HomeMy WebLinkAboutJefferson Mental Health - School Based Health Clinics - 020116or -19 CONTRACT AMENDMENT #1
, IIto For Professional Services
Between
Jefferson County
And
Jefferson Mental Health Services
For School Based Health Clinics
WHEREAS, Jefferson Mental Health (Contractor) and Jefferson County (County) entered into
an agreement on January 1, 2015 for Professional Services in connection with mental health
services in the school districts of Chimacum, Port Townsend, and Quilcene for Jefferson County,
Washington.
WHEREAS, the parties desire to amend 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, 2016.
2. Jefferson Mental Health will continue to provide enhanced mental health intervention and
treatment services in the schools for children or youth grades 1-12 who identify with
mental health issues as stated in Exhibit A, Statement of Work, Exhibit B, Fee
Schedule and Attachment A, Match Policy in order to increase Jefferson Mental
Health's ability to quickly address the mental health needs of participants within School
based Health Clinics.
3. This amendment adds $59,736 in funding, to be used specifically for case management
services and incentives directly related to the positive progress of program participants.
4. This contract shall not exceed $119,472 without express written amendment signed by
both parties.
5. All other terms and conditions of the agreement will remain the same.
Dated this day of, Z,_04CGi,i , 2016.
By:i
Kathleen Kler, Chair
Jefferson Board of County Commissioners
M.
roved as to rm only
Prosecutors O ce
Jefferson Co. ADavid Alvarez, Chief Civil
EXHIBIT A
Scope of Work
RESPONSIBILITIES:
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.
E. The names of licensed therapists working in each school will be given to the JCPH.
JCPH and the schools will be notified of any staff changes in writing, (before they
occur).
F. County must be notified of any extended leave of absence for Counselors.
G. Youth and their families along with the SBC will be notified if a Counselor is out sick
and unable to make an appointment.
H. 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.
I. Copies of background checks & Counselor resumes must be sent to JCPH.
J. Provide crisis interventions and emergency response services.
K. Provide on-going individual therapy as needed to all youth. Services are not dependent
on Medicaid eligibility.
L. Run groups as appropriate.
M. Provide Counselors with the ability to make long distance phone calls from the schools.
N. 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.
O. Parents or guardians of children or youth may be contacted as necessary following
HIPPA laws.
P. Assist school staff in identifying and developing strategies to assist students with mental
health issues.
Q. Work with social services or other agencies as needed for dually served children or youth
with mental health or chemical dependency issues.
R. Provide clinical and supervisory oversight for the therapist providing services in this
program.
S. JMH Supervisor must attend regularly scheduled Clinician meetings and quarterly
Advisory meetings.
T. Maintain a secure and confidential records system guaranteeing HIPPA.
U. Bill all revenue sources for services where appropriate.
V. Yearly report on client (students and families), utilization, referrals, outcomes.
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 MPHs 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.
G. If available, provide access to the Internet.
Exhibit B
Fee Schedule
Mental Health Therapist ranging from @ $21.42/hour to $27.17/hour
Clinical Supervision @ $55.59/hour
Project Management @ $61.82/hour
Administrative Support for scheduling, billing and bookkeeping ranging from $22.97/hour to
$52.73/hour
Indirect Rate @ 8.3%
Not to exceed $119.472 in completion of services for the duration of this signed contract
amendment.
ATTACHMENT A
JEFFERSON COUNTY MH/SA TREATMENT TAX FUNDING -
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/ 1 Oth of I% 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/SA) 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/SA 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.
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/SA 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/SA sales tax monies as
match.
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 AGREEMENT is made and entered into to provide services in the school districts of
Chimacum, Port Townsend, and Quilcene 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 4-12
who identify with mental health issues. JMH hours will be distributed as 1 day a week in
Quilcene SD, 3 days a week in Port Townsend SD, and 3 days a week in Chimacum SD. 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, 2015 and continue through December 31, 2015,
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 Health
(JCPH) staff and attend SBHC trainings. (Quilcene SD and Blue Heron students do not have
SBHC access.)
The JMHS Child and Family Therapist shall provide:
The development of goals and objectives for the school year to the SBHC
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 concerns 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 SBHC team of health
and school professionals.
• Effective and efficient clinical services using best practice standards.'
• All necessary clinical and administrative records for the SBHC.
• Data collection on number and types of services provided for the SBHC to the
SBHC Advisory Committee.
• Report of activities and services provided, should be submitted to the JCPH
Contract Representative.
Jefferson Mental Health Services — SBHC 2015
A. Contract Representatives:
JCPH and JMHS 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 -,vritten notice to the other party. The parties' representatives are as follows:
Contractor's Contract Representative
Adam Marquis, Executive Director
Jefferson Mental Health
PO Box 565
Port Townsend, WA 98368
(360) 385-0321
JCPH Contract Representative
Anna Mc Enery, DD Coordinator
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA 98368
(360) 385-9410
Section 4: COMPENSATION:
The CONTRACTOR will be reimbursed for all work performed under the terms of this contract.
The total amount payable under this Contract by County to CONTRACTOR, for school year,
shall not exceed $59,736.00 as outlined in Exhibit B- Fee Schedule, 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 15t' 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).
F. 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 DSHS, CMS and
DBHR funding rules, applicable to the use of MH/SA 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.
Jefferson Mental Health Services — SBHC 2015 2
G. The County may withhold authorization to utilize the MH/SA 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.
H. 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.
J. 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 or its equal, 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 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.
Jefferson Mental Health Services — SBHC 2015
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
($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
'
ions.ns. This
insurance coveragee shall contain no limitations on the scopee of
s ec> icati
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 $1,000,000 per incident; $3,000,000
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 may be required by the State of Washington.
E. Itis 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, paidfor and at
the risk of the Contractor.
Jefferson Mental Health Services — SBHC 2015 4
F. Any insurance c, -rage for third party liability claims prc ed 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.
H. 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
The 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 or for contributing to the state
industrial insurance program, 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
Il#e � e.,(,submitted by the 15`h of the month for the previous month's work. The
'.
monthly report shal cona;Ie 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 Anna Mc
gt==�Aoval
Sheridan, Port Townsend, and WA 98368. The County will review
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 County.
Jefferson Mental Health Services — SBHC 2015 5
Section 11: TERMINATI"N
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 the 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 this day of 20
BOARD OF COUNTY COMMISSIONERS
JEFFERSON COUNTY, WASHINGTON
ATTEST
Deputy Cl of the Board
Jefferson Mental Health Services — SBHC 2015 6
.ppro� as form only
&1
Jeff C co. P
utt ofwe
David Alvarez, Chief C it DPA
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCounfyPublicHealth.org
Public Health
Consent Agenda
January 11, 2016
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
TO:
FROM:
DATE:
SUBJECT:
AGENDA REQUEST
Board of County Commissioners
Philip Morley, County Administrator
Jean Baldwin, Director
Anna McEnery, DD Coordinator
Agenda Item — Contract Agreement Amendment 1 — Jefferson Mental
Health Services for School Based Health Center; January 1, 2015 —
December 31, 2016; $59,736.00
STATEMENT OF ISSUE:
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 Amendment 1— Jefferson Mental
Health Services for School Based Health Center; January 1, 2015 — December 31, 2016; $59,736.00
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
This is a one year contract with JCPH and Jefferson Mental Health to provide services negotiated by the
BOCC and the Substance Abuse 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 4 — 12 who identify with mental health issues. Contractor will provide Child and Family
Therapist services. Counseling services provided will include anger management, depression, conflict
resolution, and stress, relationship issues, suicidal ideation, eating disorders, domestic violence, and sexual
and physical abuse. A mental health provider will spend 3 days a week at Port Townsend School District, 3
days a week at Chimacum 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.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This is sales tax revenue raised by the County in the 1/10 of 1% Fund and is allocated by the BOCC with
advice from the Mental Health and Substance Abuse Sales Tax Advisory Committee. Should funds be
reduced or withdrawn, termination and/or renegotiation language is in place.
Community Health Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487
RECOMMENDATION:
JCPH management requests approval of the Contract Agreement Amendment 1— Jefferson Mental Health
Services for School Based Health Center; January 1, 2015 — December 31, 2016; $59,736.00
Morley, County- jdminiWatc� Date
(Routed to all Public Health Managers)
CONTRACT WITH:
CONTRACT FOR:
615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
CONTRACT REVIEW FORM
AMOUNT: Adds $59,736.00
Revenue:
Ith Services
Expenditure: $59,736.00
Matching Funds Required:
Source(s) of Matching / Funds: 1/10th of 1%
PROCESS:
JAN 112016
❑ Exempt from Bid Process
❑ Consultant Selection Process
❑ Cooperative Purchase
❑ Competitive Sealed Bid
❑ Small Work Roster
❑ Vendor List Bid
® RFP or RFQ
13 Other:
Step 1: REVIEW BY RISK AN E
Review by: �6
Date Revie
APPROVED FORM �DR�urned �for evision (SeeComments)
iments:
Step 2: REVIEW BY PBC ttFIJTING AT NEY
Review by: ii--��ezz I�tvit,
Date Reviewed:
APPROVED AS TO FORM ' Returned for r vl n (See Comments)
Commen
(This form to stay with contract throughout the contract review process)
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
(f) 360-379-4487