HomeMy WebLinkAbout040714_ca07JEFFERSON COUNTY PUBLIC 111FALTI-1 Consent Age6lda
615 Sheridan Street o Port Townsend o Washington o 98368
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Jean Baldwin, Director
January 21, 2014
4—:UBJECT: Agenda Item — Contract Agreement — Jefferson Mental Health Services
for School Based Health Center; January 1, 2014 —
December 31, 2014 $65,000
STATEMENT QE ISS' —E.'
Jefferson County Public Health, as the fund manager of the Mental Health and Substance Abuse sales tax
treatment funds, is requesting Board approval of the Contract Agreement — Jefferson Mental Health
Services for School Based Health Center; January 1, 21014 — December 31, 2014; $65,000
ANALYSIS /STRATEGIC GOALS/PRO'S and COWS:
This is a one year contract with JCPH and Jefferson Mental Health to provide services negotiated by the
BoCC Advisory Committee.
This agreement provides for mental health services in the Port Townsend, Chimacum, and Quilcene School
Districts, Mental Health services will be provided to children in grades 6 — 12 who identify with mental
health issues. Contractor will provide the services of a Child and Family Therapist who will do counseling
services in individual or group setting. Counseling services provided will include anger management,
depression, conflict resolution, and stress, relationship issues, feeling of suicide, eating disorders, domestic
violence, and sexual and physical abuse.
A mental health provider will spend 4 days a week at Port Townsend School District, 4 days a week at
Chimacurn School District and 1 day a week at Quilcene School District.
JCPH will work with JMHS to monitor service data, performance outcomes, and ongoing interface between
the schools, the county and the MH CD committee.
COMMUNHY HEALTH ENVIRONMENTAL HEALTH
DEVELOPME'NrAL MSAMLINE'S PUBLIC HEALTH WATER QUAL11Y
MAW- (360) 385 9400 ALWAYS WORKING III FOR A SAFER AND MAIN: (360) 395 9444
f`AX- (360) 385-9401 HEALTHIER COAMUNITY FAX- (360) 3794487
Consent Agenda
FISCAL IMPACT CCU T (BENEFIT ANALYSIS:
This is sale tax revenue raised by the County in the 1/10 of 1% Fund and is allocated by the BOCC with
advise from the Mental Health and Substance Abuse Sales Tax Advisory Committee, The contract states if
the sales tax revenue decreases the vendor will be contacted and the contract may be renegotiated. JMHS
responded to a local Request for Proposal which was reviewed and chosen by the Committee.
RECOMMENDATION:
JCPH management requests approval of the Contract Agreement — Jefferson Mental Health Services for
School Based health Center; January 1, 2014 — December 31, 2014; $65,000
.EWED BY:
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(Routed to all Public Health Managers)
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CONTRACT AGREEMENT
For Professional Services
Between
Jefferson County
And
Jefferson Mental Health Services
For School Based Health Clinics
This Contract for Professional Services is entered into between Jefferson County, herein referred
to as the "County" and Jefferson Mental Health Services (JMHS), herein referred to as the
"Contractor".
Section 1: PURPOSE:
THIS AGREEmEN'r is made and entered into to provide services in the school districts of
Chimacum, Port Townsend, and Quileene for Jefferson County, Washington.
The COUNTY and the three (3) school districts agree to cooperate in order to provide enhanced
mental health intervention and treatment services in the schools for children or youth grades 6-12
who identify with mental health issues. JMH hours will be distributed as I day a week in
Quilcene SID, 4 days a week in Port Townsend SID, and 4 days a week in Chimacum SID. 85 %
of that time or 50 minutes is spent seeing students and 10 minutes of each hour is spent on
charting or travel.
Section 2: TERMS:
This Agreement shall commence on January 1, 2014 and continue through December 30, 2014,
unless terminated as provided herein.
Section 3: SCOPE OF AGREEMENT:
Jefferson Mental Health Services (JMHS) will provide the services of a Child and Family
Therapist, who will perform individual and group counseling services at Jefferson County
School-Based Health Clinics (SBHC), as part of a comprehensive team. In addition, the Child
and Family Therapist shall attend monthly meetings with other Jefferson County Public I lealth
(JCPH) staff and attend SBHC trainings. Quileene SID and Blue heron students do not have
SBHC access.
The JMIIS Child and Family Therapist shall provide:
• The development of goals and objectives for the school year to the SBI-IC
Advisory Committee.
• Short-term counseling, support, and referral for youth and their families enrolled
at the Middle and High Schools at the schools.
• Group and individual counseling on a variety of issues and concerris including,
but not limited to, anger management, depression, stress, conflict resolution,
relationship issues, feelings of suicide, counseling for grief or loss, sexual and
physical abuse, eating disorders, and domestic violence.
• Ongoing collaboration and weekly consultation with the SBf IC team of health
and school professionals.
• Effective and efficient clinical services using best practice standards.
• All necessary clinical and administrative records for the S13HC.
Jefferson Mental 1-lealth Services - SBI IC 2014
Data collection on number and types of services provided for the SBHC to the
SBHC Advisory Committee.
Yearly report of activities and services provided, which are submitted to the
JCPH Contract Representative.
A. Contract Representatives:
JCPIJ and J111-1S 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:
C ontractoe fs Contract 1-
-epresentative
Sam Markow, Executive Director
Jefferson Mental Health
PO Box 565
Port Townsend, WA 98368
(360) 385-0321
JCPH Contract Representative
Jean Baldwin, Director
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA 98368
(360) 385-9400
Section 4: COMPENSATION:
The CONTRACTOR will be reimbursed for all work performed under the terms of this contract.
The total arriount payable under this Contract by County to CONTRACTOR, for school year,
shall not exceed $65,000,00 in the completion of this project without express written amendment
signed by both parties to this Agreement.
A. Contractor shall be paid for services as outlined in Exhibit A — Scope of Work,
B, CONTRACTOR shall submit monthly invoices to JCPH, 615 Sheridan St., Port
Townsend, WA 98368, Attn: Finance Department, for payment of work actually
completed to date.
C. Invoices must be submitted by the 2"d 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. 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 match for additional
funding and/or grants, then the County may authorize the Contractor to use such funds
for match. (See Attachment A).
Jefferson mewal Health Services — Sf.31 IC 2014
F. Where Contractor proposes to use chemical dependency mental health County tax
funds for match, Contractor shall be solely responsible for compliance with allstate
and federal laws and regulations, including, but not limited to DSHS, CMS, and
DBHR funding rules, applicable to the use of MH/CD sales tax monies as match,
Contractor shall document they have met this responsibility by submitting to the
County Administrator, in writing, 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
MI-1/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.
G. The County will make final payment of any balance due 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.
CONTRACTOR records 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.
a. contractor will submit the most recent financial audit within 30 days from the
beginning of this agreement.
b. The audit shall be completed by the WA State Auditor's Office or a mutually agreed
upon entity. Upon request the County shall have the option of performing an onsite
review of all records, statements, and documentation,
c. If the County finds indications of potential non-compliance during the monitoring
process, the County shall notify Contractor within ten (10) days. County and
Contractor shall meet to discuss areas of contention in an attempt to resolve issues.
d. Audit will provide statements consistent with the guidelines of Reporting for Other
Non-Profit Organizations AICPA SOP 78-10, and is performed ill 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.
,jefferson Mental I lealth Services -, SBI IC 2014
Section 6: INSURAI�ICE:
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
($1,000,000) 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: 'rhe 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. 'I"he Contractor shall participate in the Worker's Compensation and Employer's
Liability Insurance Program as may 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
the intention of the parties that the insurance policies listed above shall 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
made part of the above-listed insurance policies shall be assumed by, paid for and at
the risk of the Contractor.
Jefferson Mental Flealth Services — SBHC 2014 4
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.
C. 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.
fL 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: CONFIDENTIALITY:
Contractor, its employees, subcontractors and their employees will maintain the confidentiality
of all information provided by JCPH or acquired in performance of the Contract as required by
HIPAA and other privacy laws. This Contract, once executed by the parties, is and remains a
Public Record subject to the provision of Ch, 42.56 RCW, the Public Records Act.
Section 8: INDEPENDENCE
I'he Contractor and the County agree that the Contractor is an independent Contractor with
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 employees 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 for contributing to the state industrial
insurance program, or otherwise assuming the duties of an employer with respect to employee.
Section 9: REPORTING
The Contractor will provide a monthly service summary report to the County at the same time as
Invoices and must be submitted by the 2 d Monday of the month for the previous month's work.
The monthly report shall contain the report of services and the total hours worked by which staff,
The monthly report shall be submitted to Jefferson County Public Health in care of the Jean
Baldwin, Director, 615 Sheridan, Port Townsend, and WA 98368. 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.
Section 10: ASSIGNMENTS AND SUBCONTRACTING
The Contractor shall not sublet or assign any of the services covered by this agreement without
the express written consent of the C ounty.
Jefferson Mental Health Services SWIC 20 4
Section 11: 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 County 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 tile Contractor by voluntary resignation.
Section 12: MODIFICATION
This professional services agreement may be modified at any time by written agreement of all
parties.
Section 13. INTEGRATED AGREEMENT
This Agreement together with attachments or addenda represents the entire and integrated
agreement between the County and 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.
Approved day of
BOARD OF COUN"I'l Y COMMISSIONERS
JEFFERSON COUNTY, WASHING] .'ON
John Austin, Chairperson
-6
. ..... . . ...........
—3efferson Mental Health Services
ATTEST:
Deputy Clerk of the Board
Jeff rson Memal I lealth Services - SBHC 2014 6
ME
Exhibit A
Scope of Work
The Jefferson Mental Health Services, as a contracted provider, agrees to:
A, Work with identified youth and their families throughout the school year,
B, Work collaboratively with local mental health and substance abuse treatment agencies
for identified clients.
C. Allocate 85% of staff hours to clinical services.
D. Staff each site with licensed therapists who consistently work at the same site except for
needs for personal leave. Exceptions may only be made with the written approval of the
County. The names of licensed therapists working in each school will be given to the
JCPl I and JCPH will be notified of any changes and they will notify the schools of
changes.
E. Background checks are required for Jefferson Mental Health employees working with
children or youth who provide services under, this contract. School districts each have
different requirements and all require out of state FBI for new to WA employees. Please
verify requirements with JCPH or the school district offices.
F. Provide crisis interventions and emergency response services.
G. Provide on-going individual therapy as needed, to all youth . Services are not dependent
on Medicaid eligibility.
11, Run groups as appropriate.
i. Work with children or youth to provide support services and referral to mental health or
other treatment programs. Assist with the application and eligibility paperwork necessary
to receive outside services.
J. Parents or guardians of children or youth may be contacted as necessary Following
HIPPA laws.
K, Assist school staff in identifying and developing strategies to assist students with mental
health issues.
L Work with social services or other agencies as needed for dually served children or youth
with mental health or chemical dependency issues.
M. Provide clinical and supervisory oversight for the therapist providing services in this
program.
N. Maintain a secure and confidential records system guaranteeing HIPPA,
0, Bill all revenue sources for services where appropriate.
13, Yearly report on client (students and families), utilization, referrals, outcomes.
Jefferson Mental Healtb Services -- SBI K, 2014
School Districts agree to:
A. Educate school teachers and staff about the availability of the referral process for the
"'Partnership for Health" to assure mutual understanding of proceedings and
requirements.
B. Identify students who may need mental health intervention and refer individuals for
screening or services.
C, Refer appropriate individual to the contracted provider for services, including necessary
contact information as needed.
D. Introduce MPIls to each building principal, counselor and other staff, and provide an
overview of building protocol.
E. Assist with data collection.
F. Provide space and access to a data connection for confidential mental health services for
the professional and the student
jeffel-son Mental J,lealth Services - SBHC 2014
ATTACH !T A
JEFFERSO
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' ashington 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 (M,H/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, CMS 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.
Jefferson Mental Health Services -- SBHC 2014 9
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.
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 local 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.
Jefferson Mental Ilealtli Set-vices — SBFIC 2014 10