HomeMy WebLinkAbout021014_ca02JEFFERSON COUNTY PUBLIC I Consent Agenda
. .
615 Sheridan Street o I orl Townsend � W ashingloni o 983'68
January 7, 2014
TOO Board of County !, r
Philip Morley, County Administrator
FROM: Jean Baldwin, [Director
DATE. . c a � L+
SUBJECT: Agenda Item -- Contract Agreement — Sate Harbor Recovery Center for
Alcohol and Substance Abuse treatment services; January 1, 2814
December 31, 20914; language change only �n. Y i
STATEMENT OF ISSUE:
Jefferson County Public Health, as the fund manager of the Mental Health and Substance Abuse sales tax
treatment funds, requests ward approval of the Contract Agreement for Alcohol and Substance Abuse
treatment with Safe Harbor Recovery Center; January 1, 2014 — D'ecemb'er 31, 2014; language change only
This contract funds SHRC to serve additional Jefferson County citizens seeking alcohol and substance abuse
treatment. The treatment partnership with .Jefferson Dental Health Services, to treat people with co-
occurring disorders, is included in these Substance Abuse services.
amendment This r r^ - r- only. This amendment adds language regarding requirements and
compliance r r, chemical dependency r unty tax funds for
FISCAL IMPACT CIOST (BENEFIT ANALYSIS:
There is no fiscal to the department or county.
JCPH management -q approval • r '� - r alcohol d r abuse
treatment rr Recovery � December 11language change only
DEVELOPMENTAL O,PMENTAL, fall "SABILI NE
M , N (3 60) 385-9400
FAX� (360) 385 9401
rA' .
„T"
ENWRONMENTAL HL ALT( f
WATER ClUALITY
MMIN� (360) 385-9444
FAX: (360) 379 N7
CONTRACT AMENDMENT #1
By and Between
Safe Harbor Recovery Center
And
Jefferson County
For Expanded Mental Health (MH) & Chemical Dependency (CD) Treatment 2014
WHEREAS, the Safe flarbor Recovery Center (Contractor) and Jefferson County (County) entered into
an agreement on January 1., 2014 for Professional Services in connection with the provision of alcohol and
substance abuse treatment services to individuals impacted by mental health/substance abuse issues in
Jefferson County, Washington.
WHEREAS, the parties desire to arnend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
1, The term of the above referenced agreement ends December 31, 2014,
2, This amendment strikes Section 4. E. of the original agreement and is replaced by the following
language:
a. County reserves first right to use as match the chemical dependency mental health tax funds
and the services funded by them for purposes of qualifying for additional funding and grants.
County may allow Contractor to use the chemical dependency mental health tax funds as
match, at the County's sole discretion, Should the County decline to use chemical dependency
mental health tax funds as latch for additional funding and/or grants, then the County may
authorize the Contractor to use such funds for match. (See Attachment A)
b. Where Contractor proposes to use chemical dependency mental health County tax funds for
match, Contractor shall be solely responsible for compliance with all state and federal laws
and regulations, including, but not limited to DSl-lS, CMS and D131-IR funding rules,
applicable to the use of 1 1 -11CD sales tax monies as match. Contractor shall document it has
met this responsibility by submitting in writing to the County Administrator their match
formula, allocation plan and any other documentation required of them pursuant to Attachment
A, attached hereto and incorporated in this Agreement, The County may withhold
authorization to utilize the MH/CD sales tax monies as match. Contractor's failure to provide
adequate documentation does not relieve the Contractor of their responsibility to comply with
all state and federal laws and regulations related to match.
Total compensation under this Agreement remains unchanged and shall not exceed $114,500.00
without express written amendment.
4. All other terms and conditions of the agreement will remain the same.
Dated this day of -- 1 2'014
By:
lohn Austin, Chairniail
Jefferson Board of Cotijity Cornniissioners
By: _ -7-21-4
(Contractor)
Safe liarbor Recovery Center, Amendment 0 ' 1
roved as to am, 0 -
Q21,1 1�
Jefferson Countyl? rosgc " ait
is
ice
David Alvarez, Chief vj
DPA
D TREATMENT TAX FU N DI NG-
MATCH POLICY
Definitions:
Match: is a requirement for the grantee to provide contributions of a specified amount or percentage to
match funds provided by another grantor. Matching can be in the form of cash or in-kind contributions.
Regulations: The specific requirements for matching funds are unique to each federal or state program.
The A-102 Common Rule provides criteria for acceptable costs and contributions in regard to match.
Jefferson County Policy:
In 2005, the Washington State Legislature created an option for counties to raise the local sales tax by 0.1
percent, (the 1/10th of 1% sales tax initiative) to augment state funding for mental health and chemical
dependency treatment. Jefferson County collects and distributes the Mental Health/Chemical Dependency
(MH/CD) tax. Services purchased by the County are allocated through a formal Request for Proposal (RFP)
process, review and contracting; staffed by Jefferson County Public Health, overseen by Jefferson County Mental
Health Substance Abuse Fund Advisory Committee and adopted by the Board of County Commissioners, (BOCC).
BOCC does not assume any fiscal responsibility/liability for any of the Contractors they contract for services with.
Jefferson County reserves the first right to use as match the chemical dependency mental health tax funds and
the services funded by them for purposes of qualifying for additional funding and grants. County may make
available to the Contractor the chemical dependency mental health tax funds for the Contractor to propose as
match to state, federal or other entities, at the County's sole discretion. Contractor shall not use chemical
dependency mental health County tax funds for match without prior authorization by the Jefferson County
Administrator and County fiscal team, To request authorization of availability of the funds for match, Contractor
must apply to the County Administrator in writing, and include their match formula and allocation plan and may
include other documentation to support their request, The County Administrator will authorize or deny the
availability of match funds in writing within 30 days of the application.
if the County informs the Contractor of the availability of chemical dependency mental health County tax funds
for match, then the Contractor shall be solely responsible for compliance with all state and federal laws and
regulations, including, but not limited to DSHS, CIVIS and DBHR funding rules, applicable to the use of MH/CD sales
tax monies as match. Following state, federal and local guidelines for match is the responsibility of the
Contractor.
For example, if a Contractor provides Title XIX Medicaid services (the Policy 19.50,02 or 42CFR 430,30)
they are required by those rules to actually bill Medicaid for the services at the same time. if no Medicaid
billing exists, the match would not comply with state and federal guidelines for match.
Safe Warbor Recovery Center, Amendment # 1
Concurrent with its request for authorization of the availability of match, Contractor shall document it has met its
responsibility to follow state, federal and local guidelines for match by submitting in writing to the County
Administrator their match formula, allocation plan, and other documentation made mandatory pursuant to this
Agreement and this Attachment A. At a minimum, the Contractor shall also provide the following to the County
Administrator:
1, DSHS requires contractors to complete and submit a "Local Match Certification" form (DSHS 06-
155) or a form that has equivalent data elements prior to any agreement for DSHS services,
Submit a copy of this application and form when requesting match availability from the County
and at each monthly billing.
2, Submit the current administrative policy within WA State regulating your services and the use of
Focal match.
3, Submit to the County your last financial audit showing your use of match, County funds and
tracking systems.
4, Submit to the County the terms of the agreement showing the MH/CD allocation is an allowable
source of match.
5. Provide documentation that your financial reporting system tracks matching funds at a level that
,meets the level of documentation required by federal or state statutes.
The County may reject permission for Contractor to utilize the MH/CD sales tax monies as match.
Safe Harbor Recovery Center, Amendment # I
j f 1,._ 1-, , , , I
f �_ V t_
CONTRACT AGOREEMENT
By and Between
Jefferson County
And
Safe Harbor Recovery Center
For Mental Health (Mid) & Chemical Dependency (CD) Treatment 2014
S I ection 1: PURPOSE:
-1 HIS AGREEMENT for Professional Services is entered into between Jefferson County herein
referred to as the "County" and Safe Harbor Recovery Center (STIRC), herein referred to as the
"Contractor" to provide alcohol and substance abuse treatment services to individuals impacted
by mental health/substance abuse issues in Jefferson County, Washington.
Section 2: TERMS:
This Agreement shall commence on January 1, 2014 and continue through December 31, 2014,
unless terminated as provided herein.
Section 3: SCOPE OF ,AGREEMENT:
Contractor will increase chemical dependency treatment options to Jefferson county residents as
outlined in Exhibit A, herein incorporated by reference. Through the use of these funds the
provider will increase the number of citizens receiving Chemical Dependency Treatment. The
goal of this funding and sales tax increase is to improve the quality of life for Jefferson County
citizens by improving access to treatment and improving partnerships with Jefferson Mental
Health. Clients who need services of one agency will be screened and referred, if necessary, to
the other agency, These funds will be used to increase treatment services to citizens seeking
substance abuse treatment and those who have a co- occurring Mental T lealth disorder,
A. Contract Representatives:
Jefferson County and SHRC will each have a contract representative who will have
responsibility to administer the contract for that party. A party may change its
representative upon providing written notice to the other party, The parties'
representatives are as follows:
J014 Contrac!L�u_r
Anna McEnery
Jefferson County Public Health
615 Sheridan St.
Port'Fownsend, WA 98168
(360) 385-9400
Contractor's Contra t Re
g......__.presentative
Teresa Wirth, Administrator
Safe Harbor Recovery Center
686 Lake Street, Suite 400
Port Townsend, WA 98368
(360) 385 -3866
Section 4: COMPENSATION:
total amount payable shall not exceed $114,500.00 in completion of this project without
express written amendment signed by both parties to this Agreement. The parties acknowledge
ti,lat funding for this contract is contingent on the continuation o1 sales tax revenue in 2014. if the
sales tax revenue decreases by ten percent (10%) when applicable sales tax revenues are
compared between the most recently completed quarter year and the same quarter year revenues
S:jt'e 9 jal,[)or Recovery Ceiitei20 14
'for 2013, then this contract may be renegotiated. The parties acknowledge the funding connected
to this contract is revenue of last resort and therefore Contractor will bill all other sources of
revenue first.
A. Contractor shall be paid for services as outlined in Exhibit B Fee Schedule,
B. Contractor shall submit monthly invoices to JCPH, 615 Sheridan St., Port Townsend, WA
98368, Attn: Finance Department, for payment ofwork actually completed to date.
C. Invoices must be submitted by the 2nd Monday of the month for the previous month's
expenses. The County will review such invoices, and upon approval thereof, payment
will be made to the Contractor in the amount approved. Failure to submit timely invoices
may result in a denial of reimbursement.
D. Contractor shall provide invoices and necessary backup documentation for all invoices
including timesheets and statements. Any indirect charges require the submittal of an
indirect cost methodology and rate using OMB Circular's A-87 and A-122.
E. Contractor will not use County treatment tax funds for match without prior authorization
of their match formula and allocation use approved in writing by the Jefferson County
Administrator and County fiscal team, Please submit both formula and allocation plan for
approval, funds can not conflict with existing DSHS, CMS or DBHR funding rules. (See
Attachment A)
F, Hie County will make final payment of any balance dare the Contractor promptly upon
determining, that i) the Contractor has completed its obligations under this Agreement and
ii) the County can and does accept the work performed, by the Contractor.
G Contractor records, client records, docurnents, reports and accounts pertaining to this
agreement are to be kept available for inspection by representatives of the County and
,state for a period of'six (6) years after final payments. Copies shall be made available
upon request.
.An audit will be submitted to the County annually.
Contractor will Submit the most recent financial audit within 30 days 1' �om the
beginning of this agreement.
b. '1 he shall be completed by the WA State Auditor's Office car mutually agreed
upon entity. Llpon request the County shall have the option of performing an onsite
review of all records, statements, and documentation.
c, If the CoulitY finds indications of potential non-compliance during the monitoring
process, the County shall notify Contractor within ten (10) days, County and
Contractor shall ineet to discuss areas of contention in an attempt to resolve issues.
sai,e ilarbo� j�ecovety Cmcr-2014
d, Audit and/or recent DBHR annual fiscal review and is performed in accordance with
generally accepted auditing standards and with Federal Standards for Audit of
Governmental Organizations, Programs, Activities and Functions, and meeting all
requirements of OBM Circular A -133 or A -128, as applicable.
Section 5: INDEMNIFICATION:
The Contractor shall indemnify, defend and hold harmless the County, its officers, agents and
employees, from and against any and all claims, lawsuits, demands for money damages, losses or
liability, or any Portion thereof, including attorney's fees and costs, arising from any injury to
person or persons (including the death or injury of the Contractor or damage to personal property)
if said injury or damage was caused by the negligent acts or omissions of the Contractor.
Section 6: INSURANCE:
The Contractor shall obtain and keep in force during the terms of this Agreement, or as otherwise
required:
A. Commercial Automobile Liability Insurance providing bodily injury and property
damage liability coverage for all owned and non owned vehicles assigned to
or used in the performance of the work for a single limit of not less than
$500,000 per occurrence and an aggregate of not less than one million dollars
($I,o(0,000) Contractor shall provide proof of insurance to the County
c/o Contracts Manager at Jefferson County Public Health, 615 Sheridan St. Port
Townsend, WA 98368 prior to commencing employment.
B. General Liability (1) -- with a minimum limit per occurrence of one million dollars
($1 000,000) and an aggregate of not less than two million dollars ($2,000,000) for
bodily injury, death and property damage unless otherwise specified in the contract
specifications, This insurance coverage shall contain no limitations on the scope of
the protection provided and indicate on the certificate of insurance the following
coverage'.
1, Broad Form Property Damage with no employee exclusion;
2, Personal Injury Liability, including extended bodily injury;
3. Broad Form Contractual/Commercial Liability including completed operations
(contractors only);
4. Premises — Operations Liability (M&C)
5, Independent Contractors and Subcontractors; and
6, Blanket Contractual Liability.
(1) Note: The County shall be named as an additional insured party under
this policy.
C, Professional Liability Insurance providing $2,000,000 per incident; $4,000,000
aggregate, Contractor shall name Jefferson County Public Health as additional
insured.
D, The Contractor shall participate in the Worker's Compensation and Employer's
Liability Insurance Program as inay be required by the State of Washington.
E, It is agreed by the parties that insurers shall have no right of recovery or subrogation
against the County (including its employees and other agents and agencies) it being
Safe I Tartar Recovery Center-2014
agreed by the parties that insurers shall have no right of recovery or subrogation
E. It i
against the Col rat v (including its employees and other agents and agencies) it being
, ,
the intention of the parties that the insurance policies listed above &II protect both
parties and be primary coverage for any and all losses covered by the above-listed
insurance policies. It is further agreed by the parties that any and all deductibles
trade part of the above-listed insurance policies shall be assumed by, paid for and at
the risk of the Contractor,
F'. Any insurance coverage for third party liability claims provided to the County by a
"Risk Pool" created pursuant to Ch. 48.62 RCW shall be non-contributory with
respect to any policy of insurance the Contractor must provide to comply with this
Agreement.
G, if the proof of insurance or certificate indicating the County is an ",additional
insured" to a policy obtained by the Contractor refers to an endorsement (by number
or name) but does not provide the full text of that endorsement, then it shall be the
obligation of the Contractor to obtain the full text of that endorsement and forward
that full text to the County.
if. The County may, upon the Contractor's failure to comply with all provisions of this
contract relating to insurance, withhold payment or compensation that would
otherwise be due to the Contractor.
Section 7: CONFIDE NTIALITY:
Contractor, its employees, subcontractors and their employees will maintain the confidentiality
of all information provided by JCPH or acquired in performance of this Agreement as required
by JJIPAA and other privacy laws. This Contract, once executed by the parties, is and remains a
Public Record subJJect to the provision of Ch. 42.56 RC W, the Public Records Act.
Section 8- INDEPENDFNCE dependent Contractor with
T i
he Contractor and the County agree that the Contractor is an n
respect to the services provided pursuant to this agreement, Nothing in this agreement shall be
considered to create the relationship of employer and employee between the parties hereto. The
Contractor shall not be entitled to any benefits accorded County ernployees by virtue of the
services provided under this agreement. 'The County shall not be responsible for withholding or
otherwise deducting federal income tax or social security or for contributing to the state
industr al risurance prog i-arri otherwise assurning the duties of an employer with respect to
ernployee.
Section 9: ASSIGNMENTS AND SUBCONTRACTING
'I'lie Contractor shall not sublet or assign any of the services covered by this agreement without
the express written consent of the County.
Scctioyj J• REPORTING
I'lie (.:ontractor will provide a monthly SCI-VIUSUITImary report to the County at the same tune as
invoices and must be SUbinitied by the 2`1 Monday of the month for the previous trionth's work.
,j,jje monthly report shall contain the report of services and the total hours worked by which staff.
,1,11e jjjoajthly report shall be submitted to Jefferson County Public Flealth, Attw Fin,,inee
Sat,e j Recovery center-20 64 4
Department, 615 Sheridan, port Townsend, and WA 98368. 'The County will review such
reports, and upon approval thereof, payment will be made to the Contractor in the amount
app
reports,
Failure to submit timely reports may result in a denial of reimbursement.
Section TERMINATION
'The County reserves the right to terminate this contract in whole or in part, with 30 days notice,
in the event that expected or actual funding from any funding source is withdrawn, reduced, or
limited in any way after the effective date of this agreement. In the event of termination under
this clause, the County shall be liable for only payment for services rendered prior to the
effective date of termination.
A. 'This agreement may also be terminated as provided below:
1. With 30 days notice by the Board of Courity Commissioners for any
reason, or
2. With 30 days notice by the Board of County Commissioners for non-
performance of the specific job duties in Exhibit A.
3. With 30 days notice by the Contractor by voluntary resignation.
Section 12: DISPITUE RESOLUTION
Any dispute or disagreement concerning the terms and obligations of this Contract shall initially
be brought to the attention of the Public Health Director via a written document. The Public
Health Director shall make her determination with reasonable promptness, i.e., a decision within
ten business days shall be deemed to have been made with reasonable promptness. If the
aggrieved party is riot happy with that decision, then the Jefferson County Administrator (or as
may hereafter be amended), will decide the appeal of the Director's decision.
Section 13: MODIFICATION
This professional services agreernent may be modified at any time by written agreement of either
party and may be modified if tax revenue decreases.
Section 14: INTEGRATED AGREEMENT
This Agreement together with attachments or addenda represents, the entire and integrated
agreement between the County anal the Contractor and supersedes all prior negotiations,
representations, or agreements written or oral between the parties. This agreement may be
amended only by written instrument signed by both County and Contractor.
S,j 1e F1 arbor Recovely Ceraer-20 � z:[ 5
11 day o 20
Approved this f
BOARD OF COUNTY COMMISSIONERS
JEFFERSON COUNTY, WASHINGTON
.. . ............. ... . .....
Jamlarb C
stir, hairperson
� (-
. . .. .............. . . .
Safe Harbor Recovery Center
- T-- ... ......... . .
as only
David Alvou, Chief Civil
S( ,,Ife I ,,Ir bo,
- Hec()Vem,y ('enter-2014,
Exhibit A
Scope of Work
The Safe Harbor Recovery Center agency as a contracted provider, agrees to:
t Clinical and care management treatment services for additional Jefferson County citizens
unable to be seen in other revenue sources.
2, All employees or subcontractors of the Contractor undertaking the performance of mental
1jealth/substance abuse services under this agreement are required to be professionally
licensed or certified by the State.
3, Background checks are required for all employees; to be redone for every employee
every � years. The names of licensed therapists will be given to the County.
4, Work collaboratively with local mental health courts and substance abuse treatment
agencies to identify and treat clients with co-occurring disorders.
5 Provide UA for co-occurring disorder clients.
6. Provide crisis interventions.
7. Run groups as appropriate.
Work with social services or other agencies as needed for dually served families with
mental health or chemical dependency issues,
9. Maintain a secure records system guaranteeing the confidentiality of PHI pursuant to
1-11PPX
10, Bill other sources of revenue whenever they exist, Document what percent of clients are
covered by other sources of revenue.
include ental Health C C OD
IT service hours in those billed under ITand Drug Court,
Please track separately.
12. Monthly report on client utilization, referrals, outcomes as specified by JCPH.
11 1-11re Chemical Dependency Licensed professionals and maintain training and education
needs for those billing on this contract.
14. Group or individual therapy, or a combination of the two, of a specified duration, using
-nodels of treatment. Applicant will identify the number of clients
ev cfence based i
seen,
b, how often each week, and the number cif` lours per week and per month foi-
treatment.
l in weekly and monthly.
enrolfinent, also identify the after care ph
ing for treatment and case
15. PartMpate 112014 discussions on MH therapeutic court,
management.
S,rjtl'e I havbur RW)vej,y Ceiiier-20 14
16. Chemical dependency, mental health and/or COD assessment, treatment plan
development and review, documentation of client progress (group and individual session
notes), and aftercare planning and monitoring are documented and maintained for at least
five years or following WA state StatUtes, .
17. Referral for mental health medication and monitoring as needed.
18. Services are available throughout the county.
19. Preparation of progress reports if needed, e.g. to court.
20. Agency oversight regarding record keeping, data collection, legal and ethical issues and
standards of care are updated and meet State of" ashington standards.
21. opportunities for regular clinical supervision and psychiatric consultation are available
for staff on a regular basis.
22. Collection and preparation of .service data for evaluation purposes, and reporting to
jC plj, monthly with the invoice, Use forms supplied by K"PlIfor data.
23. Attend and report to the Mental Health Substance Abuse Sales `Fax Advisory Committee
twice during the duratiOn, of this contract period, at regularly scheduled meetings, with
progress evaluation reports,
S�fc I iarbor (,etj�er,,20H
Exhibit B
Fee Schedule
Chemical Dependency Professional @ $25.00/hour
Accountant @ $23.00/hour
Clerical/data entry @$21.00/hour
Supervision/PrO gram Management @ $50.00/hour
UA for {:EDIT clients monthly, based on lab invoice's
Not to exceed $ 114,500-00 in completion of services for the duration of this contract without
express written amendment.
s 1 [arbor RecovuY Ceiitei,-2014
ATTACHMENTA
II I E, g. NMI~ I/CD TREAT MEN I"FAX FUNQJNGI-
_Q�L_QOIJNIY
MATCH POLICY
on October 14, 2013 Jefferson County Board of County Commissioners (BoCQ adopted the
following language in the allocation off the Mental Health Chemical Dependency treatment
dollars.
Agencies May not use Jeffierson Caunry mental health countyl chemical dependency
treatment tai fang fior match, without authorization oj'their matchfib? I and
allocation use, approved by the Jefferson County Administrator andfiscal teoln. The
match may not be used without written permission.
Definitions:
Match: is a requirement for the grantee to provide contributions of a specified amount or
percentage to match funds provided by another grantor. Matching can be in the form of
cash or in-kind contributions.
Auditors ObJective: To determine whether the match amount or percentage of'
I o I'l
contributions from :ICS is ate allowable source of funding and that the vender has a
accurate accounting Systern to track the match.
Regulations: The specific requirements for matching funds are unique to each federal or
state program. The A-102 Common Rule provides criteria for acceptable costs and
contributions in regard to match.
Jefferson County Policy:
111'2005, time Washington State Legislature created an option for counties to raise the local sales
lax by 0.l 1 I)ercent. (the 1/1 Oth of I% sales tax initiative) to augment state furic ling for mental
I'le'lltil and ClIenlical dependency trealnient. Jefferson County collects and distributes the Mental
I ounty are allocated
Health/Chenucal Dependency (NIH/CD) tax, Services purchased by the C
tI-jrough a fornial Request for Proposal (RFP) process, review, and contracting; staffed by
Jefferson County Public Health, overseen by Jefferson County Mental Health Substance Abuse
I -s, (BOC(,). The
1.,'und Advisory (,,,0jjlnIttee and adopted by the Board OfCOLinty Cornmissionei
BO CC does not assume any fiscal r esponsibility/liability for any of the vendors they contract for services with. Services leveraged y a vendor using MIN-111) tax as match have no oversight or
�D
agency relationship to jefferson COUIlty; funding cannot be used withOUt prior authorization of
the vendor's match fc.)rmula'arld allocation by the Jefferson County Adniiiiistrator and fiscal
teain .
Sa�e [jciibor Recomy cc�,jun2W,4 10
Following state, federal and local guidelines for match is the responsibility of the vendor.
person (�Ounty will follow all administrative policies in authorizincy that use. If a vendor is
Je I L CP
disallowed the use of fund,-; for match according to the State of Washington or the federal
government, Jef 1 1, 1 erson County funds will not be available as matching funds.
For example, if a vendor provides Title XIX Medicaid services (the Policy
19.50.02 or 42CFR 430.30) they will not be allowed the use of match without
actually billing Medicaid for the services at the same time. If no Medicaid billing
exists, the match cannot be applied.
• The County shall verify that the local entity's financial reporting system tracks
matching funds at a level to support the use of funds; that meets the level of
documentation required by federal or state statutes.
The verification and application process for Match use within the County will include the
following steps:
DSIJS requires contractors to complete arid submit a "Local Match Certification"
form (DSHS 06-155) or a form that has equivalent data elements prior to any
agreement for DSIlS services. The County must review a copy of this application
and form prior to granting match authorization of MH/CD funds for Match and at
each monthly billing.
2. Submit the current administrative policy within WA State regulating your services
arid the use of local match.
I a
Submit to the County your last financial audit showing your use of match,
County funds and tracking systems.
4. Submit to the County the terms of the agreement to ascertain the Mf I/CD
allocation is an allowable source of match.
5. The County Administrator will authorize or deny the use of match in writing
within 30 days of the application.
sai,e I larbor R,ecove"Y (,,mie•-2W4 I I