HomeMy WebLinkAbout102416_ca02Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: David Stanko, Jefferson County Sheriff
DATE: October 24, 2016
RE: Jefferson Mental Health/Discovery Behavioral Healthcare Contract
STATEMENT OF ISSUE: This contract will allow the revitalization of the Jail's Relapse
Prevention Program which we started in 2008. The program, paid for with "Hargrove" dollars,
provides initial screening and reassessment for mental health and/or substance issues of our
inmates while in our custody and directs them to community resources upon their release.
ANALYSIS: Discovery Behavioral Healthcare intends to provide one-on-one screenings
four days a week and group sessions weekly. Given the extraordinary lack of mental health
services elsewhere in Washington State, inmates housed at the Jefferson County Jail receive
what we consider to be services far above the "industry standard". Our goal is to develop a
holistic plan inmates to re-enter our community.
FISCAL IMPACT: The Relapse Prevention Program is paid for entirely from the 1/101h of
1% Substance Abuse/Mental Health tax the County now collects. This contract runs through
December 31, 2016, which is the end of the two year contract cycle.
RECOMMENDATION:
Recommend approving this contract
REVIEWED BY:
C49 1;�7
Philip Morl unty Administrator
Date
Contract Agreement
By and Between
Jefferson County Sheriffs Office
And
Jefferson Mental Health Services/Discovery Behavioral Healthcare
Section 1. PURPOSE AND FORMATION
This Agreement (hereafter "Agreement") is entered into between the Jefferson County on behalf
of the Sheriff's Office (hereafter "JCSO") a municipal corporation in Washington State, and
Jefferson Mental Health Services/Discovery Behavioral Health Services (hereafter
"JMHS/DBH"), a non-profit corporation in Washington State, to provide Mental Health and
Chemical Dependency Case Management through Relapse Prevention Education (hereafter
"RPE") and post -discharge transitional case management services designed to assist inmates, as
described in this Agreement.
Section 2. TERM OF AGREEMENT
The term of this Agreement shall begin on the date this agreement is signed by both parties and
shall continue until December 31, 2016, unless terminated as provided in Section 13 of this
Agreement.
Section 3. SCOPE OF WORK
JMHS/DBH will provide services through use of Mental Health/Substance Abuse Sales Tax
funds allocated by the County as outlined in Exhibit A: Scope of Work, attached hereto and
incorporated herein.
Section 4. COMPENSATION
The total amount payable by JCSO to JMHS/DBH for services rendered under this Agreement
shall not exceed $15,262 without express written amendment signed by all parties to this
Agreement. JMHS/DBH shall be paid for services as outlined herein and in Exhibit B: Fee
Schedule, attached hereto and incorporated herein. The parties acknowledge that funding for this
Agreement is contingent on the adequate collection of Mental Health/Substance Abuse Sales Tax
during the period of this Agreement, and that if said Sales Tax revenue decreases by ten percent
(10%) or more during a quarter of the then current year as compared with the same quarter of the
prior year, then this Agreement may be renegotiated.
1. JMHS/DBH shall submit monthly invoices for services rendered under this Agreement to
JSCO, P.O. Box 1220, Port Townsend, WA 98368, Attn: Sharon Mitchel, for payment of
work actually completed to date. Monthly invoice totals shall not to exceed $2,637.67
per month for 2016 invoices ending December 31, 2016 under the current terms of this
Agreement.
2. Invoices must be submitted by the 15th of the month for the previous month's expenses.
JCSO will review such invoices, and upon approval thereof, payment will be made to
JMHS/DBH in the amount approved. Failure to submit timely invoices may result in a
denial of reimbursement.
3. JMHS/DBH 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 Circulars A-87 and A-122.
4. JSCO will make final payment of any balance due JMHS/DBH promptly upon
determining that i) JMHS/DBH has completed its obligations under this Agreement and
ii) JSCO can and does accept the work performed by JMHS/DBH.
5. JMHS/DBH records and accounts pertaining to this Agreement shall be kept available for
inspection representatives of JSCO and Washington State for a period of six (6) years
after final payments. Copies shall be made available upon request.
6. An audit will be submitted to JSCO annually.
a. JMHS/DBH will submit the most recent financial audit within 30 days from the
beginning of this Agreement.
b. By May 1 following the conclusion of each calendar year in which JMHS/DBH
provides service under this Agreement, JMHS/DBH shall submit a financial audit for
the year. Such audit(s) shall be completed by the Washington State Auditor's Office
or a mutually agreed entity. Upon request the County shall have the option of
performing an onsite review of all records, statements, and documentation. The
audit(s) shall provide statements consistent with the guidelines of Reporting for Other
Non -Profit Organizations AICPA SOP 78-10, and shall be performed in accordance
with generally accepted auditing standards and with Federal Standards for Audit of
governmental Organizations, Programs, Activities and Functions, and shall meet all
requirements of OMB Circular A-133 or A-128, as applicable.
c. If the County finds indications of potential non-compliance during the monitoring
process, the County shall notify JMHS/DBH within ten (10) working days. The
County and JMHS/DBH shall meet to discuss areas of contention in an attempt to
resolve issues.
Section 5. MATCH
1. Jefferson 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. Jefferson County may allow JMHS/DBH to use the
Chemical Dependency/Mental Health Tax funds and services provided thereunder 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 JMHS/DBH to use such funds for match, pursuant to Exhibit
C, attached hereto and incorporated herein.
2. Where JMHS/DBH proposes to use Chemical Dependency/Mental Health Tax funds for
match, JMHS/DBH 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 Mental Health/Chemical Dependency Sales Tax monies as match.
JMHS/DBH 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 Exhibit C. Jefferson County may withhold
authorization to utilize the Mental Health/Chemical Dependency Sales Tax monies as
match. JMHS/DBH's failure to provide adequate documentation does not relieve
JMHS/DBH of its responsibility to comply with all state and federal laws and regulations
related to match.
Section 6. INDEMNIFICATION
JMHS/DBH shall indemnify, defend and hold harmless Jefferson 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 JMHS/DBH's staff or damage to personal
property) if said injury or damage was caused by the negligent acts or omissions of JMHS/DBH.
Jefferson County shall indemnify, defend, protect and hold harmless JMHS/DHS, its agents, Board
of Directors, leadership team, employees and volunteers from and against all claims, suits and/or
actions arising from any negligent or intentional act or omission by the County's officers, officials
and employees while performing this agreement.
Section 7. INSURANCE
JMHS/DBH shall obtain and keep in force during the terms of this Agreement, or as
otherwise required:
1. 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).
2. 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:
(a) Broad Form Property Damage with no employee exclusion;
(b) Personal Injury Liability, including extended bodily injury;
(c) Broad Form Contractual/Commercial Liability including completed operations
(contractors only);
(d) Premises — Operations Liability (M&C)
(e) Independent Contractors and Subcontractors; and
(f) Blanket Contractual Liability.
(1) Note: The County shall be named as an additional insured party under this
policy.
3. Professional Liability Insurance providing $2,000,000 per incident; $4,000,000
aggregate. JMHS/DBH shall name Jefferson County as additional insured.
4. JMHS/DBH shall participate in the Worker's Compensation and Employer's Liability
Insurance Program as may be required by the State of Washington.
5. 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
JMHS/DBH.
6. All policies of insurance JMHS/DBH is required to maintain pursuant to this Contract
shall be primary to any third party liability coverage provided to the County by reason of
its membership in a Ch. 48.62 "Risk Pool." Any 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 JMHS/DBH must provide to
comply with this Agreement.
7. All insurance policies JMHS/DBH must maintain for purposes of this Agreement shall
provide coverage on an occurrence basis.
8. If the Professional Liability policy held by JMHS/DBH to insure JMHS/DBH regarding
the work to be performed under this Contract provides coverage on a claims made basis,
then each such Professional Liability insurance must have a Retroactive Date of, or prior
to, the effective date of this Agreement. For each such claims -made policy accepted by
the County, a Supplemental Extended Reporting Period (SERP) shall be purchased, at
JMHS/DBH's sole expense, with an extended reporting period of not less than three (3)
years in the event the policy is cancelled, non -renewed, switched to an Occurrence Form,
retroactive date advanced, or there is any other event triggering the right to purchase a
Supplemental Extended Reporting Period (SERP) policy during the term of this
Agreement or thereafter. JMHS/DBH agrees JMHS/DBH's insurance obligation shall
survive the completion or termination of this Agreement for a minimum period of three
years.
9. The insurance maintained by JMHS/DBH pursuant to this Agreement shall not in any
manner limit or qualify the obligations of JMHS/DBH under this Contract.
10. JMHS/DBH shall provide proof of each required type insurance to the Superior Court
Administrator and County Risk Manager prior to commencing employment, and prior to
any extension of services under this Agreement.
11. If the proof of insurance or certificate indicating the County is an "additional insured" to
a policy obtained by JMHS/DBH 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
JMHS/DBH to obtain the full text of that endorsement and forward that full text to the
County.
12. The County may, upon JMHS/DBH's failure to comply with all provisions of this
contract relating to insurance, withhold payment or compensation that would otherwise
be due to JMHS/DBH. The County will not do so without written notice to JMHS/DBH
giving JMHS/DBH ten (10) days to cure the breach.
Section 8. 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 151t 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 JSCO, P.O. Box 1220, Port Townsend, WA 98368, Attn:
Sharon Mitchel. The County will review such reports, and upon approval thereof, payment will
be made to the Contractor in the amount approved. Failure to submit timely reports may result in
a denial of reimbursement.
JMHS/DBH will provide additional reports as identified in Exhibit A: Scope of Work.
Section 9. CONFIDENTIALITY
Contractor, its employees, subcontractors and their employees will maintain the confidentiality
of all information provided by JCSO or acquired in performance of this Agreement 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 10. 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 11. ASSIGNMENT AND SUBCONTRACTING
No rights or responsibilities required or authorized by this agreement can be sublet or assigned
by any party hereto without the express written consent of the other party.
Section 12. Jefferson County Responsibilities under this Agreement
1. JSCO will provide JMHS/DBH a minimum of 16 hours per week of access to appropriate and
private consultation space at the Jail.
2. JSCO will provide JMHS/DBH staff reliable, sufficient Wi-Fi or a hard Ethernet internet access
in the consultation space.
3. JSCO will support and provide opportunities for JMHS/DBH staff to directly consult with Jail
staff.
Section 13. CONTACTS
JMHS/DBH and JSCO shall each have a contract representative who will have responsibility to
administer this Agreement for that party. A party may change its representative upon providing
written notice to the other party. The parties' representatives are as follows:
JMHS/DBH Representative
Adam Marquis, Executive Director
Jefferson Mental Health Services/Discovery
Behavioral Health Services
P.O. Box 565
Port Townsend, WA 98368
(360) 385-0321
adanlm(y)jef ferson.inhs.org
Section 14. TERMINATION
JSCO Representative
Steve Richmond, Jail Superintendent
Jefferson County Sheriff's Office
P.O. Box 1220
Port Townsend, WA 98368
(360) 385-3831 x-734
SRichmond(a?co.j efferson.wa.us
The County reserves the right to terminate this contract in whole or in part, with 30 days' notice,
in the event that Mental Health/Substance Abuse Sales Tax revenue is withdrawn, reduced, or
limited in any way after the effective date of this agreement. This agreement may also be
terminated as provided below:
1. With 30 days written notice by the County for non-performance of the specific
job duties in Exhibit A.
2. With 30 days written notice by the County for any reason, or
3. With 90 days written notice by the Contractor by voluntary resignation.
In the event of termination, the County shall be liable for only payment for services rendered
prior to the effective date of termination.
Section 15. MODIFICATION
This Agreement may be modified at any time, only by mutual written amendment, executed by
all parties.
Section 16. DISPUTES
JCSO and JMHS/DBH shall make reasonable efforts in good faith to resolve any disputes
regarding the terms and obligations of this agreement on an informal basis. The disputing party
shall contact the other party with its concerns and attempts to reconcile. If these informal
resolution efforts are unsuccessful, the disputing party shall send written notice to the MH/SA
Sales Tax Committee. The MH/SA Sales Tax Committee shall make their determination within
ten business days, unless mutually agreed to extend this time period. If the aggrieved party is not
happy with that decision, then the County Administrator will decide the appeal of the MH/SA
Sales Tax Committee's decision. Should either party appeal this decision to the Superior Court,
each party shall bear their own costs and attorney's fees.
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Section 17. APPLICABLE LAWNENUE
This Agreement shall be governed by the laws of the State of Washington. Venue for any legal
action shall be in the Superior Court for Jefferson County, Washington.
Section 18. WAIVER
No provision of this Agreement, or the right to receive reasonable performance or any act to call
for by its terms, shall be deemed waived by a breach thereof as to a participating transaction or
occurrence.
Section 19. ACKNOWLEDGMENT
The parties acknowledge that they have read and understand this Agreement, including any
supplements thereto. The parties further agree that this Agreement constitutes the entire
Agreement between the parties and supersedes all communications written or oral related to the
subject matter of this Agreement.
Section 20. SUSPENSION AND DEBARMENT
The parties to this Agreement certify, and each relies thereon in execution of this Agreement,
that neither their entity nor its leadership and staff are presently debarred, suspended, proposed
for debarment, or declared ineligible or voluntarily excluded for the award of contracts by any
Federal governmental agency or department. "Principals", for the purposes of this certification,
mean officers; directors; owners; partners; and, persons having primary management or
supervisory responsibilities within a business entity (e.g., general manager; plant manager; head
of subsidiary, division, or business segment; and similar positions). Further, each party agrees to
provide the other(s) immediate written notice if, at any time during the term of this Agreement,
including any renewals hereof, it learns that its certification was erroneous when made or has
become erroneous by reason of changed circumstances. Each party's certification via the
execution of this Agreement is a material representation of fact upon which each party has relied
in entering into this Agreement. Should either party determine, at any time during this Agreement,
including any renewals hereof, that this certification is false, or should it become false due to
changed circumstances, it may terminate this Agreement in accordance with the terms and
conditions therein.
Section 21. SEVERABILITY
If any term or condition of this Agreement, or application thereof to any person or
circumstances, is held invalid, the remainder of the Agreement or the application of such
provision to persons or circumstances other than those to which it is held invalid, unenforceable
or contrary to applicable law, shall not be affected and shall continue in force and effect
Section 22. SIGNATURES/APPROVAL
By signing this Agreement, the parties acknowledge that they have read and understood this
Agreement, including any supplements or attachments hereto, and do agree thereto to every
particular. The parties further agree to this Agreement, together with any appendices, constitute
the entire Agreement between parties and supersede all communications, written or oral,
heretofore related to the subject matter of this Agreement.
This Agreement is executed by the persons signing below, who warrant that they have the authority
to execute this Agreement.
Dated this day of
Jefferson County
Kathleen Kler, Chair Date
Jefferson Board of County Commissioners
�_.-� ,3 /'
David Stanko, Sheriff Date
Jefferson County Sheriff's Office
Attest:
Carolyn Avery Date
Deputy Clerk of the Board
Approved as to Form:
''`
Michael Haas to
Prosecuting Attorney
2016.
Jefferson Mental Health Services/
Discovery Behavioral Healthcare
Director
10/1+4
Date
EXHIBIT A: SCOPE OF WORK
JMHS/DBH staff and JCSO Jail leadership and staff will work collaboratively. Other medically
necessary services will be provided to eligible service recipients who are referred to the
JMHS/DBH Community Behavioral Health Center, through regular behavioral health programs
operated by JMHS/DBH at its clinic located at 884 W. Park Ave., Port Townsend, WA.
JMHS/DBH clinical services leadership will provide treatment coordination and clinical
supervision for the JMHS/DBH Mental Health and Chemical Dependency case managers on a
regular basis, clinical consultation and staffing regarding cases, professional training and
oversight, quality oversight of clinical processes, and general employee oversight.
In particular JMHS/DBH, as a contracted provider, agrees as follows:
1. JMHS/DBH will provide services, including but not limited to, Relapse Prevention
Education (RPE) and discharge planning, to Jefferson County Jail inmates affected by at
least, but not limited to the following: Chemical Dependency and Mental Health issues.
Services include:
a. Offer assessment of a majority of subjects booked into the jail; assessing them for
substance abuse and/or withdrawal, mania, anorexia, mood disorders, self- harm, and
other mental health conditions;
b. Actively recruit substance abusing inmates for participation in RPE for two (2)
weekly RPE classes, (one for females and one for males);
c. Directly provide assessment, early intervention, and follow-up for inmates suffering
from substance dependencies and/or mental health issues, including education and
public health interventions within the Jail;
d. Directly provide engagement, preparation for and coordination of outpatient treatment
and transitional post -discharge appointment for inmates suffering from substance
dependencies and/or mental health issues through transitional post -discharge case
management services.
e. Make appropriate referrals to and coordinate the continuum of care with: Safe Harbor,
JMHS/DBH, the Jail's medical provider, and/or Drug and Mental Health Courts. Assist
with making recommendations to refer inmates, after release, to inpatient and
outpatient programs for mental health and substance abuse.
f. Collect and share statistics and data as may be required for the administration by the
County of the services under this Agreement for reporting purposes;
g. Directly provide a minimum of five (5) hours per week contact at Jail with inmates.
Directly provide a minimum of eleven (11) hours per week contact including post-
discharge transitional case management services.
h. JMHS/DBH will submit quarterly electronic reports in a form as specified by the
County for statistical and program data collection as follows:
• JMHS/DBH will submit quarterly electronic reports for services provided pursuant
to this Agreement to:
o Jefferson County Sheriff's Office;
o Siri Kushner of Kitsap County Health District, 345 6 1 Street, Suite 300,
Bremerton WA 98337 at siri.kushner@kitsappublichealth.org; and
o Anna McEnery, Jefferson County Public Health at
arncenery@cojefferson.wa.us.
• Due dates for reports are as follows: 10/31/16 for July -September, and 1/31/17 for
October -December 2016.
• Quarterly reports will be reviewed by the Sheriff's Office, Public Health and Siri
Kushner for accuracy. JMHS/DBH will make corrections as may be required by
the County.
2. GENERAL RESPONSIBILITIES OF JMHS/DBH:
a. JMHS/DBH and JSCO Staff Relationships
Tasks and Deliverables:
o Work closely with JSCO staff as a team and meet with offenders as referred at the Jail.
o Work collaboratively with JSCO's contracted healthcare provider.
o Consult with staff regarding inmate mental health and substance abuse needs and concerns.
o Provide consultation as measured by the number of service hours delivered and satisfaction
summary.
o JMHS/DBH to deliver two (2) weekly RPE groups, one for males and one for females.
b. Referral and Collaboration with Outside Providers
Tasks and Deliverables:
o Work collaboratively with local area mental health and chemical dependency treatment
providers for referral and follow-up.
o Work with inmates to provide support services and referrals for mental health, substance
abuse, and/or other social service and treatment programs.
o Assist with application and eligibility paperwork requirements necessary to receive outside
services.
o JMHS/DBH staff will make referrals to outside sources for inmates in need of additional
services not available within the Jail.
o Work collaboratively with County Prosecutor and Inmate Defense Attorneys, where
appropriate.
o Provide continuity of care as measured by the number of transitional Mental Health and
Chemical Dependency appointments achieved within 60 days of discharge.
c. Records
Tasks and Deliverables:
o All content of records are fully covered by HIPAA and 42 and 45 CFR for the deliverance of
Mental Health and Chemical Dependency services, respectively.
o De -identified aggregate reports of service hours and numbers of individuals and referrals
made will be furnished to the MH/SA Sales Tax Committee.
o Data for internal and external evaluation and reporting will be collected and prepared.
d. Additional Staffing Requirements
Tasks and Deliverables:
o Provide minimum of bi-weekly clinical and supervisory oversight for Mental Health and
Chemical Dependency Case Managers providing program services and maintain
documentation of the supervision.
o JMHS/DBH clinical leadership will provide oversight for staff. JMHS/DBH will maintain
compliance for secure and confidential records.
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Description of the Proposed Bachelor's Level Case Managers for JCSO Jail
The team operating out of the JCSO Jail will be:
o A Bachelors level Mental Health Case Manager to provide assertive, transitional case
management services for transitional post discharge of jail inmates for a total of 11 hours per
week on a TBD regular days each week.
o A Bachelors level Chemical Dependency Case Manager to provide assertive, transitional
case management services for transitional post discharge of jail inmates for a total of 5 hours
per week on a TBD regular days each week.
o There will be a year-end review between JCSO leadership and JMHS/DBH Leadership in
December to review the value of services rendered and community partnership between the
JCSO Jail and JMHS/DBH leadership.
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EXHIBIT B: FEE SCHEDULE
Chemical Dependency Professional Case Manager $30.00/hour $ 3,900
@ $30.00/hour for 5 hours per week for RPE Groups
Mental Health Case Manager @ $30.00/hour for
11 hours per week for post -discharge transitional case
management services.
Supervision/Program Management @ $50.00/hour
for 1 hour per week
Clerical/Admin Support @ $24.00/hour for
1 hour per week
Office supplies and mileage reimbursement
Annual Total
$ 8,580
$ 1,300
$ 624
$ 858
$ 15,262
NOTE: *In alignment with the MOU between Jefferson County Public Health and JCSO,
this annualized budget above will not exceed $15,163.80 for the rest of the calendar year,
that is, this budget will be prorated and end on December 31, 2016 effectively.
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EXHIBIT C:
JEFFERSON COUNTY MH/CD 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 / 10th of 1 % sales tax initiative) to augment state funding for mental
health and chemical dependency treatment. Jefferson County collects and distributes the Mental.
Health/Chemical Dependency (MH/CD) tax through the Mental Health/Substance Abuse Sales
Tax Fund 131.
Services purchased by the County are allocated from Fund 131 through a formal Request for
Proposal (RFP) review and recommendation process through the Jefferson County Mental
Health Substance Abuse Fund Advisory Committee, staffed by Jefferson County Public Health,
and adopted by the Board of County Commissioners (County). Jefferson County Public Health
administers Fund 131 on behalf of the County. The County does not assume any fiscal
responsibility/liability for any entity with which they contract for services using an allocation of
Fund 131 funds.
The 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. The County may make available to the Sheriff's Office or its Contractor the chemical
dependency mental health tax funds for the Sheriff's Office or its Contractor to propose as match
to state, federal or other entities, at the County's sole discretion. The Sheriff's Office or its
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, the Sheriff's Office or its 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.
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If the County informs the Sheriff's Office or its Contractor of the availability of chemical
dependency mental health County tax funds for match, then the Sheriff s Office or its 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 Sheriffs Office or its 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, the Sheriff s Office or
its 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
Exhibit C. At a minimum, the Sheriff s Office or its 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 the Sheriffs Office or its Contractor to utilize the MH/CD
sales tax monies as match.
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