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Public Health August 18, 2017
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, Developmental Disabilities Coordinator
DATE: orl I I ) -Z-q
SUBJECT: Agenda Item — Contract Amendment #1 with Jumping Mouse
Children's Center; May 1, 2017 — December 31, 2017; additional
$38,010.00 for a total of $70,125.00
STATEMENT OF I S E:
Jefferson County Public Health, as the fund manager of the Mental Health and Substance Abuse sales tax
treatment funds, is requesting Board approval of a Contract Amendment with the Jumping Mouse Children's
Center, to provide mental health services for young children (along with support for their parents/
caregivers), who have suffered trauma, including loss, abuse, neglect, exposure to violence, mental illness,
and substance abuse; May 1, 2017 - December 31, 2017; additional $38,010.00 for a total of $70,125.00.
ANALY' IS TRATE IC GOALS PRO'S and COWS:
This eight-month Contract Amendment adds funds for clinical and care management services for an
additional 24 children (ages 2-12 living in east Jefferson County), for a total of 45 children and their
caregivers. This service may include long-term therapy to children affected by and/or with risk factors for
mental illness or substance abuse at home and/or in the community. Jumping Mouse will utilize promising
and/or evidence based models of treatment, referrals for mental health medication, provide parental
support and education to the adults of the children served and monitoring as required.
This Contract Amendment results from a Supplemental RFP process and is recommended by the Mental
Health and Substance Abuse Sales Tax Advisory Committee.
FISCAL, IMPACT COST BENEFIT ANALYSIS:
This is sales tax revenue raised by the County in the 1/10th of 1% Fund; is allocated by the BOCC with
advice from Mental Health and Substance Abuse Sales Tax Advisory Committee. The contract states if the
sales tax revenue decreases, the vendor will be contacted and the contract may be renegotiated.
RECOMMENDATION:
JCPH management request approval of the Contract Amendment with Jumping Mouse Children's Center;
May 1, 2017 - December 31, 2017; additional $38,010.00 for a total of $70,125.00 in funding.
REVIEWED BY:
Philip Morley, County Administrator Date
0� �+ 0 1t
360-385-9400
360-385-9401 (f)
Environmental Health
Water Quality
360-335-9444
(t) 360-379-4437
CONTRACT AMENDMENT #1
For Professional Services
Between
Jefferson County
And
Jumping Mouse Children's Center
For Expanded Mental Health (MH) & Chemical Dependency (CD) Treatment 2017
WHEREAS, Jumping Mouse Children's Center (Contractor) and Jefferson County (County) entered into
an agreement on January 1, 2017 for Professional Services to be provided in connection with the
provision of mental health services to individuals impacted by mental health/substance abuse issues in
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, 2017.
Jumping Mouse Children's Center will continue to provide mental health therapy for young
children ages 2-12 living in east Jefferson County (along with support for their
parents/caregivers), who have suffered trauma, including loss, abuse, neglect, exposure to
violence, mental illness, and substance abuse. Along with funding operations, utility/insurance
payments and necessary supplies in order for children affected by substance abuse disorders and
mental health issues to be served as stated in Exhibit A, Statement of Work and Attachment A,
Match Policy.
2. This amendment adds $38,010.00 in funding as stated in Exhibit C, Fee Schedule, to be used
specifically for clinical and care management services for up to 45 children affected by and/or with
risk factors for mental illness or substance abuse at home and/or in the community.
3. This contract shall not exceed $70,125.00 without express written amendment signed by both
parties.
4. All other terms and conditions of the agreement will remain the same.
Dated this day of
By:
. Kathleen Kler, Chair
Jefferson Board of County Commissioners
By:
(Contractor)
ATTEST:
Clerk of the Board
Approved its to form:
Philip C, I-iurIsuckr r
Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
EXHIBIT A
Scope of Work
RESPONSIBILITIES:
The Jumping Mouse Children's Center Services agency as a contracted provider, agrees to:
1) Clinical and care management services for up to 45 children and their caregivers per billing period.
2) All employees or subcontractors of the Contractor undertaking the performance of mental
health/substance abuse services under this agreement are required to be professionally licensed or
certified by the State.
3) Background checks are required for all employees; to be redone for every employee every 3 years.
The names of licensed therapists will be given to the County upon request.
4) Provide long-term therapy to children affected by and/or with risk factors for mental illness or
substance abuse at home and/or in the community.
5) Provide parent support and education to the adults of the children covered in this contract.
6) Work with social services or other agencies as needed for dually served families with mental health or
chemical dependency issues.
7) Provide care coordination with other involved agencies, and referral to supportive services such as
housing, transportation and vocational services; tracking of client involvement in recommended
services, including 12 -step or comparable support.
8) Maintain a secure records system guaranteeing the confidentiality of PHI pursuant to HIPPA.
9) Bill other revenues whenever they exist.
10) Quarterly data template on client utilization, referrals, outcomes, and required reporting, in standard
form as specified by Jefferson County Health.
1 1) Individual therapy, using promising and/or evidence based models of treatment. Applicant will
identify the number of clients seen, how often each week and the number of hours per week and per
month for treatment enrollment.
12) Referral for mental health medication and monitoring as needed.
13) Collection and preparation of data for internal and external evaluation purposes, providing a monthly
invoice to JCPH and a quarterly data report. Use forms supplied by JCPH for data.
14) Preparation of progress reports if needed, e.g. for care coordination purposes.
15) Staffed by 4 master's level, Licensed Mental Health Counselors, 3 master's level Licensed Mental
Health Counselor Associates, 3 master's level intern therapists (supervised by Washington State
Approved Clinical Supervisors), and one social worker, with support staff to include billing and
administration.
16) Clerical, billing, and general office support.
17) Operations, utility/insurance payments and necessary supplies in order for children affected by
substance abuse disorders and mental health issues to be served.
18) Agency oversight regarding record keeping, data collection, legal and ethical issues and standards of
care are updated and meet State of Washington standards.
19) Services are available throughout Jefferson County.
20) Provide data including:
• Number of intakes, individual sessions, psychiatric visits, and adult education visits provided
• Age, sex, drug of choice, psychiatric diagnosis of clients.
• Referrals to other agencies.
• Client satisfaction form indicating client's view of how program helped in their life.
21) Opportunities for regular clinical supervision and consultation are available for staff on a regular
basis. Supervision for all therapists, including interns and externs, consists of minimum one hour per
week in individual consultation, one hour per week in group consultation and three hours per month
in a clinical staff meeting. Additional individual support and supervision to interns is also provided on
a continual, as -needed basis.
22) Attend and report to the Mental Health and Substance Abuse Sales Tax Advisory Committee once
during the duration of this contract period, at a regularly scheduled meeting, with progress evaluation
reports for children and their families.
23) For clinical and care management services for up to 45 children and their caregivers per billing
period, Jumping Mouse will provide quarterly statistics in an electronic form, an illustrative example
of which is shown in Exhibit B of this contract, as will be developed and may be revised by Jefferson
County Public Health in consultation with Jumping Mouse, for statistical and program data
collection.
• Jumping Mouse Children's Center will ensure that quarterly electronic reports are sent to Siri
Kushner of Kitsap County Health District, 345 6th Street, Suite 300, Bremerton WA 98337
and/or siri.kushner@kitsappublichealth.org, and that a copy of each electronic report is also sent
to Anna McEnery of Jefferson County Public Health at amcenery@co.jefferson.wa.us.
• Due dates for reports are as follows: 4/28 for Jan -Mar, 7/28 for Apr -June, 10/31 for July -Sept,
and 1/31 of the next year for Oct -Dec.
• Quarterly reports will be reviewed by Public Health and Siri Kushner for accuracy. Any questions
will be referred back to the Jumping Mouse.
EXHIBIT B
Jefferson County 1/10th of 1% for Mental Health & Substance Abuse
2017 Quarterly Evaluation Reporting Template
For clinical and care management services for up to 45 children and their caregivers, Jumping
Mouse will provide quarterly statistics in an electronic form, an illustrative example of which is
shown below, that will be developed, and may be revised, by Jefferson County Public Health in
consultation with Jumping Mouse.
afferson County 1/10th of 1% for Mental Health Substance Abuse
17 Evaluation Reporting Template (Version 2;
Individuals
children
ervice Inquiries
Service In`ui ition:
Enrollments
client
fait list: some service
tNew
stin client
fait list: no service
vious client
losed prior. some service
lient refused
gency denied out of service
•sad altllist closed
eferred to other
)st to follow-up
risis call/walk-in
Service Counts:
Total clients served: lChild
Total clients eligible for 1/10th 1%: a portion Parent
Ineligible due to paperwork status
Total' caregivers of all clients served:
Clients by apcode of Residence
nknown due to paperwork status
rtment or house
heltered
C.Aher categories JIM dares not colflect:
Not in the work force
Private insurance
Employed work full time
M�,,.,,
Employed work part time
Medicare
Unknown
7
(1
�,,, .
Other
Parent/caregiver requesting
employment support
Referral to DVR
Total 0
Clients by Age and
Gender.
Age Range
Male
Female Total
0to6
0
7to9
0
10 to 12* may be >12 cIloae
0
Total
0
0 0
Client Mental Health
no mental health
known unknown
Status:
11
djustment Disorder
eneralized Anxiety
ttachment Disorder
or T code: = 0 0 0 0
abuse/neglect 0
sexual abuse 0
family or relational problem 0
foster child problem 0
bereavement 0
academic problem 0
ohase of life oroblem 0
e:
dhood Experiences - historical
hold Mental Illness
hold Alcoholism or Drug Addiction
Exposure in Utero
ness
K enence Count
Non -Reporting
eriences
eriences
rienceS
dame to paperwork status (different
Experiences 0 #0
Experiences #D
Experiences 0 #D
Dr more Experiences 0 #D
Client Discharge Outcome:
tccessful completion Other lease speci # and t
sappeared/Left services Not yet reported
opped out/Quit
m ltalized
.ceased Whist did client die from?
)wd out of County
ANNUAL OUTCOMES
#children
lirl,4if, id"II ,1��
e r
90% of children served will
#VALUE!
successfully participate in
medium/long
therapy
term outcome
ts aHintended
0 ineau
cce.s sfau 8 i�yd e ve II o
medium/long
skfllis/haahaviors of 2rograrn
term outcome
X% of pa rti ci pants report
#VALUE!
program has helped them
participating
improve parenting skills (4 or
satisfaction
Sl
outcome
X% of pa rti c pants report
program has helped them
reach goals for fa mily and self satisfaction
#DIVI01
# chi ldren
#children
successfully
#VALUE!
participating
artici atin
# parents
successfully
#parents
#VALUE!
developing
participating
# pa rti ci pa nts
# participants
reporting program
completing
has helped
pa renti ng s ki I I s
#VALUE!
improve parent
question
skills
# pa rti c! pa nts
reporti ng program
# participants
has helped reach
completing
#VALUE!
familyand self
goals for family
and self
goals question
EXHIBIT C
Fee Schedule
January — December 2017: Therapy and Care Management by three intern therapists @ $366.67
each per month, for a total of $1100.00 per month. Clinical supervision @ $1234.58 per month
and Administration @ $341.67 per month.
In addition: May — December 2017: Therapy and Care Management by two licensed therapists
@ $3609.75 per month. Clinical supervision @ $324.88 per month, Administration @ $408.62
per month, and Operations (supplies, utilities, insurance, etc) @ $408 per month.
Not to exceed $70,125.00 in completion of services for the duration of this contract without
express written amendment.
ATTACHMENT A
JEI_FERSON COUNTY MII/SA "11 1:A":I"MI N"1"'I`Ax FUNDING -
MATCH POLI
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 I / 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/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.