HomeMy WebLinkAbout042715_ca10615 Sheridan Street
Q.� Port Townsend, WA 98368
O` www. JeffersonCountyPublicHealth.org
Public Heolt Consent Agenda
April 10, 2015
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
TO:
FROM:
DATE:
SUBJECT:
AGENDA REQUEST
Board of County Commissioners
Philip Morley, County Administrator
Jean Baldwin, Director
Julia Danskin, Public Health Supervisor
�-f /z-q- /IS-
Agenda Item – DBHR DSHS A -12; April
15, 2015 —June 30, 2015
STATEMENT OF ISSUE:
Jefferson County Public Health requests Board approval of the DBHR Amendment #12; April 15, 2015 - June
30, 2015;
ANALYSIS /STRATEGIC GOALS /PRO'S and CON'S:
DSHS, Division of Behavioral Health and Recovery, Behavioral Health and Service Integration, Amendment
#12 deletes from section #9 language that doesn't pertain to Prevention work, and replaces the language
with restrictive language; Amendment #11, which, at this writing has been at Risk and Legal since March
16th, modifies the list of Contractor's regarding Prevention and /or Treatment Services, and Rate Plan by
adding additional counties to the list of eliminated counties. DBHR A -10, which was signed by the BOCC
1/12/2015, had previously eliminated JCPH. As well, amendment #11 deletes Section #9 and replaces it
with language that clarifies the uses of DBHR funding in regards to reimbursement of insurance co -pays
and deductible fees, and the maintenance of documentations associated with CJTA allowable
reimbursements; however, JCPH does not participate in CJTA reimbursements. Essentially the only
statement that applies to JCPH in Amendment #12 forbids the use of DBHR funding or SAPT block grant
funds to reimburse co- payments, provider or individual.
FISCAL IMPACT /COST BENEFIT ANALYSIS:
This contract has no fiscal impact.
RECOMMENDATION:
JCPH management request approval of DBHR Amendment 12; April 15, 2015 – June 30, 2015.
REV D Y•? '
Philip Morley, 'o ty Admir tr Date
Community Health
Developmental Disabilities
360- 385 -9400
360 -385 -9401 (f)
Always working for a safer and healthier community
Environmental Health
Water Quality
360- 385 -9444
(t1 360- 379 -4487
�..._
DSHS Agreement Number
COUNTY PROGRAM AGREEMENT
FE 1A 7'XRT E�.AUTA
vK.,�L.9,h[ �',&^fre,r"whd"k °!.
AMENDMENT
1163 -27310
ERV IC ES
Amendment No.
12
This Program Agreement Amendment is by and between the State of Washington
Administration or Division
Department of Social and Health Services (DSHS) and the County identified below,
Agreement Number
County Agreement Number
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE
Behavioral Health and Service Division of Behavioral 1223 1223
Integration Health and Recove
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
4500 10th Ave SE
Lucilla Mendoza
Lacey, WA 98503 -
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E -MAIL
7
360 725 -3760 1 mendol2@dshs.wa.gov
COUNTY NAME COUNTY ADDRESS
Jefferson County 615 Sheridan St
Port Townsend, WA 98368 -
COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME
NUMBER
Julia Danskin
COUNTY CON'T'ACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E -MAIL
360 385 -9420 360 385 -9401 jdanskin@co.jefferson,wa.us
IS THE COUiNTY A MBRECIPIL"ENT FOR PURPOSE'S OF THIS PROGRAM CFDA NUMBERS
AGREEMENT? 93.959
No
AMENDMENT START DATE PROGRAM AGREEMENT END DATE
04/15/2015 06/30/2015
PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM PROGRAM AGREEMENT
AMOUNT AMOUNT
$141,599.00 $0.00 $141,599.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO
EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are
incorporated into this Program Agreement Amendment by reference;
Exhibits ecif
This
Th Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all
of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other
understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment
shall be deemed to exist or bind the parties.. All other terms and conditions of the original Program Agreement remain in
full force and effect. The parties signing below warrant that they have read and understand this Program Agreement
Amendment, and have authotit to enter into this Pro ran' Agreement Amendment.
COUNTY SIGNATURE(b) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
BHSIA Contracts
DSHS Central Contract Services
161 1C County Program Agreement Amendment (6 -12 -2014)
Approved as form only
cr n Co. Prow,, utoes Ulce Page 1
David Alvarez, Chief Civil DPA
This Program Agreement between the State of Washington Department of Social and Health Services (DSHS)
and the County is hereby amended as follows:
Delete Section 9, Treatment, Multiple Payments for the Same Claim /Duplication kk. (2) (c) iii as follows:
iii. With the exception of the CJTA, the County shall not reimburse providers for individual's co-
payment or deductible fees using any DBHR funding or SAPT Block grant funds. Effective April 1,
2015 for services starting April 1, 2015, CJTA may be used to reimburse providers' co- payments or
deductibles for individuals who meet the following:
(A) Are CJTA eligible under RCW 70.96A.350.
(B) Have an income level not less than 220% of the federal poverty level.
(C) Are not Medicaid eligible.
The County shall maintain documentation of CJTA co- payments and deductibles according to
guidelines developed by DBHR.
And replace with the following:
iii. The County shall not reimburse providers for individual's co- payment or deductible fees using any
DBHR funding or SAPT Block grant funds. Effective January 1, 2015 for services starting January
1, 2015, CJTA may be used to reimburse for treatment services for clients identified who cannot
afford to pay co- payments or deductibles, or for individuals without insurance who meet the
following:
(A) Are CJTA eligible under RCW 70.96A.350.
(B) Gross household monthly income does not exceed the monthly income determined by 220% of
the Federal Poverty Guidelines.
(C) Are not Medicaid eligible.
The County shall maintain documentation of CJTA co- payments and deductibles according to
guidelines developed by DBHR.
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services
1611 CS County Program Agreement Amendment (6 -12 -2014) Page 2
COUNTY PROGRAM AGREEMENT
Chemical Dependency Prevention Services
Alit
-fThs-�—rograrn—Agreement Is by all between the Mate of V asfii—ngtoll
—
oeparlirnent of Social and Health* services psi-1 ) and the County identified
below, and is issued. In pjunction with a County and DSH8 Agreement On
I conditions, which is-Inqor.po!q!,2d b reference.
y
General Terms all( SHS INDEX NUMSE,f
�ATIUM F—D-STFS DM$ION
A4nq and Illsability Services
NAME ANI
Harvey f-uhal
A,dglInIstcAtor
I —
DSH15 CONI'ACT TrLEP11C
20S" t'r0 1 E
x
COUNTY NAME,
Jefferson County
C(5-U—N7Y FERWI Lf�PL(
NUMBF.8
-Ri11'00137.2
C(�O� `CQ1WV—ACT TECEI
t f0 386.9,408 Cxt:
oj,A$tan of Behavioral Health and 1 1223
400. Mercer Street. 800 $00
PO E30X 1220
4=30(orsonSireel
CFDA
93,960
Number
1163-27310
Admlnistrauon or usvislon
Agreement Number
County Agreement Number
1611 cs;63
res PRO GRAM AGIRFE-V I'A C —NT EN6-6A-7 Ii =MAXImulivi PROGRAM AGREEMENT AlAOUN I S7 f14fda 01 $06,43UD
�ROGRAM A%�Mr-r-l"ENi
an X� I re incorporated Into lhi�
0112011 -------- a followin5 Exhibits are attached
wh–e�j the box bellow I larkedvYiPlah
�bunly Program AWeemeni0y reforeir,11'
Data security* n E*hlblts (Ver- Ify 1 1 �l, ii,id eWuslve-
Nio Exhibits. A:, F) 4 i 0
—teap-( are an Ititegration and rep Of the !Ili'
nicalilons, orat
The �Cer�sand conditions of this ( on
understanding beMeen the parties 6tjparpeqjng and merging all previous agreement$, writings, and commu
ing the stibjeol matter of, this Contract. 7he parties signing below represent that they have read and
or otherMse, reglafd contra This Contract shall be binding On DSIAS only
kinderstond,this,Con(ijet, and have Ole authority to execute thl� COnt
— IeN ---
1
65H5 CoAtial Contract tt se
161jr
,8 County pr6jram Agreement (7,9
Akat,"(), CVN(Lky
?-30 —II
ApproVed 49 0 form '0Ili y:
tJ Page I
jofrovaon co, l rrt eoutolm
DSHS Agreement Number
aygate
COUNTY PROGRAM AGREEMENT 1163 -27310
n`11A rut uan car
Chemical Dependency Prevention Services
This Program Agreement is by and between the State of Washington Administration or division
Department of Social and Health Services (DSHS) and the County identified Agreement Number
below, and is issued in conjunction with a County and DSHS Agreement On County Agreement Number
General Terms and Conditions., which is incorporated by reference.
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE
Aging and Disability Services Division of Behavioral Health and 1223 1611 CS -63
Administration Rcove
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Harvey Funai 400 Mercer Street, Suite 600
Administrator
Seattle, WA 98109 -4641
Sf °tS CONTACT°f ELE,PHONE DSHS CONTACT FAX FDSHS CONTACT E -MAIL
(206 ) 272- 2166, Ext: 205 298.4443 funaIhrn dshsMa 0v
COUNTY NAME COUNTY ADDRESS
Jefferson County PO Box 1220
1820 Jefferson Street
Port Townsend, WA 98368
COd�NTY r °EDERAL f °Mr't -DYER IDENTIFICATION COUNT 'Y CONTACT NAME
NUMBER
916001329 Jean Baldwin
COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNT °Y CONTACT E -MAIL
360 385- 9408Ext: 3061 385 -9401 1 `baddwin co.efferson.wa,us
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS
AGREEMENT?
93.959
Yes
PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
7/1/2011 6/30/2013 _ $65,430.00
EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this
County Program Agreement by reference:
❑ Data Security: ❑ Exhibits (specify):
® No Exhibits.
The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive
understanding between the parties superseding and merging all previous agreements, writings, and communications, oral
or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and
understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only
u on si nature b DSHS,
COUNTY SIG T'UI ) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED
�c�hYl
4Q-L V) 1 00 a
cai-o q11
vn Lis �,�x
DSHS S "NATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS Central Contract Services
161 ICS County Program Agreement (7- 21 -11)
Alp roved as to 'form onlyo
YN 42",qj?_0 1 l
f ,tom° �t Page 1
TABLE OF CONTENTS
1. Definitions ................................................................................................................... ..............................3
2. Applicable Law . ................................................................................. .... ..... ......... ............ .,, ... ................ ...
3
3. Purpose ................................................................... .............................., ..,.,,,, ,,....5
4. Statement of Work ..................................................................................................... ...............................
5
a.
Background Checks (RCW 43.43, WAC 388 - 805 -200) ................ .. ....... ......... ........ .......................... ....5
b.
Six -year Strategic Plan Progress Report ................................................................... ..............................5
C.
Prevention Services (42 USC 300x -28(c) and 45 CFR 96.132(c)) ... ...... ........... _ _ ..... - .......... ,,.,.,........
5
5. Subcontract Language .............................................................................................. .............................10
a.
Subcontract Content . ........................................................................ ___ ... ___ ....... .. .............. .,......,10
b.
Subcontract Inspection ......................................................................................... ...............................
11
C.
DSHS reserves the right to inspect any subcontract document ...................................... - ............... ,.,..
11
6. Subcontractor Monitoring ................................................................. ............................... __ ............
11
a.
On -Site Monitoring: ........................................................................ ..........
11
b.
PBPS Monitoring ......................................................... ...................a.......,... .,.....,. ,..,..,,.....,.... ..,......
11
C.
Additional Monitoring Activities ............................................................................... ...............................
11
7. Consideration: .................................................................................. ......
a.
Source of Funds: ........................................................................................................ __ ...... .............
11
b.
Reimbursable Costs ............................................................................................... ....... ........................_
12
C.
Expenses ............................................................................................................ .......__...........- ........12
d.
Funding Allocation ................................................................................................ ...............................
12
e.
Training ................................................................................................................. ...............................
12
f.
Administrative Cost Limitations ................................................................................ .............................12
g.
Period of Performance Service Costs ...................................................................... .............................12
h.
Contractor Participation Match Requirement: .............................................................................
12
.
Prevention State Grant -in -Aid Match ....................................................................... .............................12
j.
Award Adjustment Request ..................................................................................... .............................13
8.
Billing and Payment .................................................................................................. .............................13
a.
Invoice System ........................................................................................................ .............................13
b.
Billing for CSAP ...................................................................................................... .............................13
c.
Timely Payment ...................................................................................................... .............................13
d.
DSHS Obligation for Payment ................................................................................. .............................14
e.
Duplication .......................................................................................................... .............................__
14
f.
Claims for Payment ................................................................................................. .............................14
g.
Billing Limitation ...................................................................................................... .............................14
h.
Non - Compliance ...................................................................................................... ....................u..,..,,.14
9.
Advance Payment and Billing Limitations ............................................................. ...............................
14
a.
Advance Payment ................................................................................................... .............................14
b.
Authorized Services .............................................................................................. ...............................
15
c.
Timely Billing ........................................................................................................... .............................15
d.
Multiple Payments for the Same Claim ................................................................. ...............................
15
10.
DATA Security Requirements . .............................................................................. . ............ .......... ......
15
a.
Data Protection ....................................................................................................... .............................15
b.
Data Disposition ...................................................................................................... ........r................,,,.15
11.
Federal Block Grant Funding Requirements ....................................................... .............................15
a.
Charitable Choice (42 USC 300x -65 (see 54.8(b) and 54. 8( c)( 4)) ........................... .............................15
b.
Continuing Education (42 USC 300x -28(b) and 45 CFR, 96.132 ( b)) ....... ............................... ............
16
C.
Notice of Federal Block Grant Funding Requirement ............................................. ...............................
16
12.
Other Requirements . ............................................................................................ .............. ........... __
16
a.
Collaboration with other Systems (42 USC 300x -28 (c) and 45 CFR 96.132 (c)) ...,.... .......................
16
b.
Services and Activities to Ethnic Minorities and Diverse Populations ...................... .............................16
13.
Audit Requirements ............................................................................................... .............................17
DSHS Central Contract Services
1611CS County Program Agreement (7- 21 -11) Page 2
Definitions.
a. "ADSA" means the Aging and Disability Services Administration or its successor.
b. "BARS" means the Washington State Auditor's Office Budgeting, Accounting, and Reporting
System which includes the DSHS HRSA -DASA Supplementary Instructions and Fiscal Policy
Standards for Reimbursable Costs as used by DBHR.
c. "Behavioral Health Administrator (BHA)" means the new functional title replacing the title Regional
Administrator for the DSHS contact identified on page one of the Contract.
d. "Boilerplate Language" means the standard contract language, including General and Special
terms, which will be common to all subcontracts issued by the Contractor for provision of the
services required by this Contract.
e. "Chemical Dependency" means an alcohol or drug addiction, or dependence on alcohol and one or
more other psychoactive chemicals.
f. "Contractor Coordinator" means the person designated by the legislative authority of a Contractor
to carry out administrative and oversight responsibilities of the Contractor chemical dependency
and prevention programs.
g. "Data" means information that is disclosed or exchanged as described by this Contract.
h. "DBHR" means the Division of Behavioral Health and Recovery or its successor.
i. "Ensure" as to this Agreement means to make sure that something will happen or will be available
within the resources identified in Consideration.
j. "Prevention Activity Data" means information input to PBPS to record all active prevention services
including outcome measures. This information will be used to verify services identified in A -19
invoices prior to payment and must be entered into PBPS by the close of business on the fifteenth
(15th) of each month for prevention activities provided during the previous month.
k. "Treatment Provider Worksheet" or "TPW" means the listing of the DSHS - certified agencies who
are subcontractors of the Contractor. The TPW identifies the type of service provided by each
subcontractor.
I. "Waiting List" means a list of persons for whom a date for service has not been scheduled due to a
lack of capacity. A person will be selected from the list to fill an opening based on the required
order of precedence identified in the Contract.
Applicable Law.
This Contract contains links to both DSHS and Federal websites to provide references, information and
forms for your use. Links may break or become inactive if a website is reorganized; DSHS is not
responsible for links that do not respond as expected.
These legal resources identified below are incorporated by reference and include but are not limited to
the following:
DSHS Central Contract Services
1611CS County Program Agreement (7- 21 -11) Page 3
a. 21 CFR Food and Drugs
Chapter 1, Subchapter C, Drugs: General
http: / /ecfr gpoaccess govlcgi/t/text/text-
idx? sid= e05a 5d3b5c9521fa83bb6cf863ec 42d &c= ecfr& t)l= /ecfrbrowse/Title21 /21cfrv4 02 t l
b. 42 CFR Subchapter A-- General Provisions
Part 2 Confidentiality of Alcohol and Drug Abuse Patient Records
htt ): / /ecfl oaccess, ov /c i /t /text/text-- idx ?c= ecfr &t l= /ecfrbrowselTitle42 /'42cfr2 main 02.t l
Part 8 Certification of Opioid Treatment Programs
http:// www. access.gpo.gov /nara /cfr /waisidx 08/42cfr8 08.html
c. 45 CFR Public Welfare, Part 96 Block Grants, Subpart L Substance Abuse Prevention and
Treatment Block Grant
htt : /leofr. oaccess. ov /o i /t/text /text..
idx? c= ecfr& sid= cf563f82becd9d1bdf1f59a5d478a12 &r n =div5 view = text &node= 45:1.01.1.54&id
no =45#4 5:1.0.1.1.54.12
d. Office of Management and Budget (OMB) links regarding federally required audit requirements A-
87, A -122, A -133
http: / /www.whitehouse.gov /omb /circulars default/ (scroll just over halfway down the page)
e. Washington Administrative Code, Department of Social and Health Services (WAC) Chemical
Dependency assistance programs 388 -800, Certification Requirements 388 -805, WorkFirst 388-
310
http://apps.leg.wa.gov/wac/default.asp ?cite=388
Washington Administrative Code, Department of Early Learning 170.295, 170.296
http: / /apps.leg.wa .qov /wac /default,aspx ?cite =170
f. Revised Code of Washington (RCW)
Counselors 18.19, CDP's 18.205, Regulation of Health Professions18.130, Abuse of Children
26.44, Public Officers and Agencies 42, State Government (Executive) 43, Rules of the Road
46.61, Uniform Controlled Substances Act 69.50, Treatment for alcoholism, intoxication, and drug
addiction 70.96A, Involuntary Commitment 70.96A.140, Developmental Disabilities 71.A, Abuse of
Vulnerable Adults 74.34, Alcoholism and drug addiction treatment and support 74.50
http: / /apps.leg.wa.gov /rcw/
g. Budgeting, Accounting and Reporting System (BARS) including the DASA BARS Supplement
http://www.sao.wa,gov/EN/ Audits /LocalGovernment/BarsManuals /Documents /2-
dshsalcohol2011.pdf
h. Specific references may be found in individual contract sections.
DSHS Central Contract Services
1611CS County Program Agreement (7- 21 -11) Page 4
3. Purpose.
The purpose of this Contract is for the Contractor to provide chemical dependency prevention, as part
of the P -I -T -A continuum. These services and activities are identified and defined in RCW 70.96A and
'VAC 388 -805.
4. Statement of Work.
The Contractor shall provide the services and staff, and otherwise do all things necessary for or
incidental to the performance of work, as set forth below:
a. Background Checks (RCW 43.43, WAC 388 - 805 -200)
(1) The Contractor shall ensure a criminal background check is conducted for all staff members;
subcontractors, such as treatment staff members, prevention staff members, case managers,
outreach staff members, etc.; or volunteers who have unsupervised access to children,
adolescents, vulnerable adults, and persons who have developmental disabilities.
(2) Background checks shall be done
(a) At the time of the initial employment decisions. (RCW 43.43.834(5)).
(b) When an employer knows or has reason to believe that a disqualifying conviction or finding
occurred after completion of the most recent background check. (RCW 43.43.832(8)(d)).
b. Six -year Strategic Plan Progress Report
The Contractor shall:
(1) Review, update, and report progress made on the 2007 — 2013 Strategic Plan submitted to
DSHS prior to July 1, 2007.
(2) Use both the previously published Strategic Plan Guidelines and the Addendum to the
guidelines when preparing the progress report.
The previously published guidelines and the Addendum to the guidelines can be accessed on
the Provider page of the DSHS website at http: / /www.dshs.wa.gov /DBHR /.
(3) Submit the Progress Report for the 2007 — 2013 Strategic Plan to the appropriate BHA by
September 30, 2012.
c. Prevention Services (42 USC 300x -28(c) and 45 CFR 96.132(c))
For the period July 1, 2011 through June 30, 2013, the County shall use prevention funds to
coordinate and implement prevention programs designed to prevent or delay the misuse and abuse
of alcohol, tobacco, and other drugs. Prevention programs and services include, but are not limited
to:
(1) Coordination of Prevention Services
The County shall ensure:
(a) Subcontractor monitoring, using a DSHS- approved protocol, including annual on -site
reviews of programs that directly serve children and /or families.
(b) News media notifications, as appropriate, when subcontractors are awarded DSHS funds;
DSHS Central Contract Services
1611 CS County Program Agreement (7- 21 -11) Page 5
the County is encouraged to develop articles on their prevention programs and
acknowledge DSHS as the funding source. The funding source shall be cited as:
Washington State Department of Social and Health Services — Behavioral Health and
Recovery.
(2) Community Coordination
(a) Services shall reflect work of the primary prevention staff coordinating, organizing, building
capacity, providing education and information related to prevention initiatives in the
community.
(b) Services shall be tied to priorities, goals, and objectives as described in their (6 -year)
Strategic Plan.
(3) Prevention Programs
The Contractor shall choose which programs to implement based on their priorities, goals, and
objectives as described in their (6 -year) Strategic Plan and enter them into PBPS by July 31,
2011. The County shall:
(a) Ensure sixty percent (unless otherwise negotiated with DBHR) of programs supported by
DSHS funds will be replication or adaptation of "Evidence -based Practices" substance
abuse prevention programs as identified in PBPS.
(b) Ensure all of the programs supported by DSHS will meet the Center for Substance Abuse
Prevention's (CSAP) Principles of Effective Substance Abuse Prevention, which can be
found in the PBPS.
(4) Prevention Programs with Special Funding Requirements
Counties participating in the Prevention Redesign Initiative (PRI), Cohort 1 beginning July 1,
2001 and Cohort 2 beginning and Cohort 2 beginning July 1, 2012.
The Contractor shall:.
(a) Provide PRI services in accordance with the Key Objectives found on the Athena Forum
Website, www.theathenaforum.org which outlines the minimal standards to participate in
Cohort 1 of the PRI.
i. Implement the Key Objectives according to the Prevention Redesign Initiative Task
Categories document accessible at: www,theathenaforum.or ,
ii. Permit the Community Coordinator associated with the PRI Cohort 1 and 2 to have
direct communication with the DBHR designated Prevention System Manager.
iii. Submit information pertaining to progress on the Task Categories as requested by
DBHR.
iv. Report monthly prevention services and activities in accordance with the requirements
and timelines to be negotiated with the DSHS Contact identified on page 1 of the
Contract.
v. Implement evaluation in accordance with the DBHR statewide PRI evaluation plan.
(b) Community Prevention Training System — Special Funding Requirements
DSHS Central Contract Services
1611CS County Program Agreement (7- 21 -11) Page 6
The Contractor receiving prevention training funds allocation based on its current "Counties
Like Us" classifications in the Risk and Prevention Profile for Substance Abuse Prevention
identified on the SRP for the Community Prevention Training System (CPTS) shall:
Ensure the CPTS training allocation is used solely for training opportunities that will
increase contractor capacity to implement science -based substance abuse prevention
programming as negotiated with their BHA.
ii. Ensure the training allocation is used to support the contractor's stated goals and
objectives as identified in their needs assessment process.
iii. Ensure prevention services subcontractors are effectively trained to implement the
programs they agree to provide.
iv. Ensure the training allocation is used to support training of staff or subcontractors in
Best Practices or Promising Approaches (evidence -based programs) or practices, or to
increase capacity to implement Best Practices or Promising Approaches (evidence -
based programs). "Increasing capacity" means activities like grant writing training,
board training, and community organizing or volunteer recruitment training.
v. Collaborate with other Counties whenever possible in the planning of local or regional
training events.
vi. Report training events in the DSHS Performance Based Prevention System in
accordance with the requirements and timelines to be negotiated with the DSHS Contact
identified on page 1 of the Contract.
vii. Ensure training funds are not used to support employee wages or benefits, or program
implementation.
viii. Ensure training that requires travel follows state travel reimbursement guidelines
accessible at: http:,//www.ofm.wa.gov/policy/10,90.htm,
(5) Prevention Reporting
(a) Prevention Reporting Requirements
The Contractor shall:
i, Implement and monitor prevention programs and reporting to assure compliance with
these guidelines.
ii. Develop and submit a protocol for monitoring subcontractors.
iii. Conduct an on -site visit of prevention subcontractors.
(b) Prevention Activity Data Reports — See Section 5 (d), Prevention Report Schedule / Due
Dates, below for schedule and reporting due dates.
The Contractor shall:
i. Ensure that monthly prevention activities are reported in the DSHS PBPS in accordance
with the requirements and timelines set forth below.
ii. Ensure demographic information is provided for each participant in single events,
mentoring, environmental and recurring programs.
DSHS Central Contract Services
1611CS County Program Agreement (7- 21 -11) Page 7
iii. Ensure any requests for extensions to reporting deadlines or exceptions to reporting are
requested in writing and sent directly to the Prevention System Manager with sufficient
time before the report due date so the Prevention System Manager approves the
extension or exception request before the date the report is due.
iv. Provide Community Coordination Reports on its efforts in the PBPS for each month of
the calendar year.
(c) Outcome Measures
i. The Contractor shall report on all Assigned Program Measures identified in the PBPS.
ii. Special situations and exceptions regarding Assigned Program Measures identified in
the PBPS include, but are not limited to, the following:
(A) The Contractor may negotiate with the Prevention System Manager to reduce
multiple administrations of surveys to individual participants.
(B) Participants in recurring program groups in which the majority of participants are
younger than 10 years old on the date of that group's first service.
(C) Recurring programs that spend less than $1,000 of DSHS prevention funds.
(D) Programs that only provide single service events.
(E) Community Coordination services.
(F) Environmental /Media services.
(d) Prevention Report Schedule / Due Dates
REPORTING
REPORT(s)
Report Due Dates
Reporting
PERIOD
_
System .._.
..._.... _._.....
One —time
. ..�_.��.��__,�.��...�......�.
Programs approved by DBHR for
..._.. —y 31 ..... 2011... _.....—
Jul
..�...._— _._._....._.
Biennium ending Jul 31, 2013
,
PBPS
Reports
— measures
As requested
Prevention activity data input for
15 �' of each month
Monthly
all active services including
for activities from
PBPS
outcome measures _
the previous month
Community Coordination Reports
of each month
Monthly
Trainln g Activity Repo
for activities from
PBPS
the previous month
15 ' of each month
Monthly
Community Prevention Training
for trainings from the
PBPS
System
revious month
Extension
Approved in writing
�_....__.
Request
Any report
by the RPM prior to
RPM
the re ort due date
(6) Performance Work Statement / Evaluation
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161 1C County Program Agreement (7- 21 -11) Page 8
(a) The Contractor shall ensure program results show positive outcomes for at least half of the
participants in each program group.
i. Positive outcomes means that at least half of the participants in a group report change
between pre and post test consistent with the positive outcome goal.
ii. Positive outcomes will be determined using the pre -test and post -test data reported in
the Performance Based Prevention System (PBPS).
iii. Survey results will be compared against the stated outcome for the program.
iv. Evaluation of PBPS data will occur on the 15th of the month following the final date of
service for each group.
(b) DSHS shall use the following protocol for evaluation:
i. Matched pre -test and post -test pairs will be used in the analysis.
ii. To allow for normal attendance drop -off, a 20% leeway will be given for missing post-
tests:
(A) If there are missing post -tests for entered pre -tests in excess of 20% of pre- tests,
missing post -test will be counted as a negative outcome.
(B) Example: there are 10 pre -tests and 7 post- tests. The denominator would be 8 and
the maximum numerator would be 7.
(c) Different groups receiving the same program will be clustered by school district.
i. In cases where multiple providers are serving the same school district, groups will be
clustered by school district and provider.
ii. The results of one provider in a given school district will not impact another provider in
the same district.
(d) In cases where the survey instrument selected for a given program includes more than one
scale, the scale that is most closely aligned with the outcome linked to the program in PBPS
will be used.
(e) Results for groups with services that span two contracting periods will be analyzed in the
contracting period that the post -test was administered.
(7) If fewer than half of the participants in a group, within a given school district, report positive
change in the intended outcome:
(a) The Contractor shall submit a Performance Improvement Plan (PIP) for the non - compliance
program to the DSHS manager within 45 days of notice by DSHS.
(b) Reimbursement for the CSAP Category row on the A19 for that program will be held until
the PIP is approved by the DSHS manager.
(c) If a second group within that same school district has fewer than half of the participants
report positive change in the intended outcome, then the following steps will be taken.
i. In cases where there is no active non - compliant program, the County shall discontinue
implementation of that program within the specified geography.
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1611 CS County Program Agreement (7- 21 -11) Page 9
ii. In cases where the same programs as the non - compliant program are active and
continuing in the same school district, those groups will be allowed to complete the
expected number of sessions. No new groups will be started.
iii. Following the conclusion of all groups completing the program, results will be reviewed
for those groups.
iv. If the results do not show positive change for each group, the County shall take the
following action:
(A) In cases where the program is being delivered by a single provider in the specified
geography, the County shall discontinue implementation of that program in the
specified geography.
(B) In cases where the program is being delivered by multiple providers in the specified
geography, the County shall discontinue implementation of that program by the
underperforming provider in the specified geography.
5. Subcontract Language.
a. Subcontract Content.
(1) The Contractor shall include in its boilerplate language all requirements and conditions in this
Contract that the Contractor is required to meet when providing services to patients, clients, or
persons seeking assistance, which include but are notlimited to:
I 1
(a) Identification of funding sources (see Section +4 - c. Federal Block Grant Funding
Requirements below).
(b) That subcontracts shall be cost related as defined in BARS.
(c) That termination of a subcontract shall not be grounds for a fair hearing for the service
applicant or a grievance for the recipient if similar services are immediately available in the
County.
(d) What actions the Contractor will take in the event of a termination of a subcontractor to
ensure all prevention data on services provided have been entered into the PBPS.
(e) Audit requirements - OMB Circular A -133 audit requirements if applicable to the
subcontractor
(f) Authorizing facility inspection
(g) Background Checks
(h) Conflict of interest
(i) Debarment and suspension certification
Q) Indemnification
(k) Nondiscrimination in employment
(1) Nondiscrimination in prevention activities
(m) Performance Based Contracts
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1611 CS County Program Agreement (7- 21 -11) Page 10
(n) Providing data
(o) Records and reports
(p) Requirements outlined in the Data Sharing provision in the Contract
(q) Services provided in accordance with law and rule and regulation
(r) PBPS data input and reconciliation
(s) Unallowable use of federal funds
b. Subcontract Inspection
c. DSHS reserves the right to inspect any subcontract document.
Subcontractor Monitoring.
a. On -Site Monitoring:
The Contractor shall
(1) Conduct a subcontractor review which shall include at least one on -site visit during the
biennium Contract period to each subcontractor site providing treatment services during the
period of performance of this Contract in order to monitor compliance with subcontract
performance criteria for the purpose of documenting that the subcontractors are fulfilling the
requirements of the subcontract.
(2) Include written documentation of each on -site visit in the annual report on the "Subcontractor
On -site Form." A copy of the full report shall be kept on file by the Contractor.
b. PBPS Monitoring
The contractor shall ensure that subcontractors have entered services funded under this Contract
in the PBPS.
c. Additional Monitoring Activities
The Contractor shall maintain records of additional monitoring activities in the Contractor's
subcontractor file and make them available to DSHS upon request including any audit and any
independent documentation.
7.. Consideration:
Total consideration payable to Contractor for satisfactory performance of the work under this Contract
is up to a maximum of $65,430, including any and all expenses, and shall be based on the following:
a. Source of Funds:
(1) The source of funds is the federal Substance Abuse Prevention and Treatment (SAPT) Block
Grant. The Catalog of Federal Domestic Assistance number is 93.959.
(2) Funds designated solely for a specific state fiscal year in this Contract may be obligated only for
work performed in the designated fiscal year as follows:
(a) $30,215 for the first fiscal year: July 1, 2011 through June 30, 2012
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161 1C County Program Agreement (7- 21 -11) Page 11
(b) $30,215 for the first fiscal year: July 1, 2012 through June 30, 2013:
b. Reimbursable Costs
The Contractor shall ensure all expenditures for services and activities under this Contract are:
(1) Expended for allowable costs, which are in accordance with the BARS DASA Supplement.
(2) Submitted on the A -19 invoice appropriate for PBPS entry.
c. Expenses
The Contractor shall receive reimbursement for travel, training and other expenses as identified
below or as authorized in advance by DSHS as reimbursable. The maximum amount to be paid to
the Contractor for such expenses shall not exceed $5,000, and such amount is included in the
contract Maximum Agreement Amount. Such expenses may include: airfare (economy or coach
class only), other transportation expenses, training fees, lodging and subsistence necessary during
periods of required travel. The Contractor shall receive compensation for travel expenses at
current State of Washington travel reimbursement rates.
d. Funding Allocation
The Contractor shall manage the contract to ensure that services are provided in a manner that
allocates the available resources over the life of the contract.
e. Training
Funds for Community Prevention Training activities shall not exceed $5,000 with $2500 allocated
for each fiscal year.
f. Administrative Cost Limitations
Contract funds shall not be used for administrative costs.
g. Period of Performance Service Costs
The Contractor shall ensure that service costs incurred are within the period of performance of this
Contract.
h. Contractor Participation Match Requirement:
The Contractor shall provide Contractor participation match, to share in the cost of services under
this Contract, in accordance with the following requirements:
(1) The Contractor shall provide a ten percent participation match for SAPT Prevention funds. The
formula for this match is the total SAPT award divided by 0.9 times 0.1. Using this formula, the
match requirement for $100,000 would be $11,111.
(2) Local Cost Sharing Agreement: The Contractor shall submit a completed Local Cost Sharing
Agreement, along with the June monthly A19 Invoice Voucher, to their BHA annually.
i. Prevention State Grant -in -Aid Match
To utilize State Grant -In -Aid funds for Prevention Services administration the County must:
(1) Pass a local sales tax in accordance with Senate Bill 5763, or secure local funds through other
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1611CS County Program Agreement (7- 21 -11) Page 12
private or public entities.
(2) Provide a hard dollar match, used for prevention services, equal to or exceeding the amount
billed to "State Grant -In -Aid" funds for prevention administration.
(3) Submit a letter of request to the DBHR BHA identifying the:
(a) Amount of prevention administration funding requested, up to 8% of the total prevention
allocation
(b) Date the local sales tax was adopted, if applicable.
(c) Amount and source of hard dollar match funds
(d) Description of prevention services to be implemented with match funds
(e) Proposed start date of the prevention administration (30 days advance notice required)
(f) Enter all services purchased through match funds into the DBHR Performance -Based
Prevention System (PBPS) upon approval of the prevention administration request.
(4) The DBHR BHA will reply, in writing, to the prevention administration request within 30 days of
receipt of the request.
j. Award Adjustment Request
With regard to all prevention services:
(1) DSHS reserves the right to reduce the Prevention funds awarded in this Contract if the
Contractor fails to provide the Prevention services /activities as stated in the Performance Based
Prevention System (PBPS).
(2) If DSHS decides to exercise the right to reduce prevention funds, DSHS will provide written
notification 30 days prior to the reduction. The notice will specify the reason for the reduction,
the amount to be reduced, and the effective date of the reduction.
8. Billing and Payment.
a. Invoice System
The Contractor shall submit invoices using State Form A -19 Invoice Voucher, or such other form as
designated by DSHS. Consideration for services rendered shall be payable upon receipt of properly
completed invoices which shall be submitted to the DSHS Contact Person stated on page one (1)
of this contract, by the Contractor, not more often than monthly. The invoices shall describe and
document to DSHS' satisfaction a description of the work performed, activities accomplished, the
progress of the project, and fees. The rates shall be in accordance with those set forth in Section
7, Consideration, of this Contract.
b. Billing for CSAP
The Contractor shall ensure expenditures for each of the six CSAP strategies are reported monthly
as part of the A -19 invoice.
c. Timely Payment
Payment shall be considered timely if made by DSHS within thirty (30) days after receipt and
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1611 CS County Program Agreement (7- 21 -11) Page 13
acceptance by the DSHS Contact Person of the properly completed invoices. Payment shall be
sent to the address designated by the Contractor on page one (1) of this Contract. DSHS may, at
its sole discretion, withhold payment claimed by the Contractor for services rendered if Contractor
fails to satisfactorily comply with any term or condition of this Contract.
d. DSHS Obligation for Payment
(1) DSHS shall not be obligated to reimburse the Contractor for any services or activities,
performed prior to having a fully executed copy of this Contract.
(2) DSHS shall pay to the Contractor all unduplicated (see e. below) reimbursable costs, insofar as
those reimbursable costs do not exceed the Contract Maximum and are in accordance with the
Standards for Reimbursable Costs as defined in the DBHR /ASA BARS Manual located at
incorporated herein by this reference and located at:
http://www.sao.wa.gov/EN/ Audits /LocalGovernment/BarsManuals /Documents /2-
dshsalcoho12011.pdf
e. Duplication
The Contractor assures that work performed and invoiced does not duplicate work to be charged to
the State of Washington under any other contract or agreement with the Contractor.
f. Claims for Payment
The Contractor shall:
(1) The Contractor shall submit by invoices for costs due and payable under this agreement that
were incurred prior to the expiration date within 90 days of the date services were provided.
(2) The Contractor shall submit final billing for services provided during each fiscal year within 90
days after the end of that fiscal year.
g. Billing Limitation
Unless otherwise specified in this Contract, DSHS shall not pay any claims for payment for services
submitted more than twelve (12) months after the calendar month in which the services were
performed.
h. Non - Compliance
(1) Failure to Maintain Reporting Requirements:
In the event the Contractor or a subcontractor fails to maintain its reporting obligations under
this Contract, DSHS reserves the right to withhold reimbursements to the Contractor until the
obligations are met.
(2) Recovery of Costs Claimed in Error:
If the Contractor claims and DSHS reimburses for expenditures under this Contract which
DSHS later finds were (1) claimed in error or (2) not allowable costs under the terms of the
Contract, DSHS shall recover those costs and the Contractor shall fully cooperate with the
recovery.
9. Advance Payment and Billing Limitations.
a. Advance Payment
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161 1C County Program Agreement (7- 21 -11)
Page 14
DSHS shall not make any payments in advance or in anticipation of the delivery of services to be
provided pursuant to this Contract.
b. Authorized Services
DSHS shall pay the Contractor only for authorized services provided in accordance with this
Contract. If this Contract is terminated for any reason, DSHS shall pay only for services authorized
and provided through the date of termination.
c. Timely Billing
DSHS shall not pay any claims for payment for services submitted more than ninety (90) days after
the calendar month in which the services were performed, unless otherwise specified in this
Contract.
d. Multiple Payments for the Same Claim
The Contractor shall not bill DSHS for services performed under this Contract, and DSHS shall not
pay the Contractor, if the Contractor has charged or will charge the State of Washington or any
other party under any other contract or agreement for the same services.
10. DATA Security Requirements.
a. Data Protection
The Contractor shall ensure that the subcontractor takes due care to protect said data from
unauthorized physical and electronic access.
b. Data Disposition
The data provided to DSHS shall be maintained in a secure fashion until such time as the
Department determines that it should be destroyed.
11. Federal Block Grant Funding Requirements.
The Contractor shall comply with the following:
a. Charitable Choice (42 USC 300x -65 (see 54.8(b) and 54.8(c)(4))
(1) The Contractor shall ensure that Charitable Choice Requirements of 42 CFR Part 54 are
followed and that Faith -Based Organizations (FBO) are provided opportunities to compete with
traditional alcohol /drug abuse prevention and treatment providers for funding.
(2) If the Contractor subcontracts with FBOs, the Contractor shall require the FBO to meet the
requirements of 42 CFR Part 54 as follows:
(a) Applicants /recipients for /of services shall be provided with a choice of prevention and
treatment providers.
(b) The FBO shall facilitate a referral to an alternative provider within a reasonable time frame
when requested by the recipient of services.
(c) The FBO shall report to the Contractor all referrals made to alternative providers.
(d) The FBO shall provide recipients with a notice of their rights.
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(e) The FBO provides recipients with a summary of services that includes any inherently
religious activities.
(f) Funds received from the federal block grant must be segregated in a manner consistent
with Federal regulations.
(g) No funds may be expended for religious activities.
(3) If the Contractor subcontracts with FBOs, the Contractor shall supply in their State annual
reports the number of referrals made to alternative providers by FBOs.
(4) DSHS shall notify the Contractor if a treatment agency identifies itself as an FBO.
b. Continuing Education (42 USC 300x -28(b) and 45 CFR 96.132 (b))
The Contractor shall ensure that continuing education is provided for employees of any entity
providing treatment services or prevention activities.
c. Notice of Federal Block Grant Funding Requirement
The Contractor shall:
(1) Notify subcontractors in writing of the federal funds, when federal block grant funds are
allocated by the Contractor to subcontractors for the delivery of services and activities under
this Contract.
(2) Ensure all subcontractors comply with all conditions and requirements for use of federal block
grant funds within any subcontracts or other agreements. (OMB A -133)
12. Other Requirements.
a. Collaboration with other Systems (42 USC 300x -28 (c) and 45 CFR 96.132 (c))
The Contractor shall take the initiative to work with other systems to reduce fragmentation or
duplication and to strengthen working relationships by addressing at least one substance abuse
system issue or a collaborative effort mutually identified by the Contractor and a respective system
regarding Prevention issues or efforts, examples of such systems are education, juvenile justice,
and other publicly- funded entities promoting substance abuse prevention
b. Services and Activities to Ethnic Minorities and Diverse Populations
The Contractor shall:
(1) Ensure all services and activities provided by the Contractor or subcontractor under this
Contract shall be designed and delivered in a manner sensitive to the needs of all ethnic
minorities.
(2) Initiate actions to ensure or improve access, retention, and cultural relevance of treatment,
prevention or other appropriate services, for ethnic minorities and other diverse populations in
need of treatment and prevention services as identified in their needs assessment.
(3) Take the initiative to strengthen working relationships with other agencies serving these
populations. The Contractor shall require its subcontractors to adhere to these requirements.
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1611 CS County Program Agreement (7- 21 -11) Page 16
(4) Report in narrative form, in their State annual report, the actions taken with the identified
populations and its relationships with other agencies, The Contractor shall also describe the
activities undertaken and the success of their actions.
13. Audit Requirements
If the Contractor is not subject to an OMB Circular A -133 audit, the Contractor shall provide to the
DSHS Contact a CPA audit or CPA review within 180 days of the subcontractor's fiscal year end. The
scope of the audit or review shall include the entire operation and related legal entity, be in accordance
with Generally Accepted Accounting Principles (GAAP), and include a management letter that
addresses any audit findings.
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