreement, it will be determined by a dispute board in
the following manner: Each party to this Agreement will appoint one member to the dispute board.
The members so appointed will jointly appoint an additional member to the dispute board. The
dispute board will review the facts, Agreement terms and applicable statutes and rules and make a
determination of the dispute. The dispute board will thereafter decide the dispute with the majority
prevailing. The determination of the dispute board will be final and binding on the parties hereto. As
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an alternative to this process, either of the parties may request intervention by the Governor, as
provided by RCW 43.17.330, in which event the Governor's process will control.
14. GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws of the state of
Washington and any applicable federal laws. The provisions of this Agreement will be construed to
conform to those laws.
In the event of an inconsistency in the terms of this Agreement, or between its terms and any
applicable statute or rule, the inconsistency will be resolved by giving precedence in the following
order:
A. Applicable Federal and State of Washington statutes and regulations;
B. Attachment 3: Federal Compliance Certifications and Assurances;
C. Attachment 1(s): Statement(s) of Work; and
D. Any other provisions of the agreement, including materials incorporated by reference.
15. INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the performance of this Agreement will
not be considered for any purpose to be employees or agents of the other party.
16. RECORDS MAINTENANCE
16.1. The parties to this Agreement will each maintain books, records, documents and other
evidence which sufficiently and properly reflect all direct and indirect costs expended by either
party in the performance of the Services described herein. These records will be subject to
inspection, review or audit by personnel of both parties, other personnel duly authorized by
either party, the Office of the State Auditor, and federal officials so authorized by law. All books,
records, documents, and other material relevant to this Agreement will be retained for six years
after expiration and the Office of the State Auditor, federal auditors, and any persons duly
authorized by the parties will have full access and the right to examine any of these materials
during this period.
16.2. Records and other documents, in any medium, furnished by one party to this Agreement to the
other party, will remain the property of the furnishing party, unless otherwise agreed. The
receiving party will not disclose or make available this material to any third parties without first
giving notice to the furnishing party and giving it a reasonable opportunity to respond. Each
party will use reasonable security procedures and protections to assure that records and
documents provided by the other party are not erroneously disclosed to third parties.
17. TREATMENT OF ASSETS
17.1. Ownership
HCA shall retain title to all property furnished by HCA to Contractor under this contract. Title to
all property furnished by the Contractor, for the cost of which the Contractor is entitled to
reimbursement as a direct item of cost under this contract, excluding intellectual property
provided by the Contractor, shall pass to and vest in HCA upon delivery of such property by the
Contractor. Title to other property, the cost of which is reimbursable to the Contractor under this
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Contract, shall pass to and vest in HCA upon (i) issuance for use of such property in the
performance of this Contract, (ii) commencement of use of such property in the performance of
this Contract, or(iii) reimbursement of the cost thereof by HCA, in whole or in part, whichever
occurs first.
17.2. Use of Property
Any property furnished to Contractor shall, unless otherwise provided herein, or approved in
writing by the HCA Contract Manager, be used only for the performance of and subject to the
terms of this Contract. Contractor's use of the equipment shall be subject to HCA's security,
administrative and other requirements.
17.3. Damage to Property
Contractor shall continuously protect and be responsible for any loss, destruction, or damage to
property which results from or is caused by Contractor's acts or omissions. Contractor shall be
liable to HCA for costs of repair or replacement for property or equipment that has been lost,
destroyed or damaged by Contractor or Contractor's employees, agents or Subcontractors.
Cost of replacement shall be the current market value of the property and equipment on the
date of the loss as determined by HCA.
17.4. Notice of Damage
Upon the loss of, destruction of, or damage to any of the property, Contractor shall notify the
HCA Contract Manager thereof within one (1) Business Day and shall take all reasonable steps
to protect that property from further damage.
17.5. Surrender of Property
Contractor will ensure that the property will be returned to HCA in like condition to that in which
it was furnished to Contractor, reasonable wear and tear excepted. Contractor shall surrender
to HCA all property upon the earlier of expiration or termination of this Contract.
18. RIGHTS IN DATA
Unless otherwise provided, data which originates from this Agreement will be "works for hire" as
defined by the U.S. Copyright Act of 1976 and will be owned by HCA. Data will include, but not be
limited to, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies,
computer programs, films, tapes and/or sound reproductions. Ownership includes the right to
copyright, patent, register and the ability to transfer these rights.
19. CONFIDENTIALITY
Each party agrees not to divulge, publish or otherwise make known to unauthorized persons
confidential information accessed under this Agreement. Contractor agrees that all materials
containing confidential information received pursuant to this Agreement, including, but not limited to
information derived from or containing patient records, claimant file and medical case management
report information, relations with HCA's clients and its employees, and any other information which
may be classified as confidential, shall not be disclosed to other persons without HCA's written
consent except as may be required by law.
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20. SEVERABILITY
If any provision of this Agreement or any provision of any document incorporated by reference will be
held invalid, such invalidity will not affect the other provisions of this Agreement, which can be given
effect without the invalid provision if such remainder conforms to the requirements of applicable law
and the fundamental purpose of this agreement, and to this end the provisions of this Agreement are
declared to be severable.
21. FUNDING AVAILABILITY
HCA's ability to make payments is contingent on funding availability. In the event funding from state,
federal, or other sources is withdrawn, reduced, or limited in any way after the effective date and
prior to completion or expiration date of this Agreement, HCA, at its sole discretion, may elect to
terminate the Agreement, in whole or part, or to renegotiate the Agreement subject to new funding
limitations and conditions. HCA may also elect to suspend performance of the Agreement until HCA
determines the funding insufficiency is resolved. HCA may exercise any of these options with no
notification restrictions.
22. TERMINATION
Either party may terminate this Agreement upon 30-days' prior written notification to the other party. If
this Agreement is so terminated, the parties will be liable only for performance rendered or costs
incurred in accordance with the terms of this Agreement prior to the effective date of termination.
23. TERMINATION FOR CAUSE
If for any cause, either party does not fulfill in a timely and proper manner its obligations under this
Agreement, or if either party violates any of these terms and conditions, the aggrieved party will give
the other party written notice of such failure or violation. The responsible party will be given the
opportunity to correct the violation or failure within 30 days. If failure or violation is not corrected, this
Agreement may be terminated immediately by written notice of the aggrieved party to the other.
24. WAIVER
A failure by either party to exercise its rights under this Agreement will not preclude that party from
subsequent exercise of such rights and will not constitute a waiver of any other rights under this
Agreement unless stated to be such in a writing signed by an Authorized Representative of the party
and attached to the original Agreement.
25. ALL WRITINGS CONTAINED HEREIN
This Agreement contains all the terms and conditions agreed upon by the parties. No other
understandings, oral or otherwise, regarding the subject matter of this Agreement will be deemed to
exist or to bind any of the parties hereto.
26. SURVIVORSHIP
The terms, conditions and warranties contained in this Agreement that by their sense and context are
intended to survive the completion of the performance, expiration or termination of this Agreement
shall so survive. In addition, the terms of the sections titled Rights in Data, Confidentiality, Disputes
and Records Maintenance shall survive the termination of this Agreement.
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Attachments
Attachment 1: Statement of Work
Attachment 2: Standard of Care
Attachment 3: Federal Compliance Certifications and Assurances
Attachment 4: Federal Subaward Identification — K8843
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ATTACHMENT 1: STATEMENT OF WORK
10/01/2025— 09/30/2026
1 WORK REQUIREMENTS
1.1 Engage incarcerated individuals in the Residential Substance Abuse Treatment (RSAT)
program, both in-custody and in the community.
1.1.1 Focus on the incarcerated participant's Substance Use Disorder (SUD), mental
health diagnosis, and other behavioral health related needs.
1.1.2 Use a standardized, risks and needs screening instrument to help determine program
eligibility.
1.1.3 Determine necessary services in accordance with an American Society of Addiction
Medicine (ASAM) assessment.
1.1.4 Develop the RSAT participant's cognitive, behavioral, social, vocational, and other
skills to solve the substance abuse and related problems.
1.1.5 Ensure a certified chemical dependency professional is on-staff, as required by WAC
246-341.
a. If Contractor choses to Subcontract, Contractor must adhere to the requirements
outlined in Contract Section 8, Subcontracting, and must subcontract with a
known and credible behavioral health treatment agency to best coordinate the
identification of, and treatment for, individuals who are currently in custody and in
need of behavioral health treatment.
b. If Contractor choses to hire their own behavioral health staff, those staff must
hold and maintain a Substance Use Disorder Professional license in the state of
Washington, or hold and maintain a Substance Use Disorder Professional
Trainee license AND have a Substance Use Disorder Professional Supervisor,
fully licensed in the state of Washington, on staff in the facility. And any other
applicable licensure requirements as identified in Title 18 RCW.
1.1.6 Provide evidence-based substance use treatment, including medications to treat
opioid use disorder and withdrawal management, in accordance with Attachment 2,
Standard of Care.
1.1.7 Develop and maintain individualized treatment plans with periodic updates to amend
according to the progress made.
a. Provide Medications for treatment of Opioid Use Disorder (MOUD).
b. Provide designated housing space, separate from the general population, for
RSAT participants.
c. Require random urinalysis and/or other proven reliable forms of drug and alcohol
testing for the RSAT participants throughout the duration of their participation in
the RSAT program.
d. Assess for aftercare needs and schedule follow-up appointments with community
agencies prior to participant's departure.
e. Prepare inmates for successful community reintegration, including scheduled and
confirmed post-release appointments for aftercare treatment and services.
f. Ensure each RSAT offender is enrolled in aftercare services upon their release
from jail with an outpatient community substance abuse treatment facility which is
certified by the state of Washington per WAC 246-341.
Washington State 10 HCA Contract#K8843
Health Care Authority Attachment 1
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g. Track the re-offense records of RSAT graduates for one (1) year.
2 REPORTING REQUIREMENTS
2.1 Program Plan Report
Contractor shall provide a Program Plan Report to the HCA Contract Manager via email for
approval. The Program Plan Report must encompass the full Contract term, October 1,
2025, through September 30, 2026, and shall include, but is not limited to, the following:
2.1.1 Current staffing/hiring;
2.1.2 Purchase of program supplies;
2.1.3 Purchase of incentive items;
2.1.4 Purchase and description of curriculum;
2.1.5 Travel planned;
2.1.6 Status of subcontracts or Memorandums of Understanding (MOU); and
2.1.7 Other components, as requested by HCA Contract Manager.
2.2 Quarterly Reports
Contractor shall use an HCA provided template to complete quarterly reports. The quarterly
reports must be submitted via email to the HCA Contract Manager to support quarterly
invoice approval.
2.2.1 The HCA Contract Manager will provide Contractor with Quarterly Report Template
within 10 Business Days of Contract execution.
a. If updated, the HCA Contract Manager will provide the updated template no less
than 10 Business Days prior to its date of implementation.
2.2.2 Contractor shall submit completed quarterly reports per the federal fiscal year
quarters:
a. Quarter 1: October 1 — December 31;
b. Quarter 2: January 1 — March 31;
c. Quarter 3: April 1 — June 30; and
d. Quarter 4: July 1 — September 30.
2.2.3 Contractor shall coordinate with the HCA Contract Manager to ensure compliance
with the following Department of Justice (DOJ)/Bureau of Justice Assistance (BJA)
reporting requirements:
a. No personal identifiable information;
b. Numbers served/completing the program are required;
c. Recidivism data, to include probation violation and new arrest convictions.
2.2.4 Report Components
The following is a list of required report components, in accordance with the DOJ/BJA
reporting requirements. Additional detail is included in the Quarterly Report Template
provided by the HCA Contract Manager.
Washington State 11 HCA Contract#K8843
Health Care Authority Attachment 1
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a. Average treatment cost per participant who receives program services.
b. Average length of stay in the program for incarcerated participants completing the
program.
c. Number of participants carried over from the previous reporting period and
number of new participants.
d. The number of participants who successfully completed the program and number
of participants who were terminated or dropped out.
e. The number of new treatment beds and the percentage of them funded with
DOJ/BJA funds provided under this Contract.
f. The number of days of residential treatment provided.
g. The number of participants completing the program who passed drug-testing.
h. The number of participants who were screened or enrolled in Medicaid.
i. Criminal recidivism of participants who successfully completed the program.
j. Criminal recidivism of participants who were unsuccessfully discharged from the
program.
2.2.5 Narrative
Narrative program analysis/evaluation reports responding to the following questions:
a. What were your accomplishments during this reporting period?
b. What goals were accomplished as they relate to your Program Plan Report?
c. What problems/barriers did you encounter, if any, within the reporting period that
prevented you from reaching your goals or milestones?
d. Is there any assistance that BJA can provide to address any problems/barriers
identified in question #c?
e. Are you on track to fiscally and programmatically complete your program as
outlined in your Program Plan Report? (Please answer YES or NO and if no,
please explain.)
f. What major activities are planned for the next six (6) months?
g. Based on your knowledge of the criminal justice field, are there any innovative
programs/accomplishments that you would like to share with BJA?
3 SUBRECIPIENT MONITORING
Per 2 CFR 200.332(e) , pass-through entities (HCA) must monitor the activities of the subrecipient
(Contractor) as necessary to ensure that the funding awarded under this Agreement is used for
authorized purposes, in compliance with applicable federal statutes, regulations, and the terms
and conditions of this Agreement; and that the goals of this Agreement are achieved.
3.1 Contractor shall coordinate with the HCA Contract Manager to complete the monitoring
activities as identified below:
3.1.1 Ensure reports align with the applicable federal grant goals as outlined in this
Agreement, and invoiced amounts are within the identified Agreement amounts and
correlate with the identified deliverables and performance measures.
3.1.2 Request training and technical assistance as needed.
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3.1.3 Complete at least one (1) virtual or in-person monitoring of Contractor compliance
with applicable federal guidelines and award conditions.
3.1.4 Review of Contractor's submitted A-19 forms and supporting billing documentation as
required by Agreement Section 5, Billing Procedure.
3.1.5 Review of Contractor's policies and procedures for internal controls, financial
management, allowability of costs, and anything else of relevance to the conditions of
the relevant federal grant and this Agreement.
3.1.6 Meet at least quarterly with the HCA Contract Manager to discuss Contractor's
subrecipient status and work related to this Agreement.
4 DELIVERABLES TABLE
# Description Due Date Report Rate Max Payment
Program Plan Report
1 04/15/2026 $15,000.00 $15,000.00
• See section 2.1 above.
01/15/2026 $33,305.25
Quarterly Reports 04/15/2026 $33,305.25
2 $133,221.00
• See section 2.2 above. 07/15/2026 $33,305.25
10/15/2026 $33,305.25
Maximum Compensation for K8843 $148,221.00
Washington State 13 HCA Contract#K8843
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ATTACHMENT 2: STANDARD OF CARE
1 PURPOSE
Contractor shall provide evidence-based substance use treatment to participants in the
Residential Substance Abuse Treatment (RSAT) program both in custody and in the community
who are identified with a Substance Use Disorder (SUD). Standard of care for participants with
Opioid Use Disorder (OUD) and Alcohol Use Disorder (AUD) must include a full Medications for
Opioid Use Disorder (MOUD) and Medications for Alcohol Use Disorder (MAUD) program with the
following elements:
1.1 an OUD/AUD screening;
1.2 discussion of MOUD/MAUD options between the incarcerated individual and provider;
1.3 initiation prior to the onset of withdrawal or continuation of MOUD/MAUD;
1.4 release and reentry planning to include connection with continued treatment;
1.5 same day release appointment when possible or MOUD/MAUD to bridge patient until next
appointment;
1.6 naloxone upon release; and
1.7 Reentry planning may also include assisting the incarcerated individual with sign-up of
Medicaid, reestablishing Medicaid and connection with the Managed Care Organizations
(MCOs).
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 jail or prison based RSAT
program 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 MOUD and/or
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.
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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.
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.
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.
a. 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
Washington State 16 HCA Contract#K8843
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2.3.2 treatment was not offered at intake. E.g., individuals with OUD but without physical
dependence, individuals with AUD who underwent withdrawal, etc.
2.3.3 Educate individuals on treatment choices and the process for continuation of access
to MOUD/MAUD during incarceration and upon release.
2.3.4 Administer methadone and buprenorphine daily or more frequently.
2.3.5 Contractor shall not use alternate-day or"balloon" dosing of buprenorphine.
2.3.6 Offer counseling to individuals for their OUD/AUD if they are expected to remain in
jail for longer than one month.
2.3.7 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.
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.
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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.
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ATTACHMENT 3: FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES
I. FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and control
mechanisms to be in place. The following represents the majority of compliance elements that
may apply to any federal funds provided under this contract. For clarification regarding any of
these elements or details specific to the federal funds in this contract, contact the HCA Contract
Manager.
a. Source of Funds Department of Justice (DOJ): This Contract is being funded partially or in full
through Cooperative Contract number 15PBJA-23-GG-01570-RSAT, the full and complete
terms and provisions of which are hereby incorporated into this Contract. Federal funds to
support this Contract are identified by the Assistance Listing Number (ALN) number 16.593 in
the amount of $148,221. The Contractor or Subrecipient is responsible for tracking and
reporting the cumulative amount expended under HCA Contract K8843.
b. Period of Availability of Funds 10/01/2025-09/30/2026: Pursuant to 45 CFR 92.23, Contractor
or Subrecipient may charge to the award only costs resulting from obligations of the funding
period specified in 15PBJA-23-GG-01570-RSAT unless carryover of unobligated balances is
permitted, in which case the carryover balances may be charged for costs resulting from
obligations of the subsequent funding period. All obligations incurred under the award must
be liquidated no later than 90 days after the end of the funding period.
c. Single Audit Act: This section applies to subrecipients only. Subrecipient (including private,
for-profit hospitals and non-profit institutions)shall adhere to the federal Office of Management
and Budget (OMB) Super Circular 2 CFR 200.501 and 45 CFR 75.501. A Subrecipient who
expends $750,000 or more in federal awards during a given fiscal year shall have a single or
program-specific audit for that year in accordance with the provisions of OMB Super Circular
2 CFR 200.501 and 45 CFR 75.501.
d. Modifications: This Contract may not be modified or amended, nor may any term or provision
be waived or discharged, including this particular Paragraph, except in writing, signed upon
by both parties.
1. Examples of items requiring Health Care Authority prior written approval include, but are
not limited to, the following:
i. Deviations from the budget and Project plan.
ii. Change in scope or objective of the Contract.
iii. Change in a key person specified in the Contract.
iv. The absence for more than one (1) months or a 25% reduction in time by the Project
Manager/Director.
v. Need for additional funding.
vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost
principles.
vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total
budget in this Contract.
2. No changes are to be implemented by the Sub-awardee until a written notice of approval
is received from the Health Care Authority.
e. Sub-Contracting: The Contractor or Subrecipient shall not enter into a sub-contract for any of
the work performed under this Contract without obtaining the prior written approval of the
Health Care Authority. If sub-contractors are approved by the Health Care Authority, the
subcontract, shall contain, at a minimum, sections of the Contract pertaining to Debarred and
Suspended Vendors, Lobbying certification, Audit requirements, and/or any other project
Federal, state, and local requirements.
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f. Condition for Receipt of Health Care Authority Funds: Funds provided by Health Care Authority
to the Contractor or Subrecipient under this Contract may not be used by the Contractor or
Subrecipient as a match or cost-sharing provision to secure other federal monies without prior
written approval by the Health Care Authority.
g. Unallowable Costs: The Contractor or Subrecipient's expenditures shall be subject to
reduction for amounts included in any invoice or prior payment made which determined by
HCA not to constitute allowable costs on the basis of audits, reviews, or monitoring of this
Contract.
h. Supplanting Compliance: SABG: If SABG funds support this Contract, the Block Grant will not
be used to supplant State funding of alcohol and other drug prevention and treatment
programs. (45 CFR section 96.123(a)(10)).
i. Federal Compliance: The Contractor or Subrecipient shall comply with all applicable State and
Federal statutes, laws, rules, and regulations in the performance of this Contract, whether
included specifically in this Contract or not.
j. Civil Rights and Non-Discrimination Obligations: During the performance of this Contract, the
Contractor or Subrecipient shall comply with all current and future federal statutes relating to
nondiscrimination. These include but are not limited to: Title VI of the Civil Rights Act of 1964
(PL 88-352), Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and
1685-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age
Discrimination Act of 1975 (42 U.S.C. §§ 6101- 6107), the Drug Abuse Office and Treatment
Act of 1972 (PL 92-255), the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and 527 of the Public Health
Service Act of 1912 (42 U.S.C. §§290dd-3 and 290ee-3), Title VIII of the Civil Rights Act of
1968 (42 U.S.C. §§3601 et seq.), and the Americans with Disability Act (42 U.S.C., Section
12101 et seq.) http://www.hhs.gov/ocr/civilrights.
HCA Federal Compliance Contact Information
Washington State Health Care Authority
Post Office Box 42710
Olympia, Washington 98504-2710
II. CIRCULARS `COMPLIANCE MATRIX' - The following compliance matrix identifies the OMB
Circulars that contain the requirements which govern expenditure of federal funds. These
requirements apply to the Washington State Health Care Authority (HCA), as the primary recipient
of federal funds and then follow the funds to the sub-awardee, Jefferson County Sheriff
Department. The federal Circulars which provide the applicable administrative requirements, cost
principles and audit requirements are identified by sub-awardee organization type.
OMB CIRCULAR
ENTITY TYPE ADMINISTRATIVE COST AUDIT
REQUIREMENTS PRINCIPLES REQUIREMENTS
State. Local and Indian Tribal
Governments and Governmental
Hospitals
Non-Profit Organizations and Non-
Profit Hospitals OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501
Colleges or Universities and
Affiliated Hospitals
For-Profit Organizations
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Ill. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances,
Certifications, and Special Conditions that apply to all federally funded (in whole or in part)
Contracts administered by the Washington State Health Care Authority.
a. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION: The undersigned
(authorized official signing for the contracting organization) certifies to the best of his or her
knowledge and belief, that the contractor, defined as the primary participant in accordance
with 45 CFR Part 76, and its principals: are not presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from covered transactions by any
Federal Department or agency have not within a 3-year period preceding this contract been
convicted of or had a civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining, attempting to obtain, or performing a public
(Federal, State, or local)transaction or contract under a public transaction; violation of Federal
or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification
or destruction of records, making false statements, or receiving stolen property; are not
presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal,
State, or local) with commission of any of the offenses enumerated in Section 2 of this
certification; and have not within a 3-year period preceding this contract had one or more public
transactions (Federal, State, or local) terminated for cause or default.
Should the Contractor or Subrecipient not be able to provide this certification, an explanation
as to why should be placed after the assurances page in the contract.
The contractor agrees by signing this contract that it will include, without modification, the
clause above certification in all lower tier covered transactions (i.e., transactions with sub-
grantees and/or contractors) and in all solicitations for lower tier covered transactions in
accordance with 45 CFR Part 76.
b. CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS: The
undersigned (authorized official signing for the contracting organization) certifies that the
contractor will, or will continue to, provide a drug-free workplace in accordance with 45 CFR
Part 76 by:
1. Publishing a statement notifying employees that the unlawful manufacture, distribution,
dispensing, possession or use of a controlled substance is prohibited in the grantee's
workplace and specifying the actions that will be taken against employees for violation
of such prohibition; Establishing an ongoing drug-free awareness program to inform
employees about:
i. The dangers of drug abuse in the workplace;
ii. The contractor's policy of maintaining a drug-free workplace;
iii. Any available drug counseling, rehabilitation, and employee assistance programs;
and
iv. The penalties that may be imposed upon employees for drug abuse violations
occurring in the workplace;
2. Making it a requirement that each employee to be engaged in the performance of the
contract be given a copy of the statement required by paragraph (I) above;
3. Notifying the employee in the statement required by paragraph (I), above, that, as a
condition of employment under the contract, the employee will—
i. Abide by the terms of the statement; and
ii. Notify the employer in writing of his or her conviction for a violation of a criminal drug
statute occurring in the workplace no later than five (5) calendar days after such
conviction;
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4. Notifying the agency in writing within ten calendar days after receiving notice under
paragraph (III)(b) from an employee or otherwise receiving actual notice of such
conviction. Employers of convicted employees must provide notice, including position
title, to every contract officer or other designee on whose contract activity the convicted
employee was working, unless the Federal agency has designated a central point for the
receipt of such notices. Notice shall include the identification number(s)of each affected
grant;
5. Taking one of the following actions, within thirty (30) calendar days of receiving notice
under paragraph (III) (b), with respect to any employee who is so convicted—
i. Taking appropriate personnel action against such an employee, up to and including
termination, consistent with the requirements of the Rehabilitation Act of 1973, as
amended; or
ii. Requiring such employee to participate satisfactorily in a drug abuse assistance or
rehabilitation program approved for such purposes by a Federal, State, or local
health, law enforcement, or other appropriate agency;
6. Making a good faith effort to continue to maintain a drug-free workplace through
implementation of paragraphs (I) through (V).
For purposes of paragraph (V) regarding agency notification of criminal drug convictions,
Authority has designated the following central point for receipt of such notices:
Legal Services Manager
WA State Health Care Authority
PO Box 42700
Olympia, WA 98504-2700
c. CERTIFICATION REGARDING LOBBYING: Title 31, United States Code, Section 1352,
entitled "Limitation on use of appropriated funds to influence certain Federal contracting and
financial transactions," generally prohibits recipients of Federal grants and cooperative
Contracts from using Federal (appropriated) funds for lobbying the Executive or Legislative
Branches of the Federal Government in connection with a SPECIFIC grant or cooperative
Contract. Section 1352 also requires that each person who requests or receives a Federal
grant or cooperative Contract must disclose lobbying undertaken with non-Federal
(nonappropriated) funds. These requirements apply to grants and cooperative Contracts
EXCEEDING $100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing for the contracting organization) certifies, to the
best of his or her knowledge and belief, that:
1. No Federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer or employee of Congress,
or an employee of a Member of Congress in connection with the awarding of any Federal
contract, the making of any Federal grant, the making of any Federal loan, the entering
into of any cooperative Contract, and the extension, continuation, renewal, amendment,
or modification of any Federal contract, grant, loan, or cooperative Contract.
2. If any funds other than Federally appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress, or an employee of
a Member of Congress in connection with this Federal contract, grant, loan, or
cooperative Contract, the undersigned shall complete and submit Standard Form-LLL,
"Disclosure of Lobbying Activities," in accordance with its instructions. (If needed,
Washington State 22 HCA Contract#K8843
Health Care Authority Attachment 3
Standard Form-LLL, "Disclosure of Lobbying Activities," its instructions, and continuation
sheet are included at the end of this application form.)
3. The undersigned shall require that the language of this certification be included in the
award documents for all subcontracts at all tiers (including subcontracts, subcontracts,
and contracts under grants, loans and cooperative Contracts) and that all sub-recipients
shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for
making or entering into this transaction imposed by Section 1352, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than $10,000
and not more than $100,000 for each such failure.
d. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA): The
undersigned (authorized official signing for the contracting organization) certifies that the
statements herein are true, complete, and accurate to the best of his or her knowledge, and
that he or she is aware that any false, fictitious, or fraudulent statements or claims may subject
him or her to criminal, civil, or administrative penalties. The undersigned agrees that the
contracting organization will comply with the Public Health Service terms and conditions of
award if a contract is awarded.
e. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE: Public Law 103-
227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted
in any portion of any indoor facility owned or leased or contracted for by an entity and used
routinely or regularly for the provision of health, day care, early childhood development
services, education or library services to children under the age of 18, if the services are
funded by Federal programs either directly or through State or local governments, by Federal
grant, contract, loan, or loan guarantee. The law also applies to children's services that are
provided in indoor facilities that are constructed, operated, or maintained with such Federal
funds. The law does not apply to children's services provided in private residence, portions of
facilities used for inpatient drug or alcohol treatment, service providers whose sole source of
applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are
redeemed.
Failure to comply with the provisions of the law may result in the imposition of a civil monetary
penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance
order on the responsible entity.
By signing the certification, the undersigned certifies that the contracting organization will
comply with the requirements of the Act and will not allow smoking within any portion of any
indoor facility used for the provision of services for children as defined by the Act.
The contracting organization agrees that it will require that the language of this certification be
included in any subcontracts which contain provisions for children's services and that all sub-
recipients shall certify accordingly.
The Public Health Services strongly encourages all recipients to provide a smoke-free
workplace and promote the non-use of tobacco products. This is consistent with the
PHS mission to protect and advance the physical and mental health of the American
people.
f. CERTIFICATION REGARDING OTHER RESPONSIBILITY MATTERS
1. The inability of a person to provide the certification required below will not necessarily
result in denial of participation in this covered transaction. The prospective contractor
shall submit an explanation of why it cannot provide the certification set out below. The
certification or explanation will be considered in connection with the department or
Washington State 23 HCA Contract#K8843
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agency's determination whether to enter into this transaction. However, failure of the
prospective contractor to furnish a certification or an explanation shall disqualify such
person from participation in this transaction.
2. The certification in this clause is a material representation of fact upon which reliance
was placed when the department or agency determined to enter into this transaction. If
it is later determined that the prospective contractor knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal Government, the
department or agency may terminate this transaction for cause of default.
3. The prospective contractor shall provide immediate written notice to the department or
agency to whom this contract is submitted if at any time the prospective contractor learns
that its certification was erroneous when submitted or has become erroneous by reason
of changed circumstances.
4. The terms covered transaction, debarred, suspended, ineligible, lower tier covered
transaction, participant, person, primary covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause, have the meanings set out in the Definitions
and Coverage sections of the rules implementing Executive Order 12549. You may
contact the person to whom this contract is submitted for assistance in obtaining a copy
of those regulations.
5. The prospective contractor agrees by submitting this contract that, should the proposed
covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this covered transaction, unless authorized by
Authority.
6. Nothing contained in the foregoing shall be construed to require establishment of a
system of records in order to render in good faith the certification required by this clause.
The knowledge and information of a participant is not required to exceed that which is
normally possessed by a prudent person in the ordinary course of business dealings.
7. Except for transactions authorized under paragraph 6 of these instructions, if a
participant in a covered transaction knowingly enters into a lower tier covered transaction
with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal
Government, HCA may terminate this transaction for cause or default.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFICIAL: TITLE:
Chief of Corrections
PLEASE ALSO PRINT OR TYPE NAME:
David Fortino
ORGANIZATION NAME: (if applicable) DATE:
Washington State 24 HCA Contract#K8843
Health Care Authority Attachment 3
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ATTACHMENT 4: FEDERAL SUBAWARD IDENTIFICATION — K8843
1. Federal Awarding Agency Department of Justice
2. Federal Award Identification Number(FAIN) 15PBJA-23-GG-01570-RSAT
3. Federal Award Date 09/14/2023
4. Assistance Listing Number and Title 16.593 - Residential Substance Abuse Treatment
(RSAT)for State Prisoners
5. Is the Award for Research and Development? ❑ Yes ® No
Teesha Kirschbaum, Assistant Director
6. Contact Information for HCA's Awarding Official WA State Health Care Authority
Division of Behavioral Health and Recovery
teesha.kirschbaum(cr7hca.wa.gov
7. Subrecipient name (as it appears in SAM.gov) Jefferson County Sheriff Department
8. Subrecipient's Unique Entity Identifier (UEI) LP11B7JKFN38
9. Subaward Project Description Residential Substance Abuse Treatment (RSAT)
10. Primary Place of Performance 98339-9700
11. Subaward Period of Performance 10/01/2025-09/30/2026
12. Amount of Federal Funds Obligated by this Action $148,221
13. Total Amount of Federal Funds Obligated by HCA $148,221
to the Subrecipient, including this Action
14. Indirect Cost Rate for the Federal Award (including de minimus (15%)
if the de minimis rate is charged)
This Contract is subject to 2 CFR Chapter 1, Part 170 Reporting Sub-Award and Executive Compensation
Information. The authorized representative for the Subrecipient identified above must answer the questions
below. If you have questions or need assistance, please contact subrecipientmonitorinq a(�hca.wa.gov.
1. Did the Subrecipient receive (1) 80% or more of its annual gross revenue from federal contracts,
subcontracts, grants, loans, subgrants, and/or cooperative agreements; and (2) $25,000,000 or more in
annual gross revenues from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative
agreements?
❑ YES ❑ NO
2. Does the public have access to information about the compensation of the executives in your business or
organization through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of
1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986?
❑ YES ❑ NO
Washington State 25 HCA Contract#K8843
Health Care Authority Attachment 4