HomeMy WebLinkAbout022618_ca04615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHF'E_I�1lak,„tyggenda
January 18, 2018
Public Health JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, DD & 1/10th County Coordinator
DATE: 0 1 aw 1 X01
SUBJECT: Agenda Item — Contract Amendment #1, Olympic Community Action
Program (OlyCAP) — Transitional Housing; January 1, 2018 —March 31,
2018; Additional $9,069.00 for a total of $49,069.00
STATEMENT OF ISSUE:
Jefferson County Public Health, (JCPH) requests Board approval of a contract amendment with Olympic
Community Action Program, (OlyCAP) to provide transitional housing for individuals with substance abuse
disorders and/or mental health issues; January 1, 2018 —March 31, 2018; Additional $9,069.00 for a total
of $49,069.00.
ANALYSIS STRATEGIC GOALS PRO'S and CON'S:
This is a three month contract amendment between JCPH and Olympic Community Action, (OlyCAP); for
transitional housing for individuals with substance use disorder or mental illness.
This contract amendment funds an OlyCAP case manager, provides maintenance and operations for each
Haines Street Cabin, and assures continued use as transitional housing specifically for individuals suffering
from substance use disorder and/or mental illness. OlyCAP does not charge rent for the Haines Street
Cabins.
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. The contract states if
the sales tax revenue decreases, the vendor will be contacted and the contract may be renegotiated.
RFP Panel members of the Substance Abuse Mental Health Advisory Committee are still deliberating about
2018 1/101h of 1% funding recommendations. Public Health is recommending a three month amendment
to maintain continuity of services.
RECOMMENDATION:
JCPH management requests approval of the contract amendment with OlyCAP; January
2018; Additional $9,069.00 for a total of $49,069.00..
REVIEWED. Y•
Philip ori County inist Date
Community Heallh Environmental Health
Developmental Disabilities Water Quality
360-385-9400 360-385-9444
1, 2018 —March 31,
360-385-9401 (f) Always working for a safer and healthier community (f) 360-379-4487
CONTRACT AMENDMENT #1
For Professional Services
Between
Jefferson County
And
Olympic Community Action Program
For Transitional Housing Services
WHEREAS, Olympic Community Action (OlyCAP), (Contractor) and Jefferson County
(County) entered into an agreement on May 1, 2017 for Transitional Housing to homeless
residents of Jefferson County who are participating in Therapeutic Courts or who are
discharged from Jail or a Hospital without a home.
WHEREAS, the parties desire to amend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
THIS AGREEMENT is made and entered into to provide services to individuals with
substance abuse disorders and/or mental health issues in need of transitional housing in
Jefferson County, Washington.
The term of the above referenced agreement ends March 31, 2018.
1. Olympic Community Action will continue to as stated in Exhibit A, Statement of
Work and Attachment A, Match Policy.
2. This amendment adds $9069.00 in funding as stated in Exhibit B, Fee Schedule, to
be used specifically for assistance to homeless individuals from Jefferson County,
Washington, who are participating in Therapeutic Courts or who are discharged from
Jail or a Hospital without a home.
3. The contract, including this amendment, shall not exceed $49,069.00 without express
written amendment signed by both parties. Work performed between January 1, 2018
and the execution of this Amendment that is consistent with the provisions of this
Agreement is hereby ratified.
4. All other terms and conditions of the agreement will remain the same.
Dated this
IN
day of
, 2018.
ATTEST:
David Sullivan, Chairman
Jefferson County Board of Commissioners By:
Contractor
Carolyn Avery, Deputy Clerk of the Board
APPROVED AS TO FOR ONLY:
By:
Philip Hunsucker, Chief Civil, Depu y Prosecuting
Attorney
EXHIBIT A
Scope of Work
RESPONSIBILITIES:
Olympic Community Action Program, as a contracted provider, agrees to:
1) Provide housing and assistance to homeless individuals who are participating in
Therapeutic Courts or who are discharged from Jail or a Hospital without a home.
2) Work with DSHS, CPS, Safe Harbor and Discovery Behavioral Healthcare to help
guide the client to self-sufficiency.
3) 'Assess client's ability to afford housing and refer them to DSHS and /or Social
Security for financial support.
4) Support the client through their Social Security application and when appropriate
participation in Social Security interview.
5) Refer clients to OlyCAP and supports them to fill out subsidized housing
applications, (i/e/ Crossroads, HARP, Permanent Solutions, Consolidated Homeless
Grants).
6) Provide support to clients by reviewing all pending applications for housing and
other services, (i/e/ DSHS, CPS, DVR and Work Source).
7) Provide weekly status checks concerning any finished applications for housing and
other services, (i/e/ DSHS, CPS, DVR and Work Source).
8) Research leads for Section 8 housing if the client has a voucher.
9) Refer clients to the Division of Vocational Rehabilitation for employment services.
10) Support client in securing any documents needed when they are called off a waitlist
(i/e/ current ID, social security card).
11) Meet with clients monthly to continue focus on quest for permanent housing.
12) Attend weekly Therapeutic Courts; participate in staffing discussions for treatment
and case management.
13) Do housing intakes (screening/assessment) and discharge planning for inmates with
mental health and substance abuse issues who are leaving the Jefferson County Jail.
14) Refer clients to Therapy Courts.
15) Does intake, assessment and then refers/enrolls clients to the OlyCAP's Haines
Street Cottages.
16) Agency oversight regarding record keeping, data collection, legal and ethical issues
and standards of care are updated and meet State of Washington standards.
17) Assure that these services are available for any Jefferson County resident.
18) Bill other revenues whenever they exist. Document what percent of clients are
covered by other sources of revenue.
19) Attend and report to the Mental Health Substance Abuse Sales Tax Advisory
Committee when requested with progress evaluation reports.
20) Provide maintenance, operations, utility payments and necessary materials for
upkeep and repairs for each cabin to assure continued use as transitional housing
specifically for individuals suffering from substance use disorder or mental illness.
OlyCAP does not charge rent for the Haines Street Cabins.
Exhibit B
Fee Schedule
Case Manager: At $25.00 an hour
Maintenance Staff: At $20.00 an hour
Utilities/Supplies: Up to $11,196.00
OlyCAP can bill no more than $3023.00 a month for services
Not to exceed a total of $49,069.00 for the duration of this contract amendment without
express written amendment signed by both parties.
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 1/10th 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 (MI-I/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
Olympic Community Action Program
For Transitional Housing Services for People with
Mental Health (MH) & Substance Abuse Disorders
This Contract for Professional Services is entered into between Jefferson County, herein referred
to as the "County" and Olympic Community Action (OlyCAP), herein referred to as the
"Contractor".
Section 1: PURPOSE:
THIS AGREEMENT is made and entered into to provide housing and assistance to homeless
residents affected by Mental Health and Substance Use Disorders for Jefferson County,
Washington.
Section 2: TERM:
This Agreement shall commence on May 1, 2017 and continue through December 31, 2017,
unless terminated as provided herein. Work performed between May 1, 2017 and execution of
this agreement that is consistent with the provisions of this agreement is hereby ratified.
Section 3: SCOPE OF AGREEMENT:
OlyCAP will provide housing and assistance services to homeless residents of Jefferson County
who are participating in Therapeutic Courts or who are discharged from Jail or a Hospital without
a home, as described in Exhibit A: Scope of Work, attached hereto and incorporated herein.
Section 4: CONTRACT REPRESENTATIVES:
JCPH and OlyCAP will each have a contract representative who will have responsibility to
administer the contract for that party. A party may change its representative upon providing
written notice to the other party. The parties' representatives are as follows:
Contractor's Contrad Representative
Kathy Morgan, Housing Director
Olympic Community Action Program
823 Commerce Loop Rd.
Port Townsend, WA 98368
(360) 385-2571
JCPH Contract Representative
Anna Mc Enery, DD Coordinator
Jefferson County Public Health
615 Sheridan St.
Port Townsend, WA 98368
(360) 385-94101
Section 5: COMPENSATION:
The CONTRACTOR will be reimbursed for all work performed under the terms of this contract
as outlined in Exhibit C- Fee Schedule. The total amount payable under this Contract by County
to CONTRACTOR shall not exceed $40,000.00 in the completion of this project without express
written amendment signed by both parties to this Agreement.
A. Contractor shall be paid for services as outlined in Exhibit A — Scope of Work.
OlyCAP Transitional Housing Services 2017
Page 1 of 13
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 15th of the month for the previous month's
expenses. Invoices submitted after the 7th of the month may not be paid until the
following month. 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 or timely reports pursuant to Section 10 of this agreement may result in
a denial of reimbursement. Invoices not submitted within 60 days may be denied.
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
fielding and grants. County may allow Contractor to use the chemical dependency
mental health tax fields as match, at the County's sole discretion. Should the County
decline to use chemical dependency mental health tax funds as match for additional
fimding 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
fimds 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 N"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.
G. The County may withhold authorization to utilize the M WSA 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.
I. 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 upon request.
a. Upon request, Contractor will submit the most recent financial audit within 30 days.
OlyCAP Transitional Housing Services 2017
Page 2 of 13
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 6: 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.
Section 7: 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
specifications. This insurance coverage shall contain no limitations on the scope of the
protection provided and indicate on the certificate of insurance the following coverage:
1. Broad Form Property Damage with no employee exclusion;
2. Personal Injury Liability, including extended bodily injury;
3. Broad Form Contractual/Commercial Liability including completed operations
(contractors only);
4. Premises — Operations Liability (M&C)
5. Independent Contractors and Subcontractors; and
6. Blanket Contractual Liability.
(1) Note: The County shall be named as an additional insured party under
this policy.
C. Professional Liability Insurance providing $1,000,000 per incident; $3,0010,000
aggregate. Contractor shall name Jefferson County Public Health as additional insured.
OIyCAP Transitional Housing Services 2017
Page 3 of 13
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. It is agreed by the parties that insurers shall have no right of recovery or subrogation
against the County (including its employees and other agents and agencies) it being
the intention of the parties that the insurance policies listed above shall protect both
parties and be primary coverage for any and all losses covered by the above -listed
insurance policies. It is further agreed by the parties that any and all deductibles
made part of the above -listed insurance policies shall be assumed by, paid for and at
the risk of the Contractor.
F. 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 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 8: 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 9: 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 10: REPORTING
The Contractor will provide a monthly invoice to the County for the previous month's work. The
invoice shall include the total hours worked by which staff. A quarterly report of services and will
be recorded on a form created or approved by the Public Health contracted Epidemiologist.
The monthly invoice shall be submitted to Jefferson County Public Health in care of the Anna
McEnery, DD Coordinator, 615 Sheridan, Port Townsend, and WA 98368. The County will
review such invoices, and upon approval thereof, payment will be made to the Contractor in the
amount approved. Failure to submit invoices within 45 days of the due date, may result in a denial
of reimbursement.
OlyCAP Transitional Housing Services 2017
Page 4 of 13
The OlyCAP shall submit:
• Monthly invoices with timesheets for Case Manager and Maintenance Staff and receipts
for expenditures related to utilities and supplies. Each invoice may include only hours
directly related to Exhibit A, Scope of Work.
■ Quarterly electronic reports to Siri Kushner of Kitsap County Health District in a form as
specified by Jefferson County Public Health and/or Kitsap County Health District as
outlined in as outlined in Exhibit B, 2017 Quarterly Evaluation Reporting Template.
a OlyCAP will send a copy of each electronic report to the JCPH Contract Representative.
Upon request, reports of activities and services provided, to the JCPH Contract
Representative.
Section 11: 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.
Section 12: TERMINATION
The County reserves the right to terminate this contract in whole or in part, with 30 days' notice,
in the event that expected or actual funding from any funding source is withdrawn, reduced, or
limited in any way after the effective date of this agreement. in the event of termination under this
clause, the County shall be liable for only payment for services rendered prior to the effective date
of termination.
A. This agreement may also be tenninated 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 13: MODIFICATION
This professional services agreement may be modified at any time by written agreement of all
parties.
Section 14: 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.
OlyCAP Transitional Housing Services 2017
Page 5 of 13
Approved this day of ill. , 20 1 -14 -
BOARD OF COUNTY COMMISSIONERS
JEFFERSON COUNTY, WASHINGTON
Kathleen mer, Chair ' D*
EnFH!*1Dbj"
Olympic Community Action Program
ATTEST:
Lt? �Lq,2,kI
/66 1 U(1, I
Clerk of the Ward, �wrt,�'J"
A p roved u to form:
C' Z,4 7
Philip C. Hunsucker
Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
OlyCAP Transitional Housing Services 2017
Page 6 of 13
EXHIBIT A
Scope of Work
RESPONSIBILITIES:
Olympic Community Action Program, as a contracted provider, agrees to:
1) Provide housing and assistance to homeless individuals who are participating in
Therapeutic Courts or who are discharged from Jail or a Hospital without a home.
2) Work with DSHS, CPS, Safe Harbor and Discovery Behavioral Healthcare to help guide
the client to self-sufficiency.
3) Assess client's ability to afford housing and refer them to DSHS and /or Social Security
for financial support.
4) Support the client through their Social Security application and when appropriate
participatiori in Social Security interview.
5) Refer clients to OlyCAP and supports them to fill out subsidized housing applications,
(i/e/ Crossroads, HARP, Permanent Solutions, Consolidated Homeless Grants).
6) Provide support to clients by reviewing all pending applications for housing and other
services, (i/e/ DSHS, CPS, DVR and Work Source).
7) Provide weekly status checks concerning any finished applications for housing and other
services, (i/e/ DSHS, CPS, DVR and Work Source).
8) Research leads for Section 8 housing if the client has a voucher.
9) Refer clients to the Division of Vocational Rehabilitation for employment services.
10) Support client in securing any documents needed when they are called off a waitlist (i/e/
current ID, social security card).
11) Meet with clients monthly to continue focus on quest for permanent housing.
12) Attend weekly Therapeutic Courts; participate in staffing discussions for treatment and
case management.
OIyCAP Transitional Housing Services 2017
Page 7 of 13
13) Do housing intakes (screeninglassessment) and discharge planning for inmates with
mental health and substance abuse issues who are leaving the Jefferson County Jail.
14) Refer clients to Therapy Courts.
15) Does intake, assessment and then refers/enrolls clients to the OlyCAP's Haines Street
Cottages.
16) Agency oversight regarding record keeping, data collection, legal and ethical issues and
standards of care are updated and meet State of Washington standards.
17) Assure that these services are available for any Jefferson County resident.
18) Bill other revenues whenever they exist. Document what percent of clients are covered by
other sources of revenue.
19) Attend and report to the Mental Health Substance Abuse Sales Tax Advisory Committee
when requested with progress evaluation reports.
20) Provide maintenance, operations, utility payments and necessary materials for upkeep and
repairs for each cabin to assure continued use as transitional housing specifically for
individuals suffering from substance use disorder or mental illness. OlyCAP does not
charge rent for the Haines Street Cabins.
OIyCAP Transitional Housing Services 2017
Page 8 of 13
EXHIBIT B
Jefferson County 1/101h of 1% for Mental Health & Substance Abuse
2017 Quarterly Evaluation Reporting Template
OlyCAP Housing Contract - Reporting ideas DRAFT 7-31-17
Haines Street Cottages - clean and sober housing, 8 cabins x 4 beds=32 total
Instructions: Each row is information for one client.
Drop down menu text is shown below so you can see it as we develop this but the menus will not be visible.
Scroll to the right to see annual outcomes that will be generated.
QoMlnn 4
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OIyCAP Transitional Housing Services 2017
Page 9 of 13
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down: down: down: down:
In prooess In process In process In process In process In process In process In process In process yes referred yes referred
successful successful successful successful successful successful successful successful successful no welt list no waltllst
failed failed failed failed failed failed failed failed failed n/a successful n/a successful
n/a n/a n/a n/a n/a n/a n/a n/a n/a failed failed
unknown unknown
OIyCAP Transitional Housing Services 2017
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ANNUAL OUTCOMES
SMART ObJectiVe Tyne of Meat Source Numerator Denominator %A l6 ceic
% of Individuals complete a stability
medium term
program
# participants with
total participants
#VALUEI
lawn
outcome
complete plan
medium/long
Total participants
_
% of individuals who obtain
employment
term outcome
program
# with employment
with employment
MVALUEI
Oal
% of individuals who obtain social
medium/long
# with social
Total participants
security
term outcome
program
security
with social security
#VALUEI
goal
o
/o of individuals who go back to school
medium/long
# with
Total participants
and/or get job training
term outcome
program
school/training
with school/job
NVALUE I
oaI
who are reunified with
% of individuals#
medium/long
with family
Total participants
family
term outcome
program
reunification
with family
#NACU€I
reunification goal
u
� of individuals who gettheirchildren
medium/long
Total participants
back
program
#with children
with goal to get
MVALUEI
term outcome
children
% of individuals who discharge into
medium/long
I
program
1housing
# with permanent
Total participants
NVALUEI
permanent housing
term outcome
OlyCAP Transitional Housing Services 2017
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EXHIBIT C
Fee Schedule
Case Manager: At $25.00 an hour -up to $2,536.12 a month for a total of $17,752.80
Maintenance Staf. At $20.00 an hour -up to $1,578.70 a month for a total of $11,051.20
Utilities/Supplies: Up to $11,196.00
Not to exceed a total of $40,000.00 for the duration of this contract without express written
amendment signed by both panties.
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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 /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
OLYCAPR 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.
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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.
OlyCAP Transitional Housing Services 2017
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