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Washington State Health Care Authority - 011419
kc�' 10'1�oi 9 1 1 1A . .10 _W-�A - _;Joc) - WaShin On State HCA Contract Number: K32115 �} PROFESSIONAL SERVICES Resulting from Solicitation Number Health CareArnty CONTRACT for K3300 Opiate Treatment Networks ContractorNendor Contract Number: THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Jefferson County, (Contractor). CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) Jefferson County Sheriffs Office CONTRACTOR ADDRESS I Street City 11 State Zip Code 79 Elkins RoadPort Hadlock i WA 98339-9700 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS Art Frank, Undersheriff 360-3449734 afrank@co.jefferson.wa.us Is Contractor a Subreciplent under this Contract? CFDA NUMBER(S) FFATA Fotm Required ®YES []NO 93.768 ®YES ONO HCAPROGRAM Stste Opioid Response HCA DIVISIONISECTION DBHRISUD Treatment HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Stephanie Endler, Medical Program Specialist 3 Health Care Authority 450010"' Avenue SE Lacey, WA 98503 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS (360) 725-1998 stephanie.endler@hce.wa.gov CONTRACT END DATE 12/31/18 9/29/2019 $463,000 PURPOSE OF CONTRACT: Providing quality and culturally competent replications of evidence -based and research -based substance use prevention programs that focus on reducing the issue and abuse of opioids that would be provided by community-based organizations or public agencies throughout the state of Washington. The parties signing below warrant that they have read and understand this Contract, and have authority to execute this Contract. This Contract will be binding on HCA only upon signature by HCA. CONTRACIPR SIMATURE PRINTED NAME AND TIT%LE[^ DATE SIGNED // 1 y/' ` HCASIQWATURE 11144--'s /V xoow� I PRINTED NAME AND TITLE Jim Gayton, HCA Contracts Administrator I DTE SIGNED l f 41 wlo. I Rev 4/2012017 Washington State PROFESSIONAL SERVICES HCA Contract Number: K3285 Resulting from Solicitation Number Health Care uthority CONTRACT for Opiate Treatment Networks K3300 Contractor/Vendor Contract Number: THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Jefferson County, (Contractor). CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) Jefferson County Sheriffs Office CONTRACTOR ADDRESS I Street City State Zip Code 79 Elkins Road Port Hadlock WA 98339-9700 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS Art Frank, Undersheriff 360-344-9734 afrank@co.jefferson.wa.us Is Contractor a Subrecipient under this Contract? CFDA NUMBER(S): FFATA Form Required ®YES []NO93.788 ®YES ❑NO HCA PROGRAM State Opioid Response HCA DIVISION/SECTION DBHR/SUD Treatment HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Stephanie Endler, Medical Program Specialist 3 Health Care Authority HCA SIG ATURE 4500 10th Avenue SE DATE SIGNED Lacey, WA 98503 HCA CONTACT TELEPHONE HCA CONTACT E-MAIL ADDRESS (360) 725-1998 stephanie.endler@hca.wa.gov CONTRACT START DATE I CONTRACT END DATE I TOTAL MAXIMUM CONTRACT AMOUNT 12/31/18 9/29/2019 i $463,000 Providing quality and culturally competent replications of evidence -based and research -based substance use prevention programs that focus on reducing the issue and abuse of opioids that would be provided by community-based organizations or public agencies throughout the state of Washington. The parties signing below warrant that they have read and understand this Contract, and have authority to execute this Contract. This Contract will be binding on HCA only upon signature by HCA. CONTRACT SIMATURE PRINTED NAME AND TITLE DATE SIGNED i lit r l/1y [- HCA SIG ATURE PRINTED NAME AND TITLE DATE SIGNED Jim Gayton, HCA Contracts Administrator Rev 4/20/2017 TABLE OF CONTENTS Recitals.............................................................................................................................................. 5 1. STATEMENT OF WORK (SOW).................................................................................................. 5 2. DEFINITIONS............................................................................................................................... 5 3. SPECIAL TERMS AND CONDITIONS....................................................................................... 11 3.1 PERFORMANCE EXPECTATIONS.................................................................................. 11 3.2 TERM................................................................................................................................. 12 3.3 COMPENSATION.............................................................................................................. 12 3.4 INVOICE AND PAYMENT.................................................................................................. 13 3.5 CONTRACTOR and HCA CONTRACT MANAGERS......................................................... 14 3.6 LEGAL NOTICES............................................................................................................... 15 3.7 SAMHSA Award Terms...................................................................................................... 15 3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE .......................... 17 3.9 Business Associates Agreement........................................................................................ 17 4. GENERAL TERMS AND CONDITIONS..................................................................................... 18 4.1 ACCESS TO DATA............................................................................................................ 18 4.2 ADVANCE PAYMENT PROHIBITED................................................................................. 18 4.3 AMENDMENTS.................................................................................................................. 18 4.4 ASSIGNMENT....................................................................................................................18 4.5 ATTORNEYS' FEES.......................................................................................................... 18 4.6 CONFIDENTIAL INFORMATION PROTECTION............................................................... 19 4.7 CONFIDENTIAL INFORMATION SECURITY..................................................................... 19 4.8 CONFIDENTIAL INFORMATION BREACH - REQUIRED NOTIFICATION ....................... 19 4.9 CONTRACTOR'S PROPRIETARY INFORMATION........................................................... 20 4.10 COVENANT AGAINST CONTINGENT FEES.................................................................... 21 4.11 DEBARMENT.....................................................................................................................21 4.12 DISPUTES......................................................................................................................... 21 4.13 ENTIRE AGREEMENT....................................................................................................... 22 4.14 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) .................. 22 4.15 FORCE MAJEURE............................................................................................................. 22 4.16 FUNDING WITHDRAWN, REDUCED OR LIMITED........................................................... 23 4.17 GOVERNING LAW............................................................................................................. 23 4.18 INDEMNIFICATION............................................................................................................ 24 4.19 INDEPENDENT CAPACITY OF THE CONTRACTOR....................................................... 24 4.20 INDUSTRIAL INSURANCE COVERAGE........................................................................... 24 Washington State 2 Description of Services Health Care Authority HCA Contract #K 4.21 LEGAL AND REGULATORY COMPLIANCE...................................................................... 24 4.22 LIMITATION OF AUTHORITY............................................................................................ 24 4.23 NO THIRD -PARTY BENEFICIARIES................................................................................. 25 4.24 NONDISCRIMINATION...................................................................................................... 25 4.25 OVERPAYMENTS TO CONTRACTOR.............................................................................. 25 4.26 PAY Equity 25 4.27 PUBLICITY.........................................................................................................................26 4.28 RECORDS AND DOCUMENTS REVIEW.......................................................................... 26 4.29 REMEDIES NON-EXCLUSIVE........................................................................................... 27 4.30 RIGHT OF INSPECTION.................................................................................................... 27 4.31 RIGHTS IN DATA/OWNERSHIP........................................................................................ 27 4.32 RIGHTS OF STATE AND FEDERAL GOVERNMENTS..................................................... 28 4.33 SEVERABILITY..................................................................................................................28 4.34 SITE SECURITY................................................................................................................ 28 4.35 SUBCONTRACTING.......................................................................................................... 29 4.36 SUBRECIPIENT.................................................................................................................29 4.37 SURVIVAL..........................................................................................................................31 4.38 TAXES............................................................................................................................... 31 4.39 TERMINATION...................................................................................................................31 4.40 TERMINATION PROCEDURES......................................................................................... 33 4.41 WAIVER............................................................................................................................. 34 4.42 WARRANTIES....................................................................................................................34 Attachments Attachment 1: Confidential Information Security Requirements Attachment 2: Federal Compliance, Certifications and Assurances Attachment 3: Federal Funding Accountability and Transparency Act Data Collection Form Attachment 4: SAMHSA Center for Substance Abuse Treatment, 1 H79T1081705, Washington State Opioid Response (SOR) Grant, Notice of Award (NOA). Attachment 5: Business Associate Agreement Washington State 3 Description of Services Health Care Authority HCA Contract #K Schedules Schedule A: Statement of Work (SOW) SOR Opiate Treatment Networks Exhibits Exhibit A: HCA RFA #K3300 for SOR Opiate Treatment Networks Exhibit B: Jefferson County Response to HCA RFA #K3300 for SOR Opiate Treatment Networks Note: Exhibits A and B are not attached but are available upon request from the HCA Contracts Administrator. Washington State 4 Description of Services Health Care Authority HCA Contract #K Contract #K3300 for Opiate Treatment Networks Recitals The state of Washington, acting by and through the Health Care Authority (HCA), issued a Request for Applications (RFA) dated October 26, 2018 (Exhibit A) for the purpose to develop Medication Assisted Treatment (MAT) OTNs, with the goal of reducing the morbidity and mortality associated with Opioid Use Disorder (OUD) through an interagency, collaborative statewide effort. The services are in accordance with its authority under chapters 39.26 and 41.05 Revised Code of Washington (RCW). The Contractor submitted a timely Response to HCA's RFA #3300 (Exhibit B). HCA evaluated all properly submitted Responses to the above -referenced RFA and has identified Jefferson County as the Apparently Successful Bidder. HCA has determined that entering into a Contract with Jefferson County will meet RCA's needs and will be in the State's best interest. NOW THEREFORE, HCA awards to Jefferson County this Contract, the terms and conditions of which will govern Contractor's providing to HCA those services aimed at reducing the morbidity and mortality associated with Opioid Use Disorder (OUD) through an interagency, collaborative statewide effort in accordance with the State Opioid Response (SOR) federal grant. IN CONSIDERATION of the mutual promises as set forth in this Contract, the parties agree as follows: 1. STATEMENT OF WORK (SOW) The Contractor will provide the services and staff as described in Schedule A: Statement of Work. 2. DEFINITIONS "Action Plan" means a document that the Contractor completed during the application process and is included Exhibit B. "Agonist" means an FDA -approved opioid agonist medication (e.g., methadone, buprenorphine products including buprenorphine/naloxone combination formulations and buprenorphine mono -product formulations) for the maintenance treatment of opioid use disorder. "Antagonist" means the FDA -approved opioid antagonist medication (e.g., naltrexone products including extended-release and oral formulations) to prevent relapse to opioid use. Washington State 5 Description of Services Health Care Authority HCA Contract #K "ADAI" means the University of Washington's Alcohol and Drug Abuse Institute, and its employees and authorized agents. "ASAM" means the American Society of Addiction Medicine. "Application" means Contractor's Application to HCAs RFA #K3300 for Opiate Treatment Network and is Exhibit B. "Authorized Representative" means a person to whom signature authority has been delegated in writing acting within the limits of his/her authority. "Breach" means the unauthorized acquisition, access, use, or disclosure of Confidential Information that compromises the security, confidentiality, or integrity of the Confidential Information. "Business Associate" means a Business Associate as defined in 45 Code of Federal Regulations (CFR) 160.103, who performs or assists in the performance of an activity for or on behalf of HCA, a Covered Entity, that involves the use or disclosure of protected health information (PHI). Any reference to Business Associate in this DSA includes Business Associate's employees, agents, officers, Subcontractors, third party contractors, volunteers, or directors. "Care Manager" means the nurse or other employee at the Initiation Site who is responsible for providing medical support to the prescribing physician or other waivered prescribers. Duties of the Care Manager include, but are not limited to patient screening, MAT education, assisting with MAT inductions, taking vital signs, drug testing, lab work, medical assessments, charting, care planning, stabilization, maintenance, ongoing coordination of follow-up care, relapse prevention, support for patient self-management, and observation of the patient. "Care Navigator" means the position responsible to provide support and work collaboratively with the Care Manager. In addition, the Care Navigator will work closely and collaboratively with staff at each Local MAT Treatment Site to coordinate patient care, keep the patient engaged with services, address issues related to relapse, and communicate together on patient needs. Duties will also include conducting screenings, scheduling appointments, following up on missed appointments, medication diversion control, grant data recordkeeping and reporting, and making referrals to the appropriate Local MAT Treatment Site. The Care Navigator can be a licensed chemical dependency professional (CDP), behavioral healthcare worker, social worker, primary healthcare worker, or other staff depending on the personnel needs of the Initiation Site. "Chemical Dependency Professional" or "CDP" means an individual certified in chemical dependency counseling by the Washington State Department of Health professional licensing. "CFR" means the Code of Federal Regulations. All references in this Contract to CFR chapters or sections include any successor, amended, or replacement regulation. The CFR may be accessed at httg://www.ecfr.gov/cqi-bin/ECFR?page=browse. Washington State 6 Description of Services Health Care Authority HCA Contract #K "Confidential Information" means information that may be exempt from disclosure to the public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other state or federal statutes or regulations. Confidential Information includes, but is not limited to, any information identifiable to an individual that relates to a natural person's health, (see also Protected Health Information); finances, education, business, use or receipt of governmental services, names, addresses, telephone numbers, social security numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and any other identifying numbers, law enforcement records, HCA source code or object code, or HCA or State security information. "Contract" means this Contract document and all schedules, exhibits, attachments, incorporated documents and amendments. "Contractor" means Jefferson County, its employees and agents. Contractor includes any firm, provider, organization, individual or other entity performing services under this Contract. It also includes any Subcontractor retained by Contractor as permitted under the terms of this Contract. "Covered entity" means a health plan, a health care clearinghouse or a health care provider who transmits any health information in electronic form to carry out financial or administrative activities related to health care, as defined in 45 CFR 160.103. "CLAS" or national "Culturally and Linguistically Appropriate Services" means the standards in health and health care intended to advance health equity, improve quality, and help eliminate health disparities by establishing a blueprint for health and health care organizations. "Data" means information produced, furnished, acquired, or used by Contractor in meeting requirements under this Contract. "Data Coordinator" means the person responsible for managing all data collection activities and also serves as the liaison between the OTN and the Project Evaluators (RDA). The Coordinator must become competent in all aspects of GPRA data collection (intake, three- month and six-month follow ups and discharge) required for this project (including completion of SAMHSA GRPA training and project data collection systems) and be available and responsive to Project Evaluators (RDA). "DBHR" means the Division of Behavioral Health and Recovery or its successor. "DUNS" or "Data Universal Numbering System" means a unique identifier for businesses. DUNS numbers are assigned and maintained by Dun and Bradstreet (D&B) and are used for a variety of purposes, including applying for government contracting opportunities. "Effective Date" means the first date this Contract is in full force and effect. It may be a specific date agreed to by the parties; or, if not so specified, the date of the last signature of a party to this Contract. Washington State 7 Description of Services Health Care Authority HCA Contract #K "Electronic Health Records or "EHR" means a certified electronic health record system that has been tested and certified by an approved Office of National Coordinator for Health Information Technology's (ONC) certifying body. "Evidence -based Practice" or "EBP" means a prevention or treatment service or practice that has been validated by some form of documented research evidence and is appropriate for use with individuals with an opioid use disorder. "FDA" means the U.S. Food and Drug Administration. "GPRA" means Government Performance Results and Modernization Act. Grantees must comply with the GPRA Modernization Act of 2010. "HCA Contract Manager" means the individual identified on the cover page of this Contract who will provide oversight of the Contractor's activities conducted under this Contract. "Health Care Authority" or "HCA" means the Washington State Health Care Authority, any division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully representing HCA. "Health Disparities" means "a particular type of health difference that is closely linked with social, economic, and/or environmental disadvantage. Health disparities adversely affect groups of people who have systematically experienced greater obstacles to health based on their racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics historically linked to discrimination or exclusion." (Healthy People 2020). "Health Equity" means the "attainment of the highest level of health for all people. Achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequalities, historical and contemporary injustices, and the elimination of health and health care disparities." (Healthy People 2020). "Induct" means the medically monitored initiation of treatment medication when a person with an opioid use disorder has abstained from using opioids for the appropriate amount of time in order to tolerate the utilization of MAT. "Initiation Site Prescriber" or "Waivered Prescriber" means a physician, physician's assistant (PA), or nurse practitioner (NP) that has obtained and maintained a current DATA 2000 Waiver to prescribe buprenorphine and other medications. A prescriber will also inform individuals regarding the risks and benefits of MAT, allow for shared -decision making and address other presenting medical needs either directly or by referral. "Integrated Care" means the organized delivery and/or coordination of medical, behavioral or social and recovery support services provided for individuals. Washington State 8 Description of Services Health Care Authority HCA Contract #K "Local MAT Treatment Site" means a facility that will provide Opioid Use Disorder (OUD) treatment medications, behavioral health treatment and/or primary healthcare services, and/or wrap around services, and referrals. Local MAT Treatment Site may be a federally qualified health center (FQHC), opioid treatment program, outpatient substance use disorder treatment facility, mental health clinic, or integrated behavioral health clinic. "Medication Assisted Treatment" or "MAT" means the use of FDA -approved opioid agonist medications (e.g., methadone, buprenorphine products including buprenorphine/naloxone combination formulations and buprenorphine mono -product formulations) for the treatment of opioid use disorder and the use of opioid antagonist medication (e.g. naltrexone products including extended-release and oral formulations) to prevent relapse to opioid use. "OTN" means an Opioid Treatment Network that includes an Initiation Site and Local MAT Treatment Site(s). "OUD" means Opioid Use Disorder as defined by a pattern of problematic use of opioids, whether prescription painkillers, or heroin, or other illicit synthetic opioids. Practitioners use criteria from the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) to diagnose opioid use disorder "Overpayment" means any payment or benefit to the Contractor in excess of that to which the Contractor is entitled by law, rule, or this Contract, including amounts in dispute. "Prescriber/Administrator" means the position responsible for developing, administering, and overseeing the program and ongoing performance of the OTN. Initiation Sites may use funding to provide oversight and management to an administrator if more appropriate, depending on the business needs of the OTN. "Proprietary Information" means information owned by Contractor to which Contractor claims a protectable interest under law. Proprietary Information includes, but is not limited to, information protected by copyright, patent, trademark, or trade secret laws. "Protected Health Information" or "PHI" means individually identifiable information that relates to the provision of health care to an individual; the past, present, or future physical or mental health or condition of an individual; or past, present, or future payment for provision of health care to an individual, as defined in 45 CFR 160.103. Individually identifiable information is information that identifies the individual or about which there is a reasonable basis to believe it can be used to identify the individual, and includes demographic information. PHI is information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501. PHI does not include education records covered by the Family Educational Rights and Privacy Act, as amended, 20 United States Code (USC) 1232g(a)(4)(b)(iv). "Report" or "Monthly Report" means and refers to a report that the Contractor will complete and submit to DBHR on a monthly basis prior to monthly reimbursement. Washington State 9 Description of Services Health Care Authority HCA Contract #K "RDA" means the Department of Social and Health Services, Research and Data Analysis Division, to whom the Contractor will send required patient and program data through a secure data file transfer. "Response" means Contractor's Response to HCA's RFA #K3300 for SOR Opiate Treatment Networks and is Exhibit B hereto. "RCW" means the Revised Code of Washington. All references in this Contract to RCW chapters or sections include any successor, amended, or replacement statute. Pertinent RCW chapters can be accessed at: http://apps.lea.wa.aov/rcw/. "RFA" means the Request for Applications used as the solicitation document to establish this Contract, including all its amendments and modifications and is attached as Exhibit A. "SAMHSA" means the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and its employees and authorized agents. "SPARS" means SAMHSA's Performance Accountability and Reporting System—SPARS is an online data entry, reporting, technical assistance request, and training system to support grantees in reporting timely and accurate data to SAMHSA. This system or an alternative system, which will be defined later, will be required for GRPA reporting. "Standard Reporting Tool" or "RDA -SRT" means a reporting tool provided by RDA to routinely report on items required by SAMHSA that includes, but is not limited to: treatment requirements, training requirements, and other services and outcomes to be determined. "Statement of Work" or "SOW" means a detailed description of the work activities the Contractor is required to perform under the terms and conditions of this Contract, including the deliverables and timeline, and is Schedule A hereto. "State Opioid Response" or "SOR" means the Federal Substance Abuse and Mental Health Services Administration (SAMHSA) Grants Funding Opportunity TI -18-015 supporting implementation of this state grant project. Anticipated start date 9/30/2018; length of project period is up to two years. More information can be found at: https://www.samhsa.gov/sites/default/files/g rants/pdf/sorfoafinal.6.14.18. pdf. "Subcontractor" means a person or entity that is not in the employment of the Contractor, who is performing all or part of the business activities under this Contract under a separate contract with Contractor. The term "Subcontractor" means subcontractor(s) of any tier. "Subrecipient" means a contractor operating a federal or state assistance program receiving federal funds and having the authority to determine both the services rendered and disposition of program. See Office of Management and Budget (OMB) Super Circular 2 CFR 200.501 and 45 CFR 75.501, "Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards for additional detail. Washington State 10 Description of Services Health Care Authority HCA Contract #K "SUD" means substance use disorder. Practitioners use criteria from the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5). "Unique" means an individual who is counted once, regardless of the number of times he/she enters treatment within the same Opioid Treatment Network. "USC" means the United States Code. All references in this Contract to USC chapters or sections shall include any successor, amended, or replacement statute. The USC may be accessed at http://uscode.house. aov/ 3. SPECIAL TERMS AND CONDITIONS 3.1 PERFORMANCE EXPECTATIONS EXPECTED PERFORMANCE UNDER THIS CONTRACT INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING: 3.1.1 Knowledge of applicable state and federal laws and regulations pertaining to subject of contract; 3.1.1.1 21 CFR Food and Drugs Chapter 1, Subchapter C, Drugs: General hftps://www.law.cornelI.edu/cfr/text/21/chapter-I/subchapter-C 3.1.1.2 42 CFR Subchapter A -General Provisions Part 2 Confidentiality of Alcohol and Drug Abuse Patient Records hftps://www.law.cornell.edu/cfr/text/45/part-96/subpart-L 3.1.1.3 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for HHS Awards 2 CFR Part 200 in 45 CFR Part 75 https://www.law.cornel1.edu/cfr/text/2/part-200 hftps://www.law.cornell.edu/cfr/text/45/part-75 3.1.2 Use of professional judgment; 3.1.3 Collaboration with HCA staff in Contractor's conduct of the services; 3.1.4 Conformance with HCA directions regarding the delivery of the services; 3.1.5 Timely, accurate and informed communications; 3.1.6 Regular completion and updating of project plans, reports, documentation and communications; 3.1.7 Ensure all services and activities provided by the Contractor or subcontractor, shall be designed and delivered in a manner sensitive to the needs of all diverse populations; Washington State 11 Description of Services Health Care Authority HCA Contract #K 3.1.8 Regular, punctual attendance at all meetings; and 3.1.9 Provision of high quality services. 3.1.10 Prior to payment of invoices, HCA will review and evaluate the performance of Contractor in accordance with Contract and these performance expectations and may withhold payment if expectations are not met or Contractor's performance is unsatisfactory. 3.2 TERM 3.2.1 The initial term of the Contract will commence on December 31, 2018, and continue through September 29, 2019, unless terminated sooner as provided herein. 3.2.2 This Contract may be extended in whatever time increments HCA deems appropriate. In addition, HCA reserves the sole right to extend the contract beyond this date in accordance with the terms of RFA #K3300 (Exhibit A). No change in terms and conditions will be permitted during these extensions unless specifically agreed to in writing. 3.2.3 Work performed without a contract or amendment signed by the authorized representatives of both parties will be at the sole risk of the Contractor. HCA will not pay any costs incurred before a contract or any subsequent amendment(s) is fully executed. 3.3 COMPENSATION 3.3.1 Compensation for the work provided in accordance with this Agreement has been established under the terms of RCW 39.34.130. The Maximum Compensation payable to Contractor for the performance of all things necessary for or incidental to the performance of work as set forth in Schedule A: Statement of Work is $463,000, and includes any allowable expenses. 3.3.2 Contractor's compensation for services rendered will be based on the amounts listed in the Deliverables Table Schedule A: Statement of Work. 3.3.3 Federal funds disbursed through this Contract were received by HCA through OMB Catalogue of Federal Domestic Assistance (CFDA) Number: Washington State 12 Description of Services Health Care Authority HCA Contract #K 3.3.3.1 93.788, SAMHSA Center for Substance Abuse Treatment, 1 H79T1081705, Washington State Opioid Response (SOR) Grant. 3.3.3.2 Contractor agrees to comply with applicable rules and regulations associated with these federal funds and has signed Attachment 2: Federal Compliance, Certification and Assurances, attached. 3.4 INVOICE AND PAYMENT 3.4.1 Contractor must submit accurate State Form A-19 invoices, or other such forms as designated by HCA to the following address for all amounts to be paid by HCA via e-mail to: Acctspay(a-)_hca.wa.gov. Include the HCA Contract number in the subject line of the email and cc the Contract Manager when submitting the invoice. 3.4.2 Invoices must describe and document to HCA's satisfaction a description of the work performed, the progress of the project, and fees. If expenses are invoiced, invoices must provide a detailed breakdown of each type. 3.4.3 Contractor must submit properly itemized invoices to include the following information, as applicable: 3.4.3.1 HCA Contract number K3285; 3.4.3.2 Contractor name, address, phone number; 3.4.3.3 Description of Services; 3.4.3.4 Date(s) of delivery; 3.4.3.5 Net invoice price for each item; 3.4.3.6 Applicable taxes; 3.4.3.7 Total invoice price; and 3.4.3.8 Payment terms and any available prompt payment discount. 3.4.4 HCA will return incorrect or incomplete invoices to the Contractor for correction and reissue. The Contract Number must appear on all invoices, bills of lading, packages, and correspondence relating to this Contract. 3.4.5 In order to receive payment for services or products provided to a state agency, Contractor must register with the Statewide Payee Desk at http://des wa gov/services/ContractingPurchasing/BusinessNendorPav/Pages/defa ult.aspx. 3.4.6 Payment will be considered timely if made by HCA within thirty (30) calendar days of receipt of properly completed invoices. Payment will be directly deposited in the bank account or sent to the address Contractor designated in its registration. Washington State 13 Description of Services Health Care Authority HCA Contract #K 3.4.7 Upon expiration of the Contract, any claims for payment for costs due and payable under this Contract that are incurred prior to the expiration date must be submitted by the Contractor to HCA within sixty (60) calendar days after the Contract expiration date. HCA is under no obligation to pay any claims that are submitted sixty-one (61) or more calendar days after the Contract expiration date ("Belated Claims"). HCA will pay Belated Claims at its sole discretion, and any such potential payment is contingent upon the availability of funds. 3.4.7.1 Submit final billing for services provided within forty-five (45) days after the end of the State Fiscal Year. 3.4.7.2 Submit final billing for services for SOR within forty-five (45) days after the end of each Federal Fiscal Year. 3.4.8 SOR funds may not be carried forward from year to year. 3.5 CONTRACTOR AND HCA CONTRACT MANAGERS 3.5.1 Contractor's Contract Manager will have prime responsibility and final authority for the services provided under this Contract and be the principal point of contact for the HCA Contract Manager for all business matters, performance matters, and administrative activities. 3.5.2 HCA's Contract Manager, or designee is responsible for monitoring the Contractor's performance and will be the contact person for all communications regarding contract performance and deliverables. The HCA Contract Manager, or designee has the authority to accept or reject the services provided and must approve Contractor's invoices prior to payment. 3.5.3 The contact information provided below may be changed by written notice of the change (email acceptable) to the other party. CONTRACTOR Contract Manager Information Health Care Authority Contract Manager Information Name: Art Frank Name: Stephanie Endler Title: Undersheriff Title: Medical Program Specialist 3 Address: 79 Elkins Road; Port Hadlock, WA 98339-9700 Address: Post Office Box 45330; Olympia, WA 98504-5330 Phone: 360-344-9734 Phone: 360-725-1998 Email: afrank@co.jefferson.wa.us Email: stephanie.endler@hca.wa.gov Washington State 14 Description of Services Health Care Authority HCA Contract #K 3.6 LEGAL NOTICES Any notice or demand or other communication required or permitted to be given under this Contract or applicable law is effective only if it is in writing and signed by the applicable party, properly addressed, and delivered in person, via email, or by a recognized courier service, or deposited with the United States Postal Service as first-class mail, postage prepaid certified mail, return receipt requested, to the parties at the addresses provided in this section. 3.6.1 In the case of notice to the Contractor: Art Frank, Undersheriff Jefferson County 79 Elkins Road Port Hadlock, WA 98339-9700 3.6.2 In the case of notice to HCA: Attention: Contracts Administrator Health Care Authority Division of Legal Services Post Office Box 42702 Olympia, WA 98504-2702 3.6.3 Notices are effective upon receipt or four (4) Business Days after mailing, whichever is earlier. 3.6.4 The notice address and information provided above may be changed by written notice of the change given as provided above. 3.7 SAMHSA AWARD TERMS. 3.7.1 General. If the Contractor is a Subrecipient of federal awards under any Program Agreement as defined by 2 CFR Part 200, the Contractor shall: 3.7.1.1 Comply with the all applicable provisions of the Notice of Awards for SOR grants, Attachment 4. This includes any linked documents for Fiscal Year 2018 — Award Standard Terms, if applicable. 3.7.1.2 Maintain records that identify, in its accounts, all federal awards received and expended and the federal programs under which they were received, by Catalog of Federal Domestic Assistance (CFDA) title and number, award number and year, name of the federal agency, and name of the pass-through entity; 3.7.1.3 Maintain internal controls that provide reasonable assurance that the Contractor is managing federal awards in compliance with laws, regulations, and Washington State 15 Description of Services Health Care Authority HCA Contract #K provisions of contracts or grant agreements that could have a material effect on each of its federal programs; 3.7.1.4 Comply with requirements of Charitable Choice (42 USC 300x-65 and 42 CFR Section 54); 3.7.1.4.1 The Contractor shall ensure that Charitable Choice Requirements of 42 CFR Part 54 are followed and that Faith -Based Organizations (FBO) are provided opportunities to compete with traditional alcohol/drug abuse prevention providers for funding. 3.7.1.4.2 If the Contractor subcontracts with FBOs, the Contractor shall require the FBO to meet the requirements of 42 CFR Part 54 as follows: 3.7.1.4.3 Applicants/recipients for/of services shall be provided with a choice of prevention providers. 3.7.1.4.4 The FBO shall facilitate a referral to an alternative provider within a reasonable time frame when requested by the recipient of services. 3.7.1.4.5 The FBO shall report to the Contractor all referrals made to alternative providers. 3.7.1.4.6 The FBO shall provide recipients with a notice of their rights. 3.7.1.4.7 The FBO provides recipients with a summary of services that includes any inherently religious activities. Prepare appropriate financial statements, including a schedule of expenditures of federal awards; 3.7.1.5 Prepare appropriate financial statements, including a schedule of expenditures of federal awards; 3.7.1.6 Incorporate 2 CFR Part 200, Subpart F audit requirements into all agreements between the Contractor and its Subcontractors who are Subrecipients; 3.7.1.7 Comply with the applicable requirements of 2 CFR Part 200, including any future amendments to 2 CFR Part 200, and any successor or replacement Office of Management and Budget (OMB) Circular or regulation; and 3.7.1.8 Comply with the Omnibus Crime Control and Safe Streets Act of 1968; Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of 1973; Title II of the Americans with Disabilities Act of 1990; Title IX of the Education Amendments of 1972; The Age Discrimination Act of 1975; and The Department of Justice Non -Discrimination Regulations at 28 CFR Part 42, Subparts C, D, E, and G, and 28 CFR Parts 35 and 39. (Go to Washington State 16 Description of Services Health Care Authority HCA Contract #K www.oip.usdoi..qov/ocr/ for additional information and access to the aforementioned Federal laws and regulations.) 3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE Each of the documents listed below is by this reference incorporated into this Contract. In the event of an inconsistency, the inconsistency will be resolved in the following order of precedence: 3.8.1 Applicable Federal and State of Washington statutes and regulations; 3.8.2 Business Associate Agreement, Attachment 5; 3.8.3 Recitals 3.8.4 Special Terms and Conditions; 3.8.5 General Terms and Conditions; 3.8.6 Attachment 1: Confidential Information Security Requirements; 3.8.7 Attachment 2: Federal Compliance, Certifications and Assurances; 3.8.8 Attachment 3: Federal Funding Accountability and Transparency Act Data Collection Form; 3.8.9 Schedule A(s): Statement(s) of Work; 3.8.10 Exhibit A: HCA RFA #K3300 for SOR Opiate Treatment Networks, dated 10/26/18; 3.8.11 Exhibit B: Contractor's Response dated November 20, 2018; and 3.8.12 Any other provision, term or material incorporated herein by reference or otherwise incorporated. 3.9 BUSINESS ASSOCIATES AGREEMENT Contractor agrees that it is a "Business Associate" of HCA as that term is defined in the rules promulgated under the Health Insurance Portability and Accountability (HIPAA). Contractor further agrees to comply with such rules and as further set forth in Attachment 5, Business Associate Agreement, of this Contract. If there is a conflict between the provisions of Attachment 5 and provisions of this Agreement, then Attachment 5 controls. If the other Contract is terminated, Attachment 5 nonetheless continues in effect. Washington State 17 Description of Services Health Care Authority HCA Contract #K 4. GENERAL TERMS AND CONDITIONS 4.1 ACCESS TO DATA In compliance with RCW 39.26.180 (2) and federal rules, the Contractor must provide access to any data generated under this Contract to HCA, the Joint Legislative Audit and Review Committee, the State Auditor, and any other state or federal officials so authorized by law, rule, regulation, or agreement at no additional cost. This includes access to all information that supports the findings, conclusions, and recommendations of the Contractor's reports, including computer models and methodology for those models. 4.2 ADVANCE PAYMENT PROHIBITED No advance payment will be made for services furnished by the Contractor pursuant to this Contract. 4.3 AMENDMENTS This Contract may be amended by mutual agreement of the parties. Such amendments will not be binding unless they are in writing and signed by personnel authorized to bind each of the parties. 4.4 ASSIGNMENT 4.4.1 Contractor may not assign or transfer all or any portion of this Contract or any of its rights hereunder, or delegate any of its duties hereunder, except delegations as set forth in Section 4.35, Subcontracting, without the prior written consent of HCA. Any permitted assignment will not operate to relieve Contractor of any of its duties and obligations hereunder, nor will such assignment affect any remedies available to HCA that may arise from any breach of the provisions of this Contract or warranties made herein, including but not limited to, rights of setoff. Any attempted assignment, transfer or delegation in contravention of this Subsection 4.4.1 of the Contract will be null and void. 4.4.2 HCA may assign this Contract to any public agency, commission, board, or the like, within the political boundaries of the State of Washington, with written notice of thirty (30) calendar days to Contractor. 4.4.3 This Contract will inure to the benefit of and be binding on the parties hereto and their permitted successors and assigns. 4.5 ATTORNEYS' FEES In the event of litigation or other action brought to enforce the terms of this Contract, each party agrees to bear its own attorneys' fees and costs. Washington State 18 Description of Services Health Care Authority HCA Contract #K 4.6 CONFIDENTIAL INFORMATION PROTECTION 4.6.1 Contractor acknowledges that some of the material and information that may come into its possession or knowledge in connection with this Contract or its performance may consist of Confidential Information. Contractor agrees to hold Confidential Information in strictest confidence and not to make use of Confidential Information for any purpose other than the performance of this Contract, to release it only to authorized employees or Subcontractors requiring such information for the purposes of carrying out this Contract, and not to release, divulge, publish, transfer, sell, disclose, or otherwise make the information known to any other party without HCA's express written consent or as provided by law. Contractor agrees to implement physical, electronic, and managerial safeguards to prevent unauthorized access to Confidential Information (See Attachment 1: Confidential Information Security Requirements). 4.6.2 Contractors that come into contact with Protected Health Information may be required to enter into a Business Associate Agreement with HCA in compliance with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub. L. 104-191, as modified by the American Recovery and Reinvestment Act of 2009 ("ARRA"), Sec. 13400 — 13424, H.R. 1 (2009) (HITECH Act) (HIPAA). 4.6.3 HCA reserves the right to monitor, audit, or investigate the use of Confidential Information collected, used, or acquired by Contractor through this Contract. Violation of this section by Contractor or its Subcontractors may result in termination of this Contract and demand for return of all Confidential Information, monetary damages, or penalties. 4.6.4 The obligations set forth in this Section will survive completion, cancellation, expiration, or termination of this Contract. 4.7 CONFIDENTIAL INFORMATION SECURITY The federal government, including the Substance Abuse and Mental Health Services Administration (SAMHSA), and the State of Washington all maintain security requirements regarding privacy, data access, and other areas. Contractor is required to comply with the Confidential Information Security Requirements set out in Attachment 1 to this Contract and appropriate portions of the Washington OCIO Security Standard, 141.10 (https://ocio.wa.gov/policies/141-securing-information- technologv-assets/14110-securing-information-technologv-assets). 4.8 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION 4.8.1 Contractor must notify the HCA Privacy Officer(HCAPrivacvOfficer(&hca.wa.gov) within five Business Days of discovery of any Breach or suspected Breach of Confidential Information. Washington State 19 Description of Services Health Care Authority HCA Contract #K 4.8.2 Contractor will take steps necessary to mitigate any known harmful effects of such unauthorized access including, but not limited to, sanctioning employees and taking steps necessary to stop further unauthorized access. Contractor agrees to indemnify and hold HCA harmless for any damages related to unauthorized use or disclosure of Confidential Information by Contractor, its officers, directors, employees, Subcontractors or agents. 4.8.3 If notification of the Breach or possible Breach must (in the judgment of HCA) be made under the HIPAA Breach Notification Rule, or RCW 42.56.590 or RCW 19.255.010, or other law or rule, then: 4.8.3.1 HCA may choose to make any required notifications to the individuals, to the U.S. Department of Health and Human Services Secretary (DHHS) Secretary, and to the media, or direct Contractor to make them or any of them. 4.8.3.2 In any case, Contractor will pay the reasonable costs of notification to individuals, media, and governmental agencies and of other actions HCA reasonably considers appropriate to protect HCA clients (such as paying for regular credit watches in some cases). 4.8.3.3 Contractor will compensate HCA clients for harms caused to them by any Breach or possible Breach. 4.8.4 Any breach of this clause may result in termination of the Contract and the demand for return or disposition (Attachment 1, Section 6) of all Confidential Information. 4.8.5 Contractor's obligations regarding Breach notification survive the termination of this Contract and continue for as long as Contractor maintains the Confidential Information and for any breach or possible breach at any time. 4.9 CONTRACTOR'S PROPRIETARY INFORMATION Contractor acknowledges that HCA is subject to chapter 42.56 RCW, the Public Records Act, and that this Contract will be a public record as defined in chapter 42.56 RCW. Any specific information that is claimed by Contractor to be Proprietary Information must be clearly identified as such by Contractor. To the extent consistent with chapter 42.56 RCW, HCA will maintain the confidentiality of Contractor's information in its possession that is marked Proprietary. If a public disclosure request is made to view Contractor's Proprietary Information, HCA will notify Contractor of the request and of the date that such records will be released to the requester unless Contractor obtains a court order from a court of competent jurisdiction enjoining that disclosure. If Contractor fails to obtain the court order enjoining disclosure, HCA will release the requested information on the date specified. Washington State 20 Description of Services Health Care Authority HCA Contract #K 4.10 COVENANT AGAINST CONTINGENT FEES Contractor warrants that no person or selling agent has been employed or retained to solicit or secure this Contract upon an agreement or understanding for a commission, percentage, brokerage or contingent fee, excepting bona fide employees or bona fide established agents maintained by the Contractor for the purpose of securing business. HCA will have the right, in the event of breach of this clause by the Contractor, to annul this Contract without liability or, in its discretion, to deduct from the contract price or consideration or recover by other means the full amount of such commission, percentage, brokerage or contingent fee. 4.11 DEBARMENT By signing this Contract, Contractor certifies that it is not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal department or agency from participating in transactions (debarred). Contractor agrees to include the above requirement in any and all subcontracts into which it enters, and also agrees that it will not employ debarred individuals. Contractor must immediately notify HCA if, during the term of this Contract, Contractor becomes debarred. HCA may immediately terminate this Contract by providing Contractor written notice, if Contractor becomes debarred during the term hereof. 4.12 DISPUTES The parties will use their best, good faith efforts to cooperatively resolve disputes and problems that arise in connection with this Contract. Both parties will continue without delay to carry out their respective responsibilities under this Contract while attempting to resolve any dispute. When a genuine dispute arises between HCA and the Contractor regarding the terms of this Contract or the responsibilities imposed herein and it cannot be resolved between the parties' Contract Managers, either party may initiate the following dispute resolution process. 4.12.1 The initiating party will reduce its description of the dispute to writing and deliver it to the responding party (email acceptable). The responding party will respond in writing within five (5) Business Days (email acceptable). If the initiating party is not satisfied with the response of the responding party, then the initiating party may request that the HCA Director review the dispute. Any such request from the initiating party must be submitted in writing to the HCA Director within five (5) Business Days after receiving the response of the responding party. The HCA Director will have sole discretion in determining the procedural manner in which he or she will review the dispute. The HCA Director will inform the parties in writing within five (5) Business Days of the procedural manner in which he or she will review the dispute, including a timeframe in which he or she will issue a written decision. Washington State 21 Description of Services Health Care Authority HCA Contract #K 4.12.2 A party's request for a dispute resolution must: 4.12.2.1 Be in writing; 4.12.2.2 Include a written description of the dispute; 4.12.2.3 State the relative positions of the parties and the remedy sought; 4.12.2.4 State the Contract Number and the names and contact information for the parties; 4.12.3 This dispute resolution process constitutes the sole administrative remedy available under this Contract. The parties agree that this resolution process will precede any action in a judicial or quasi-judicial tribunal. 4.13 ENTIRE AGREEMENT HCA and Contractor agree that the Contract is the complete and exclusive statement of the agreement between the parties relating to the subject matter of the Contract and supersedes all letters of intent or prior contracts, oral or written, between the parties relating to the subject matter of the Contract, except as provided in Section 4.42 Warranties. 4.14 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) 4.14.1 This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. 4.14.2 To comply with the act and be eligible to enter into this Contract, Contractor must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If Contractor does not already have one, a DUNS® number is available free of charge by contacting Dun and Bradstreet at www.dnb.com. 4.14.3 Information about Contractor and this Contract will be made available on www.uscontractorregistration.com by HCA as required by P.L. 109-282. HCA's Attachment 3: Federal Funding Accountability and Transparency Act Data Collection Form, is considered part of this Contract and must be completed and returned along with the Contract. 4.15 FORCE MAJEURE A party will not be liable for any failure of or delay in the performance of this Contract for the period that such failure or delay is due to causes beyond its reasonable control, including but not limited to acts of God, war, strikes or labor disputes, embargoes, government orders or any other force majeure event. Washington State 22 Description of Services Health Care Authority HCA Contract #K 4.16 FUNDING WITHDRAWN, REDUCED OR LIMITED If HCA determines in its sole discretion that the funds it relied upon to establish this Contract have been withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding after the effective date of this contract but prior to the normal completion of this Contract, then HCA, at its sole discretion, may: 4.16.1 Terminate this Contract pursuant to Section 4.39.3, Termination for Non -Allocation of Funds; 4.16.2 Renegotiate the Contract under the revised funding conditions; or 4.16.3 Suspend Contractor's performance under the Contract upon five (5) Business Days' advance written notice to Contractor. HCA will use this option only when HCA determines that there is reasonable likelihood that the funding insufficiency may be resolved in a timeframe that would allow Contractor's performance to be resumed prior to the normal completion date of this Contract. 4.16.3.1 During the period of suspension of performance, each party will inform the other of any conditions that may reasonably affect the potential for resumption of performance. 4.16.3.2 When HCA determines in its sole discretion that the funding insufficiency is resolved, it will give Contractor written notice to resume performance. Upon the receipt of this notice, Contractor will provide written notice to HCA informing HCA whether it can resume performance and, if so, the date of resumption. For purposes of this subsection, "written notice" may include email. 4.16.3.3 If the Contractor's proposed resumption date is not acceptable to HCA and an acceptable date cannot be negotiated, HCA may terminate the contract by giving written notice to Contractor. The parties agree that the Contract will be terminated retroactive to the date of the notice of suspension. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the retroactive date of termination. 4.17 GOVERNING LAW This Contract is governed in all respects by the laws of the state of Washington, without reference to conflict of law principles. The jurisdiction for any action hereunder is exclusively in the Superior Court for the state of Washington, and the venue of any action hereunder is in the Superior Court for Thurston County, Washington. Nothing in this Contract will be construed as a waiver by HCA of the State's immunity under the 11 m Amendment to the United States Constitution. Washington State 23 Description of Services Health Care Authority HCA Contract #K 4.18 INDEMNIFICATION To the extent permitted by law, Contractor must defend, indemnify, and save HCA harmless from and against all claims, including reasonable attorneys' fees resulting from such claims, for any or all injuries to persons or damage to property, or Breach of its confidentiality and notification obligations under Section 4.6 Confidential Information Protection and Section 4.7 Confidentiality Breach -Required Notification, arising from intentional or negligent acts or omissions of Contractor, its officers, employees, or agents, or Subcontractors, their officers, employees, or agents, in the performance of this Contract. 4.19 INDEPENDENT CAPACITY OF THE CONTRACTOR The parties intend that an independent contractor relationship will be created by this Contract. Contractor and its employees or agents performing under this Contract are not employees or agents of HCA. Contractor will not hold itself out as or claim to be an officer or employee of HCA or of the State of Washington by reason hereof, nor will Contractor make any claim of right, privilege or benefit that would accrue to such employee under law. Conduct and control of the work will be solely with Contractor. 4.20 INDUSTRIAL INSURANCE COVERAGE Prior to performing work under this Contract, Contractor must provide or purchase industrial insurance coverage for the Contractor's employees, as may be required of an "employer" as defined in Title 51 RCW, and must maintain full compliance with Title 51 RCW during the course of this Contract. 4.21 LEGAL AND REGULATORY COMPLIANCE 4.21.1 During the term of this Contract, Contractor must comply with all local, state, and federal licensing, accreditation and registration requirements/standards, necessary for the performance of this Contract and all other applicable federal, state and local laws, rules, and regulations. 4.21.2 While on the HCA premises, Contractor must comply with HCA operations and process standards and policies (e.g., ethics, Internet / email usage, data, network and building security, harassment, as applicable). HCA will make an electronic copy of all such policies available to Contractor. 4.21.3 Failure to comply with any provisions of this section may result in Contract termination. 4.22 LIMITATION OF AUTHORITY Only the HCA Authorized Representative has the express, implied, or apparent authority to alter, amend, modify, or waive any clause or condition of this Contract. Washington State 24 Description of Services Health Care Authority HCA Contract #K Furthermore, any alteration, amendment, modification, or waiver or any clause or condition of this Contract is not effective or binding unless made in writing and signed by the HCA Authorized Representative. 4.23 NO THIRD -PARTY BENEFICIARIES HCA and Contractor are the only parties to this contract. Nothing in this Contract gives or is intended to give any benefit of this Contract to any third parties. 4.24 NONDISCRIMINATION During the performance of this Contract, the Contractor must comply with all federal and state nondiscrimination laws, regulations and policies, including but not limited to: Title VII of the Civil Rights Act, 42 U.S.C. §12101 et seq.; the Americans with Disabilities Act of 1990 (ADA), 42 U.S.C. §12101 et seq., 28 CFR Part 35; and Title 49.60 RCW, Washington Law Against Discrimination. In the event of Contractor's noncompliance or refusal to comply with any nondiscrimination law, regulation or policy, this Contract may be rescinded, canceled, or terminated in whole or in part under the Termination for Default sections, and Contractor may be declared ineligible for further contracts with HCA. 4.25 OVERPAYMENTS TO CONTRACTOR In the event that overpayments or erroneous payments have been made to the Contractor under this Contract, HCA will provide written notice to Contractor and Contractor shall refund the full amount to HCA within thirty (30) calendar days of the notice. If Contractor fails to make timely refund, HCA may charge Contractor one percent (1%) per month on the amount due, until paid in full. If the Contractor disagrees with HCA's actions under this section, then it may invoke the dispute resolution provisions of Section 4.12 Disputes. 4.26 PAY EQUITY 4.26.1 Contractor represents and warrants that, as required by Washington state law (Laws of 2017, Chap. 1, § 147), during the term of this Contract, it agrees to equality among its workers by ensuring similarly employed individuals are compensated as equals. For purposes of this provision, employees are similarly employed if (i) the individuals work for Contractor, (ii) the performance of the job requires comparable skill, effort, and responsibility, and (iii) the jobs are performed under similar working conditions. Job titles alone are not determinative of whether employees are similarly employed. 4.26.2 Contractor may allow differentials in compensation for its workers based in good faith on any of the following: (i) a seniority system; (ii) a merit system; (iii) a system that measures earnings by quantity or quality of production; (iv) bona fide job- related factor(s); or (v) a bona fide regional difference in compensation levels. Washington State 25 Description of Services Health Care Authority HCA Contract #K 4.26.3 Bona fide job-related factor(s)" may include, but not be limited to, education, training, or experience, that is: (i) consistent with business necessity; (ii) not based on or derived from a gender-based differential; and (iii) accounts for the entire differential. 4.26.4 A "bona fide regional difference in compensation level" must be (i) consistent with business necessity; (ii) not based on or derived from a gender-based differential; and (iii) account for the entire differential. 4.26.5 Notwithstanding any provision to the contrary, upon breach of warranty and Contractor's failure to provide satisfactory evidence of compliance within thirty (30) Days of RCA's request for such evidence, HCA may suspend or terminate this Contract. 4.27 PUBLICITY 4.27.1 The award of this Contract to Contractor is not in any way an endorsement of Contractor or Contractor's Services by HCA and must not be so construed by Contractor in any advertising or other publicity materials. 4.27.2 Contractor agrees to submit to HCA, all advertising, sales promotion, and other publicity materials relating to this Contract or any Service furnished by Contractor in which HCA's name is mentioned, language is used, or Internet links are provided from which the connection of HCA's name with Contractor's Services may, in HCA's judgment, be inferred or implied. Contractor further agrees not to publish or use such advertising, marketing, sales promotion materials, publicity or the like through print, voice, the Web, and other communication media in existence or hereinafter developed without the express written consent of HCA prior to such use. 4.28 RECORDS AND DOCUMENTS REVIEW 4.28.1 The Contractor must maintain books, records, documents, magnetic media, receipts, invoices or other evidence relating to this Contract and the performance of the services rendered, along with accounting procedures and practices, all of which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Contract. At no additional cost, these records, including materials generated under this Contract, are subject at all reasonable times to inspection, review, or audit by HCA, the Office of the State Auditor, and state and federal officials so authorized by law, rule, regulation, or agreement [See 42 USC 1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC 1396a(a)(42(A); 42 CFR 431, Subpart Q; and 42 CFR 447.202]. 4.28.2 The Contractor must retain such records for a period of six (6) years after the date of final payment under this Contract. Washington State 26 Description of Services Health Care Authority HCA Contract #K 4.28.3 If any litigation, claim or audit is started before the expiration of the six (6) year period, the records must be retained until all litigation, claims, or audit findings involving the records have been resolved. 4.29 REMEDIES NON-EXCLUSIVE The remedies provided in this Contract are not exclusive, but are in addition to all other remedies available under law. 4.30 RIGHT OF INSPECTION The Contractor must provide right of access to its facilities to HCA, or any of its officers, or to any other authorized agent or official of the state of Washington or the federal government, at all reasonable times, in order to monitor and evaluate performance, compliance, and/or quality assurance under this Contract. 4.31 RIGHTS IN DATA/OWNERSHIP 4.31.1 HCA and Contractor agree that all data and work products (collectively "Work Product') produced pursuant to this Contract will be considered a work for hire under the U.S. Copyright Act, 17 U.S.C. §101 et seq, and will be owned by HCA. Contractor is hereby commissioned to create the Work Product. Work Product includes, but is not limited to, discoveries, formulae, ideas, improvements, inventions, methods, models, processes, techniques, findings, conclusions, recommendations, reports, designs, plans, diagrams, drawings, Software, databases, documents, pamphlets, advertisements, books, magazines, surveys, studies, computer programs, films, tapes, and/or sound reproductions, to the extent provided by law. Ownership includes the right to copyright, patent, register and the ability to transfer these rights and all information used to formulate such Work Product. 4.31.2 If for any reason the Work Product would not be considered a work for hire under applicable law, Contractor assigns and transfers to HCA, the entire right, title and interest in and to all rights in the Work Product and any registrations and copyright applications relating thereto and any renewals and extensions thereof. 4.31.3 Contractor will execute all documents and perform such other proper acts as HCA may deem necessary to secure for HCA the rights pursuant to this section. 4.31.4 Contractor will not use or in any manner disseminate any Work Product to any third party, or represent in any way Contractor ownership of any Work Product, without the prior written permission of HCA. Contractor shall take all reasonable steps necessary to ensure that its agents, employees, or Subcontractors will not copy or disclose, transmit or perform any Work Product or any portion thereof, in any form, to any third party. Washington State 27 Description of Services Health Care Authority HCA Contract #K 4.31.5 Material that is delivered under this Contract, but that does not originate therefrom ("Preexisting Material'), must be transferred to HCA with a nonexclusive, royalty - free, irrevocable license to publish, translate, reproduce, deliver, perform, display, and dispose of such Preexisting Material, and to authorize others to do so. Contractor agrees to obtain, at its own expense, express written consent of the copyright holder for the inclusion of Preexisting Material. HCA will have the right to modify or remove any restrictive markings placed upon the Preexisting Material by Contractor. 4.31.6 Contractor must identify all Preexisting Material when it is delivered under this Contract and must advise HCA of any and all known or potential infringements of publicity, privacy or of intellectual property affecting any Preexisting Material at the time of delivery of such Preexisting Material. Contractor must provide HCA with prompt written notice of each notice or claim of copyright infringement or infringement of other intellectual property right worldwide received by Contractor with respect to any Preexisting Material delivered under this Contract. 4.32 RIGHTS OF STATE AND FEDERAL GOVERNMENTS In accordance with 45 C.F.R. 95.617, all appropriate state and federal agencies, including but not limited to the Centers for Medicare and Medicaid Services (CMS), will have a royalty -free, nonexclusive, and irrevocable license to reproduce, publish, translate, or otherwise use, and to authorize others to use for Federal Government purposes: (i) software, modifications, and documentation designed, developed or installed with Federal Financial Participation (FFP) under 45 CFR Part 95, subpart F; (ii) the Custom Software and modifications of the Custom Software, and associated Documentation designed, developed, or installed with FFP under this Contract; (iii) the copyright in any work developed under this Contract; and (iv) any rights of copyright to which Contractor purchases ownership under this Contract. 4.33 SEVERABILITY If any provision of this Contract or the application thereof to any person(s) or circumstances is held invalid, such invalidity will not affect the other provisions or applications of this Contract that can be given effect without the invalid provision, and to this end the provisions or application of this Contract are declared severable. 4.34 SITE SECURITY While on HCA premises, Contractor, its agents, employees, or Subcontractors must conform in all respects with physical, fire or other security policies or regulations. Failure to comply with these regulations may be grounds for revoking or suspending security access to these facilities. HCA reserves the right and authority to immediately revoke security access to Contractor staff for any real or threatened Washington State 28 Description of Services Health Care Authority HCA Contract #K breach of this provision. Upon reassignment or termination of any Contractor staff, Contractor agrees to promptly notify HCA. 4.35 SUBCONTRACTING 4.35.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for any of the work contemplated under this Contract without prior written approval of HCA. HCA has sole discretion to determine whether or not to approve any such subcontract. In no event will the existence of the subcontract operate to release or reduce the liability of Contractor to HCA for any breach in the performance of Contractor's duties. 4.35.2 Any agreement between Contractor and .a Subcontractor shall include the terms and conditions that meet or exceed all requirements and conditions in this Contract that the Contractor is required to meet when providing services to patients, clients, or persons seeking assistance, including but not limited to: (a) identification of funding sources; (b) DUNS number and zip code +4 of subcontractor; (c) determination of eligible clients; (d) payment or reimbursement arrangement; (e) termination of a subcontract shall be grounds for a fair hearing for the service applicant or a grievance for the recipient if similar services are immediately available in the County; (f) informing service applications and recipients of their right to a grievance in the case of a denial or termination of service and/or failure to act upon a request for services with reasonable promptness; (g) audit requirements in compliance with OMB 2, Part 200, Subpart F (A-133); (h) authorizing Contractor to conduct an inspection of any and all subcontractor facilities where services are provided; (i) requiring Subcontractor to perform background checks on its employees and independent contractors used to perform the services; 0) representation and warranty that Subcontractor is not has not been debarred or suspended by any state or the federal government; (k) Business Associate Agreement in compliance with the requirements of HIPAA; (1) protection of the Confidential Information and restrictions on the providing and sharing of data; and (m) identifying unallowable uses of federal funds. 4.35.3 If at any time during the progress of the work HCA determines in its sole judgment that any Subcontractor is incompetent or undesirable, HCA will notify Contractor, and Contractor must take immediate steps to terminate the Subcontractor's involvement in the work. 4.35.4 The rejection or approval by the HCA of any Subcontractor or the termination of a Subcontractor will not relieve Contractor of any of its responsibilities under the Contract, nor be the basis for additional charges to HCA. 4.36 SUBRECIPIENT 4.36.1 General Washington State 29 Description of Services Health Care Authority HCA Contract #K If the Contractor is a Subrecipient (as defined in 45 CFR 75.2 and 2 CFR 200.93) of federal awards, then the Contractor, in accordance with 2 CFR 200.501 and 45 CFR 75.501, shall: 4.36.1.1 Maintain records that identify, in its accounts, all federal awards received and expended and the federal programs under which they were received, by Catalog of Federal Domestic Assistance (CFDA) title and number, award number and year, name of the federal agency, and name of the pass-through entity; 4.36.1.2 Maintain internal controls that provide reasonable assurance that the Contractor is managing federal awards in compliance with laws, regulations, and provisions of contracts or grant agreements that could have a material effect on each of its federal programs; 4.36.1.3 Prepare appropriate financial statements, including a schedule of expenditures of federal awards; 4.36.1.4 Incorporate OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 audit requirements into all agreements between the Contractor and its Subcontractors who are Subrecipients; 4.36.1.5 Comply with any future amendments to OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 and any successor or replacement Circular or regulation; 4.36.1.6 Comply with the applicable requirements of OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 and any future amendments to OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, and any successor or replacement Circular or regulation; and 4.36.1.7 Comply with the Omnibus Crime Control and Safe streets Act of 1968, Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, The Age Discrimination Act of 1975, and The Department of Justice Non -Discrimination Regulations, 28 C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to http://omp.gov/about/offices/ocr.htm for additional information and access to the aforementioned Federal laws and regulations.) 4.36.2 Single Audit Act Compliance If the Contractor is a Subrecipient and expends $750,000 or more in federal awards from any and/or all sources in any fiscal year, the Contractor shall procure and pay for a single audit or a program -specific audit for that fiscal year. Upon completion of each audit, the Contractor shall: 4.36.2.1 Submit to the Authority contact person the data collection form and reporting package specified in OMB Super Circular 2 CFR 200.501 and 45 CFR Washington State 30 Description of Services Health Care Authority HCA Contract #K 75.501, reports required by the program -specific audit guide (if applicable), and a copy of any management letters issued by the auditor; 4.36.2.2 Follow-up and develop corrective action for all audit findings; in accordance with OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501, prepare a "Summary Schedule of Prior Audit Findings." 4.36.3 Overpayments 4.36.3.1 If it is determined by HCA, or during the course of a required audit, that Contractor has been paid unallowable costs under this or any Program Agreement, Contractor shall refund the full amount to HCA as provided in Section 4.25 Overpayments to Contractors. 4.37 SURVIVAL 4.38 TAXES The terms and conditions contained in this Contract that, by their sense and context, are intended to survive the completion, cancellation, termination, or expiration of the Contract will survive. In addition, the terms of the sections titled Confidential Information Protection, Confidential Information Breach — Required Notification, Contractor's Proprietary Information, Disputes, Overpayments to Contractor, Publicity, Records and Documents Review, Rights in Data/Ownership, and Rights of State and Federal Govemments, and Business Associate Agreement (BAA) will survive the termination of this Contract. The right of HCA to recover any overpayments will also survive the termination of this Contract. HCA will pay sales or use taxes, if any, imposed on the services acquired hereunder. Contractor must pay all other taxes including, but not limited to, Washington Business and Occupation Tax, other taxes based on Contractor's income or gross receipts, or personal property taxes levied or assessed on Contractor's personal property. HCA, as an agency of Washington State government, is exempt from property tax. Contractor must complete registration with the Washington State Department of Revenue and be responsible for payment of all taxes due on payments made under this Contract. 4.39 TERMINATION 4.39.1 TERMINATION FOR DEFAULT In the event HCA determines that Contractor has failed to comply with the terms and conditions of this Contract, HCA has the right to suspend or terminate this Contract. HCA will notify Contractor in writing of the need to take corrective action. If corrective action is not taken within five (5) Business Days, or other time period Washington State 31 Description of Services Health Care Authority HCA Contract #K agreed to in writing by both parties, the Contract may be terminated. HCA reserves the right to suspend all or part of the Contract, withhold further payments, or prohibit Contractor from incurring additional obligations of funds during investigation of the alleged compliance breach and pending corrective action by Contractor or a decision by HCA to terminate the Contract. In the event of termination for default, Contractor will be liable for damages as authorized by law including, but not limited to, any cost difference between the original Contract and the replacement or cover Contract and all administrative costs directly related to the replacement Contract, e.g., cost of the competitive bidding, mailing, advertising, and staff time. If it is determined that Contractor: (i) was not in default, or (ii) its failure to perform was outside of its control, fault or negligence, the termination will be deemed a "Termination for Convenience." 4.39.2 TERMINATION FOR CONVENIENCE When, at HCA's sole discretion, it is in the best interest of the State, HCA may terminate this Contract in whole or in part by providing ten (10) calendar days' written notice. If this Contract is so terminated, HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. No penalty will accrue to HCA in the event the termination option in this section is exercised. 4.39.3 TERMINATION FOR NONALLOCATION OF FUNDS If funds are not allocated to continue this Contract in any future period, HCA may immediately terminate this Contract by providing written notice to the Contractor. The termination will be effective on the date specified in the termination notice. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. HCA agrees to notify Contractor of such nonallocation at the earliest possible time. No penalty will accrue to HCA in the event the termination option in this section is exercised. 4.39.4 TERMINATION FOR WITHDRAWAL OF AUTHORITY In the event that the authority of HCA to perform any of its duties is withdrawn, reduced, or limited in any way after the commencement of this Contract and prior to normal completion, HCA may immediately terminate this Contract by providing written notice to the Contractor. The termination will be effective on the date specified in the termination notice. HCA will be liable only for payment in accordance with the terms of this Contract for services rendered prior to the effective date of termination. HCA agrees to notify Contractor of such withdrawal of authority at the earliest possible time. No penalty will accrue to HCA in the event the termination option in this section is exercised. Washington State 32 Description of Services Health Care Authority HCA Contract #K 4.39.5 TERMINATION FOR CONFLICT OF INTEREST HCA may terminate this Contract by written notice to the Contractor if HCA determines, after due notice and examination, that there is a violation of the Ethics in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in public acquisitions and procurement and performance of contracts. In the event this Contract is so terminated, HCA will be entitled to pursue the same remedies against the Contractor as it could pursue in the event Contractor breaches the contract. 4.40 TERMINATION PROCEDURES 4.40.1 Upon termination of this Contract, HCA, in addition to any other rights provided in this Contract, may require Contractor to deliver to HCA any property specifically produced or acquired for the performance of such part of this Contract as has been terminated. 4.40.2 HCA will pay Contractor the agreed-upon price, if separately stated, for completed work and services accepted by HCA and the amount agreed upon by the Contractor and HCA for (i) completed work and services for which no separate price is stated; (ii) partially completed work and services; (iii) other property or services that are accepted by HCA; and (iv) the protection and preservation of property, unless the termination is for default, in which case HCA will determine the extent of the liability. Failure to agree with such determination will be a dispute within the meaning of Section 4.12 Disputes. HCA may withhold from any amounts due the Contractor such sum as HCA determines to be necessary to protect HCA against potential loss or liability. 4.40.3 After receipt of notice of termination, and except as otherwise directed by HCA, Contractor must: 4.40.3.1 Stop work under the Contract on the date of, and to the extent specified in, the notice; 4.40.3.2 Place no further orders or subcontracts for materials, services, or facilities except as may be necessary for completion of such portion of the work under the Contract that is not terminated; 4.40.3.3 Assign to HCA, in the manner, at the times, and to the extent directed by HCA, all the rights, title, and interest of the Contractor under the orders and subcontracts so terminated; in which case HCA has the right, at its discretion, to settle or pay any or all claims arising out of the termination of such orders and subcontracts; 4.40.3.4 Settle all outstanding liabilities and all claims arising out of such termination of orders and subcontracts, with the approval or ratification of HCA to Washington State 33 Description of Services Health Care Authority HCA Contract #K the extent HCA may require, which approval or ratification will be final for all the purposes of this clause; 4.40.3.5 Transfer title to and deliver as directed by HCA any property required to be furnished to HCA; 4.40.3.6 Complete performance of any part of the work that was not terminated by HCA; and 4.40.3.7 Take such action as may be necessary, or as HCA may direct, for the protection and preservation of the records related to this Contract that are in the possession of the Contractor and in which HCA has or may acquire an interest. 4.41 WAIVER Waiver of any breach of any term or condition of this Contract will not be deemed a waiver of any prior or subsequent breach or default. No term or condition of this Contract will be held to be waived, modified, or deleted except by a written instrument signed by the parties. Only the HCA Authorized Representative has the authority to waive any term or condition of this Contract on behalf of HCA. 4.42 WARRANTIES 4.42.1 Contractor represents and warrants that it will perform all services pursuant to this Contract in a professional manner and with high quality and will immediately re- perform any services that are not in compliance with this representation and warranty at no cost to HCA. 4.42.2 Contractor represents and warrants that it shall comply with all applicable local, State, and federal licensing, accreditation and registration requirements and standards necessary in the performance of the Services. 4.42.3 Any written commitment by Contractor within the scope of this Contract will be binding upon Contractor. Failure of Contractor to fulfill such a commitment may constitute breach and will render Contractor liable for damages under the terms of this Contract. For purposes of this section, a commitment by Contractor includes: (i) Prices, discounts, and options committed to remain in force over a specified period of time; and (ii) any warranty or representation made by Contractor to HCA or contained in any Contractor publications, or descriptions of services in written or other communication medium, used to influence HCA to enter into this Contract. Washington State 34 Description of Services Health Care Authority HCA Contract #K Attachment 1 Confidential Information Security Requirements Definitions In addition to the definitions set out in Section 4.7 of this Contract for SOR Opiate Treatment Networks, the definitions below apply to this Attachment. a. "Hardened Password" means a string of characters containing at least three of the following character classes: upper case letters; lower case letters; numerals; and special characters, such as an asterisk, ampersand or exclamation point. Passwords for external authentication must be a minimum of 10 characters long. Passwords for internal authentication must be a minimum of 8 characters long. iii. Passwords used for system service or service accounts must be a minimum of 20 characters long. b. "Portable/Removable Media" means any Data storage device that can be detached or removed from a computer and transported, including but not limited to: optical media (e.g. CDs, DVDs); USB drives; or flash media (e.g. CompactFlash, SD, MMC). c. "Portable/Removable Devices" means any small computing device that can be transported, including but not limited to: handhelds/PDAs/Smartphones; Ultramobile PC's, flash memory devices (e.g. USB flash drives, personal media players); and laptops/notebook/tablet computers. If used to store Confidential Information, devices should be Federal Information Processing Standards (FIPS) Level 2 compliant. d. "Secured Area" means an area to which only Authorized Users have access. Secured Areas may include buildings, rooms, or locked storage containers (such as a filing cabinet) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. e. "Transmitting" means the transferring of data electronically, such as via email, SFTP, webservices, AWS Snowball, etc. "Trusted System(s)" means the following methods of physical delivery: (1) hand - delivery by a person authorized to have access to the Confidential Information with written acknowledgement of receipt; (2) United States Postal Service ("USPS") first class mail, or USPS delivery services that include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery services (e.g. FedEx, UPS, DHL) which offer tracking and receipt confirmation; and (4) the Washington State Washington State Page 35 of 72 #K Health Care Authority Attachment Campus mail system. For electronic transmission, the Washington State Governmental Network (SGN) is a Trusted System for communications within that Network. g. "Unique User ID" means a string of characters that identifies a specific user and which, in conjunction with a password, passphrase, or other mechanism, authenticates a user to an information system. Confidential Information Transmitting a. When transmitting HCA's Confidential Information electronically, including via email, the Data must be encrypted using NIST 800 -series approved algorithms (http://csrc.nist.gov/publications/PubsSPs.html). This includes transmission over the public internet. b. When transmitting RCA's Confidential Information via paper documents, the Receiving Party must use a Trusted System. Protection of Confidential Information The Contractor agrees to store Confidential Information as described: a. Data at Rest: Data will be encrypted with NIST 800 -series approved algorithms. Encryption keys will be stored and protected independently of the data. Access to the Data will be restricted to Authorized Users through the use of access control lists, a Unique User ID, and a Hardened Password, or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Systems which contain or provide access to Confidential Information must be located in an area that is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. Data stored on Portable/Removable Media or Devices: Confidential Information provided by HCA on Removable Media will be encrypted with NIST 800 -series approved algorithms. Encryption keys will be stored and protected independently of the Data. HCA's data must not be stored by the Receiving Party on Portable Devices or Media unless specifically authorized within the Data Share Agreement. If so authorized, the Receiving Party must protect the Data by: Encrypting with NIST 800 -series approved algorithms. Encryption keys will be stored and protected independently of the data; Washington State Page 36 of 72 #K Health Care Authority Attachment 2. Control access to the devices with a Unique User ID and Hardened Password or stronger authentication method such as a physical token or biometrics; 3. Keeping devices in locked storage when not in use; 4. Using check-in/check-out procedures when devices are shared; 5. Maintain an inventory of devices; and 6. Ensure that when being transported outside of a Secured Area, all devices with Data are under the physical control of an Authorized User. b. Paper documents. Any paper records containing Confidential Information must be protected by storing the records in a Secured Area that is accessible only to authorized personnel. When not in use, such records must be stored in a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons have access. Confidential Information Segregation HCA Confidential Information received under this Contract must be segregated or otherwise distinguishable from non -HCA data. This is to ensure that when no longer needed by the Contractor, all HCA Confidential Information can be identified for return or destruction. It also aids in determining whether HCA Confidential Information has or may have been compromised in the event of a security Breach. A. THE HCA CONFIDENTIAL INFORMATION MUST BE KEPT IN ONE OF THE FOLLOWING WAYS: on media (e.g. hard disk, optical disc, tape, etc.) which will contain only HCA Data; or ii. in a logical container on electronic media, such as a partition or folder dedicated to RCA's Data; or iii. in a database that will contain only HCA Data; or iv. within a database and will be distinguishable from non -HCA Data by the value of a specific field or fields within database records; or V. when stored as physical paper documents, physically segregated from non - HCA Data in a drawer, folder, or other container. 4.43 WHEN IT IS NOT FEASIBLE OR PRACTICAL TO SEGREGATE HCA CONFIDENTIAL INFORMATION FROM NON -HCA DATA, THEN BOTH THE HCA CONFIDENTIAL Washington State Page 37 of 72 #K Health Care Authority Attachment INFORMATION AND THE NON -HCA DATA WITH WHICH IT IS COMMINGLED MUST BE PROTECTED AS DESCRIBED IN THIS ATTACHMENT. Confidential Information Shared with Subcontractors If HCA Confidential Information provided under this Contract is to be shared with a Subcontractor, the contract with the Subcontractor must include all of the Confidential Information Security Requirements. Confidential Information Disposition When the Confidential Information is no longer needed, except as noted below, the Confidential Information must be returned to HCA or destroyed. Media are to be destroyed using a method documented within NIST 800-88 (hftp://csrc.nist.gov/publiGations/PubsSPs.html). a. For HCA's Confidential Information stored on network disks, deleting unneeded Confidential Information is sufficient as long as the disks remain in a Secured Area and otherwise meet the requirements listed in Section 0, above. Destruction of the Confidential Information as outlined in this section of this Attachment may be deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area. Washington State Page 38 of 72 #K Health Care Authority Attachment ATTACHMENT 2 FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES In the event federal funds are included in this agreement, the following sections apply: I. Federal Compliance and II. Standard Federal Assurances and Certifications. In the instance of inclusion of federal funds, the Contractor may be designated as a sub -recipient and the effective date of the amendment shall also be the date at which these requirements go into effect. FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and control mechanisms to be in place. The following represents the majority of compliance elements that may apply to any federal funds provided under this contract. For clarification regarding any of these elements or details specific to the federal funds in this contract, contact: Stephanie Endler a. Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement number 1 H79TI081705-01, the full and complete terms and provisions of which are hereby incorporated into this agreement can be found by reference in Attachment 4. Federal funds to support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number 93.788 and amount to $463,000. The sub-awardee is responsible for tracking and reporting the cumulative amount expended under HCA Contract No. K3285. b. Period of Availability of Funds: Pursuant to 45 CFR 92.23, Sub-awardee may charge to the award only costs resulting from obligations of the funding period specified in lH79TI081705-01, unless carryover of unobligated balances is permitted, in which case the carryover balances may be charged for costs resulting from obligations of the subsequent funding period. All obligations incurred under the award must be liquidated no later than 90 days after the end of the funding period. C. Single Audit Act: A sub-awardee (including private, for-profit hospitals and non-profit institutions) shall adhere to the federal Office of Management and Budget (OMB) Super Circular 2 CFR 200.501 and 45 CFR 75.501. A sub-awardee who expends $750,000 or more in federal awards during a given fiscal year shall have a single or program -specific audit for that year in accordance with the provisions of OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501. d. Modifications: This agreement may not be modified or amended, nor may any term or provision be waived or discharged, including this particular Paragraph, except in writing, signed upon by both parties. 1. Examples of items requiring Health Care Authority prior written approval include, but are not limited to, the following: i. Deviations from the budget and Project plan. ii. Change in scope or objective of the agreement. iii. Change in a key person specified in the agreement. Washington State Page 39 of 72 #K Health Care Authority Attachment iv. The absence for more than three months or a 25% reduction in time by the Project Manager/Director. v. Need for additional funding. vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost principles. vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total budget in this agreement. 2. No changes are to be implemented by the Sub-awardee until a written notice of approval is received from the Health Care Authority. e. Sub -Contracting: The sub-awardee shall not enter into a sub -contract for any of the work performed under this agreement without obtaining the prior written approval of the Health Care Authority. If sub- contractors are approved by the Health Care Authority, the subcontract, shall contain, at a minimum, sections of the agreement pertaining to Debarred and Suspended Vendors, Lobbying certification, Audit requirements, and/or any other project Federal, state, and local requirements. f. Condition for Receipt of Health Can; Authority Funds: Funds provided by Health Care Authority to the sub-awardee under this agreement may not be used by the sub-awardee as a match or cost-sharing provision to secure other federal monies without prior written approval by the Health Care Authority. g. Unallowable Costs: The sub-awardees' expenditures shall be subject to reduction for amounts included in any invoice or prior payment made which determined by HCA not to constitute allowable costs on the basis of audits, reviews, or monitoring of this agreement. h. Citizenship/Alien Verification/Determination: The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public benefits should be made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a "federal public benefit" must make a citizenship/qualified alien determination/ verification of applicants at the time of application as part of the eligibility criteria. Non -US citizens and unqualified aliens are not eligible to receive the services. PL 104-193 also includes specific reporting requirements. i. Federal Compliance: The sub-awardee shall comply with all applicable State and Federal statutes, laws, rules, and regulations in the performance of this agreement, whether included specifically in this agreement or not. Civil Rights and Non -Discrimination Obligations During the performance of this agreement, the Contractor shall comply with all current and future federal statutes relating to nondiscrimination. These include but are not limited to: Title VI of the Civil Rights Act of 1964 (PL 88-352), Title IX of the Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and 1685-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101- 6107), the Drug Abuse Office and Treatment Act of 1972 (PL 92-255), the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290dd-3 and 290ee-3), Title VIII of the Civil Rights Act of 1968 (42 U.S.C. §§3601 et seq.), and the Americans with Disability Act (42 U.S.C., Section 12101 et seq.) http://www.hhs.gov/ocr/civilrights Washington State Page 40 of 72 #K Health Care Authority Attachment HCA Federal Compliance Contact Information Federal Grants and Budget Specialist Health Care Policy Washington State Health Care Authority Post Office Box 42710 Olympia, Washington 98504-2710 II. CIRCULARS `COMPLIANCE MATRIX' - The following compliance matrix identifies the OMB Circulars that contain the requirements which govern expenditure of federal funds. These requirements apply to the Washington State Health Care Authority (HCA), as the primary recipient of federal funds and then follow the funds to the sub-awardee Community Counseling Institute. The federal Circulars which provide the applicable administrative requirements, cost principles and audit requirements are identified by sub-awardee organization type. Washington State Page 41 of 72 NK Health Care Authority Attachment OMB CIRCULAR ENTITY TYPE ADMINISTRATIVE COST AUDIT REQUIREMENTS REQUIREMENTS PRINCIPLES State. Local and Indian OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501 Tribal Governments and Governmental Hospitals Non -Profit Organizations and Non -Profit Hospitals Colleges or Universities and Affiliated Hospitals For -Profit Organizations Washington State Page 41 of 72 NK Health Care Authority Attachment Definitions: "Sub -recipient"; means the legal entity to which a sub -award is made and which is accountable to the State for the use of the funds provided in carrying out a portion of the State's programmatic effort under a sponsored project. The term may include institutions of higher education, for-profit corporations or non -U.S. Based entities. "Sub -award and Sub -grant" are used interchangeably and mean a lower tier award of financial support from a prime awardee (e.g., Washington State Health Care Authority) to a Sub -recipient for the performance of a substantive portion of the program. These requirements do not apply to the procurement of goods and services for the benefit of the Washington State Health Care Authority. IV. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances, Certifications, and Special Conditions that apply to all federally funded (in whole or in part) agreements administered by the Washington State Health Care Authority. CERTIFICATIONS 1. CERTIFICATION REGARDING DEBARMENT AND SUSPENSION The undersigned (authorized official signing for the contracting organization) certifies to the best of his or her knowledge and belief, that the contractor, defined as the primary participant in accordance with 45 CFR Part 76, and its principals: b) have not within a 3 -year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; a) are not presently debarred, suspended, proposed for debarment, declared c) ineligible, or voluntarily excluded from covered transactions by any Federal Department or agency; Washington State Page 42 of 72 are not presently indicted or otherwise criminally or civilly charged by a governmental entity (Federal, State, or local) with commission of any of the offenses enumerated in paragraph (b) of this certification; and #K Health Care Authority Attachment d) have not within a 3 -year period preceding this contract had one or more public transactions (Federal, State, or local) terminated for cause or default. Should the contractor not be able to provide this certification, an explanation as to why should be placed after the assurances page in the contract. The contractor agrees by signing this contract that it will include, without modification, the clause titled "Certification Regarding Debarment, Suspension, In eligibility, and Voluntary Exclusion --Lower Tier Covered Transactions" in all lower tier covered transactions (i.e., transactions with sub -grantees and/or contractors) and in all solicitations for lower tier covered transactions in accordance with 45 CFR Part 76. 2. CERTIFICATION REGARDING DRUG- FREE WORKPLACE REQUIREMENTS The undersigned (authorized official signing for the contracting organization) certifies that the contractor will, or will continue to, provide a drug-free workplace in accordance with 45 CFR Part 76 by: a) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, Washington State possession or use of a controlled substance is prohibited in the grantee's workplace and specifying the actions that will be taken against employees for violation of such prohibition; b) Establishing an ongoing drug-free awareness program to inform employees about (1) The dangers of drug abuse in the workplace; (2) The contractor's policy of maintaining a drug-free workplace; (3) Any available drug counseling, rehabilitation, and employee assistance programs; and (4) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; c) Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph (a) above; d) Notifying the employee in the statement required by paragraph (a), above, that, as a condition of employment under the contract, the employee will— (1) Abide by the terms of the statement; and Page 43 of 72 (2) Notify the employer in writing of his or her conviction for a violation of a criminal drug statute occurring in the workplace no later than five calendar days after such conviction; #K Health Care Authority Attachment e) Notifying the agency in writing within ten calendar days after receiving notice under paragraph (d)(2) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every contract officer or other designee on whose contract activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected grant; f) Taking one of the following actions, within 30 calendar days of receiving notice under paragraph (d) (2), with respect to any employee who is so convicted— (1) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or (2) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State, or local health, law enforcement, or other appropriate agency; g) Making a good faith effort to continue to maintain a drug-free workplace through implementation of paragraphs (a), (b), (c), (d), (e), and (f). For purposes of paragraph (e) regarding agency notification of criminal drug convictions, Authority has designated the following central point for receipt of such notices: Legal Services Manager Washington State WA State Health Care Authority PO Box 42700 Olympia, WA 98504-2700 3. CERTIFICATION REGARDING LOBBYING Title 31, United States Code, Section 1352, entitled "Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions," generally prohibits recipients of Federal grants and cooperative agreements from using Federal (appropriated) funds for lobbying the Executive or Legislative Branches of the Federal Government in connection with a SPECIFIC grant or cooperative agreement. Section 1352 also requires that each person who requests or receives a Federal grant or cooperative agreement must disclose lobbying undertaken with non -Federal (nonappropriated) funds. These requirements apply to grants and cooperative agreements EXCEEDING $100,000 in total costs (45 CFR Part 93). The undersigned (authorized official signing for the contracting organization) certifies, to the best of his or her knowledge and belief, that: (1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an Page 44 of 72 #K Health Care Authority Attachment officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement. (2) If any funds other than Federally appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure of Lobbying Activities," in accordance with its instructions. (If needed, Standard Form - LLL, "Disclosure of Lobbying Activities," its instructions, and continuation sheet are included at the end of this application form.) 1352, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. 4. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT (PFCRA) The undersigned (authorized official signing for the contracting organization) certifies that the statements herein are true, complete, and accurate to the best of his or her knowledge, and that he or she is aware that any false, fictitious, or fraudulent statements or claims may subject him or her to criminal, civil, or administrative penalties. The undersigned agrees that the contracting organization will comply with the Public Health Service terms and conditions of award if a contract is awarded. 5. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE Public Law 103-227, also known as the Pro - Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or (3) The undersigned shall require that the contracted for by an entity and used routinely language of this certification be included or regularly for the provision of health, day in the award documents for all care, early childhood development services, subcontracts at all tiers (including education or library services to children subcontracts, subcontracts, and contracts under grants, loans and under the age of 18, if the services are cooperative agreements) and that all funded by Federal programs either directly or sub -recipients shall certify and disclose through State or local governments, by accordingly. Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in indoor facilities This certification is a material representation of fact upon which reliance was placed when this that are constructed, operated, or maintained transaction was made or entered into. Submission with such Federal funds. The law does not of this certification is a prerequisite for making or apply to children's services provided in entering into this transaction imposed by Section private residence, portions of facilities used Washington State Page 45 of 72 #K Health Care Authority Attachment for inpatient drug or alcohol treatment, service providers whose sole source of applicable Federal funds is Medicare or Medicaid, or facilities where WIC coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. By signing the certification, the undersigned certifies that the contracting organization will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. The contracting organization agrees that it will require that the language of this certification be included in any subcontracts which contain provisions for children's services and that all sub -recipients shall certify accordingly. The Public Health Services strongly encourages all recipients to provide a smoke-free workplace and promote the non- use of tobacco products. This is consistent with the PHS mission to protect and advance the physical and mental health of the American people. S. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS INSTRUCTIONS FOR CERTIFICATION Washington State 1) By signing and submitting this proposal, the prospective contractor is providing the certification set out below. 2) The inability of a person to provide the certification required below will not necessarily result in denial of participation in this covered transaction. The prospective contractor shall submit an explanation of why it cannot provide the certification set out below. The certification or explanation will be considered in connection with the department or agency's determination whether to enter into this transaction. However, failure of the prospective contractor to furnish a certification or an explanation shall disqualify such person from participation in this transaction. 3) The certification in this clause is a material representation of fact upon which reliance was placed when the department or agency determined to enter into this transaction. If it is later determined that the prospective contractor knowingly rendered an erroneous certification, in addition to other remedies available to the Federal Government, the department or agency may terminate this transaction for cause of default. 4) The prospective contractor shall provide immediate written notice to the department or agency to whom this contract is submitted if at any time the prospective contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. 5) The terms covered transaction, debarred, suspended, ineligible, lower tier covered transaction, participant, person, primary covered transaction, principal, proposal, and voluntarily excluded, as used in this clause, have the meanings set out in the Definitions and Coverage sections of the rules implementing Executive Order 12549. You may contact the person to whom this contract is submitted for assistance in obtaining a copy of those regulations. 6) The prospective contractor agrees by submitting this contract that, should the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by Authority. Page 46 of 72 #K Health Care Authority Attachment 7) The prospective contractor further agrees by submitting this contract that it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion -- Lower Tier Covered Transaction," provided by HHS, without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions. 8) A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its principals. Each participant may, but is not required to, check the Non -procurement List (of excluded parties). 9) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. 10) Except for transactions authorized under paragraph 6 of these instructions, if a participant in a covered transaction knowingly enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in addition to other remedies available to the Federal Government, Authority may terminate this transaction for cause or default. 7. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS - - PRIMARY COVERED TRANSACTIONS 1) The prospective contractor certifies to the best of its knowledge and belief, that it and its principals: a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from Washington State covered transactions by any Federal department or agency; b) Have not within a three-year period preceding this contract been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; c) Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses enumerated in paragraph (1)(b) of this certification; and d) Have not within a three-year period preceding this contract had one or more public transactions (Federal, State or local) terminated for cause or default. 2) Where the prospective contractor is unable to certify to any of the statements in this certification, such prospective contractor shall attach an explanation to this proposal. Page 47 of 72 #K Health Care Authority Attachment CONTRACTOR SIGNATURE REQUIRED SIGNATURE OF AUTHORIZED CERTIFYING TITLE OFFICIAL Please also print or type name: lk-�— b evv\,- ORGANIZATION NAME: (if applicable) DATE Washington State Page 48 of 72 #K Health Care Authority Attachment Attachment 3 Federal Funding Accountability and Transparency Act (FFATA) Data Collection Form This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make information available online so the public can see how federal funds are spent. To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting Dun and Bradstreet at www.dnb.com. Required Information about your organization and this contract will be made available on USASpending.gov by the Washington State Health Care Authority (HCA) as required by P.L. 109-282. As a tool to provide the information, HCA encourages registration with the Central Contractor Registry (CCR) because less data entry and re-entry is required by both HCA and your organization. You may register with CCR on-line at hftps://www.uscontractorre-gistration.com/. Contractor must complete this form and return it to the Health Care Authority (HCA). CONTRACTOR 1. Legal Name 2. DUNS Number Jefferson County 619143741 3. Principle Place of Performance 3a. Congressional District 79 Elkins Road 6th 3b. City 3c. State Port Hadlock WA 3d. Zip+4 3e. Country 98339-9700 USA 4. Are you registered in CCR (https://www.uscontractorregistration.com/)? MvES (skip to page 2. Sign, date and return) ❑NO 5. In the preceding fiscal year did your organization: a. Receive 80% or more of annual gross revenue from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements; and c. The public does not have access to information about the compensation of the executives through periodic reports filled with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330 ® NO (skip the remainder of this section - Sign, date and return) ❑ YES (You must report the names and total compensation of the top 5 highly compensated officials of your organization). Name Of Official Total Compensation 1. 2. 3. 4. 5. Washington State Page 49 of 72 #K Health Care Authority Attachment Note: "Total compensation" means the cash and noncash dollar value earned by the executive during the sub - recipient's past fiscal year of the following (for more information see 17 CFR 229.402 (c)(2)). By signing this document, the Contractor Authorized Representative attests to the information. Signature Contractor Authorized Representative Date !LL=:_ V,HM HCA will not endorse the Contractor's subaward until this form is completed and returned. FOR HEALTH CARE AUTHORITY USE ONLY HCA Contract Number: K3285 Sub -award Project Description (see instructions and examples below) Instructions for Sub -award Project Description: In the first line of the description provide a title for the sub -award that captures the main purpose of the subrecipients work. Then, indicate the name of the subrecipient and provide a brief description that captures the overall purpose of the sub -award, how the funds will be used, and what will be accomplished. Example of a Sub -award Project Description: Washington State Page 50 of 72 #K Health Care Authority Attachment Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments. Washington State Page 51 of 72 #K Health Care Authority Attachment Attachment 4 SOR Grant Notice of Award 1 H79TI081795 is included as separate document. Washington State Page 52 of 72 #K Health Care Authority Attachment Notice of Award SOR Issue Date: 09/19/2018 Z Department of Health and Human Services Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Grant Number: 1 H79TI081705-01 FAIN: H79TI081705 Program Director: Alicia C Hughes Project Title: Washington State Opioid Response (SOR) Grant Grantee Address HEALTH CARE AUTHORITY Mr. Thomas Fuchs Washington State Health Care Authority 626 8th Ave SE PO Box 45330 Olympia, WA 985045330 Budget Period: 09/30/2018 — 09/29/2019 Project Period: 09/30/2018 — 09/29/2020 Dear Grantee: Business Address Mr. Michael Langer Washington State Health Care Authority PO Box 45330 Olympia, WA 985045330 The Substance Abuse and Mental Health Services Administration hereby awards a grant in the amount of $21,573,093 (see "Award Calculation" in Section I and "Terms and Conditions" in Section III) to HEALTH CARE AUTHORITY in support of the above referenced project. This award is pursuant to the authority of Title II Division H of the Consolidated Appropriations Act and is subject to the requirements of this statute and regulation and of other referenced, incorporated or attached terms and conditions. Award recipients may access the SAMHSA website at www.samhsa.gov (click on "Grants" then SAMHSA Grants Management), which provides information relating to the Division of Payment Management System, HHS Division of Cost Allocation and Postaward Administration Requirements. Please use your grant number for reference. Acceptance of this award including the "Terms and Conditions" is acknowledged by the grantee when funds are drawn down or otherwise obtained from the grant payment system. If you have any questions about this award, please contact your Grants Management Specialist and your Government Project Officer listed in your terms and conditions. Sincerely yours, Odessa Crocker Grants Management Officer Division of Grants Management See additional information below Page -1 SECTION I — AWARD DATA —1 H79TIO81705-01 Award Calculation (U.S. Dollars) Other $21,573,093 Direct Cost $21,573,093 Approved Budget $21,573,093 Federal Share $21,573,093 Cumulative Prior Awards for this Budget Period $0 AMOUNT OF THIS ACTION (FEDERAL SHARE) $21,573,093 SUMMARY TOTALS FOR ALL YEARS YR AMOUNT 1 $21,573,093 $21,573,093 *Recommended future year total cost support, subject to the availability of funds and satisfactory progress of the project. Fiscal Information: CFDA Number: EIN: Document Number: Fiscal Year: IC CAN TI C96N600 93.788 191141278OAl 18TI81705A 2018 Amount $21,573,093 IC I CAN 2018 12019 TI JC96N600 $21,573,093 1 $21,573,093 TI Administrative Data: PCC: SOR / OC: 4145 SECTION II — PAYMENT/HOTLINE INFORMATION —1 H79TIO81705-01 Payments under this award will be made available through the HHS Payment Management System (PMS). PMS is a centralized grants payment and cash management system, operated by the HHS Program Support Center (PSC), Division of Payment Management (DPM). Inquiries regarding payment should be directed to: The Division of Payment Management System, PO Box 6021, Rockville, MD 20852, Help Desk Support — Telephone Number: 1-877-614-5533. The HHS Inspector General maintains a toll-free hotline for receiving information concerning fraud, waste, or abuse under grants and cooperative agreements. The telephone number is: 1- 800 -HHS -TIPS (1-800-447-8477). The mailing address is: Office of Inspector General, Department of Health and Human Services, Attn: HOTLINE, 330 Independence Ave., SW, Washington, DC 20201. SECTION III —TERMS AND CONDITIONS — 1 H79TIO81705-01 This award is based on the application submitted to, and as approved by, SAMHSA on the above -title project and is subject to the terms and conditions incorporated either directly or by Page -2 SAM14SA NGA D I Version: 6 - 06/07/2018 13:04 001 Generated on_ 09/19/2018 1254:51 reference in the following: a. The grant program legislation and program regulation cited in this Notice of Award. b. The restrictions on the expenditure of federal funds in appropriations acts to the extent those restrictions are pertinent to the award. c. 45 CFR Part 75 as applicable. d. The HHS Grants Policy Statement. e. This award notice, INCLUDING THE TERMS AND CONDITIONS CITED BELOW. Treatment of Program Income: Additional Costs In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to 45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements, and procurement contracts with cumulative total value greater than $10,000,000 must report and maintain information in the System for Award Management (SAM) about civil, criminal, and administrative proceedings in connection with the award or performance of a Federal award that reached final disposition within the most recent five-year period. The recipient must also make semiannual disclosures regarding such proceedings. Proceedings information will be made publicly available in the designated integrity and performance system (currently the Federal Awardee Performance and Integrity Information System (FAPIIS)). Full reporting requirements and procedures are found in Appendix XII to 45 CFR Part 75. SECTION IV — TI Special Terms and Conditions —1 H79TI081705-01 REMARKS: This Notice of Award (NoA) is issued to inform your organization that the application submitted through Funding Opportunity Announcement (FOA) TI -18-015 has been selected for funding. Based on the availability of additional available funding for the State Opioid Response (SOR) program, the annual approval funding amount for your state has increased. As a result, all funds have been placed in the Other Budget Category and a revised budget is required to be submitted per the special conditions of award reflected below. Key Personnel (or key staff positions, if staff has not been selected) are listed below: TBD (Acting PD: Alicia C Hughes) Program Director P_ 100% level of effort TBD, State Opioid Coordinator --- (a) 100% level of effort Any changes in key staff including level of effort involving separation from the project for more than three months or a 25 percent reduction in time dedicated to the project, requires prior approval. Reference the Prior Approval Standard Term for additional information and instructions. Recipients are expected to plan their work to ensure that funds are expended within the 12 -month budget period reflected on this Notice of Award. If activities proposed in the approved budget cannot be completed within the current budget period, SAMSHA cannot guarantee the approval of any request for carryover of remaining unobligated funding. Register your Program Director/Project Director (PD) in eRA Commons: You must complete registrations in order to submit an FY19 Continuation Application in eRA Commons. You must register both the Organization and the PD. Additional information for eRA registration can be found at: https://era.nih.ciov/reg accounts/register commons.cfm. Page -3 SAMHSA NGA D I Version: 0 - 06/07/2018 13:04 001 Generated on: 09/19/2018 12:54:51 The response to term and conditions of award must be submitted as .pdf documents in the "View Terms Tracking Details" page in eRA Commons. For more information on how to upload a document in response to a tracked term, please reference under heading "4 Additional Materials — grantee" in the User Guide located at: https:Hera.nih.gov/files/TCM User Guide Grantee pdf. SPECIAL TERMS OF AWARD: SOR funds shall be used to fund services and practices that have a demonstrated evidence -base, and that are appropriate for the population(s) of focus. SOR funds shall not be utilized for services that can be supported through other accessible sources of funding such as other federal discretionary and formula grant funds, e.g. HHS (CDC, CMS, HRSA, and SAMHSA), DOJ (OJP/BJA) and non-federal funds, 3rd party insurance, and sliding scale self -pay among others. SOR funds for treatment and recovery support services shall only be utilized to provide services to individuals with a diagnosis of an opioid use disorder or to individuals with a demonstrated history of opioid overdose problems. Grantees are expected to report data as required in the FOA and to fully participate in any SAMHSA-sponsored evaluation of this program. All required data must be reported to the SPARS system within SAMHSA specified timelines. The submission of these data in the form required by SAMHSA is a requirement of funding. Medication Assisted Treatment (MAT) using one of the FDA -approved medications for the maintenance treatment of opioid use disorder (methadone, buprenorphine/naloxone products/buprenorphine products including sublingual tablets/film, buccal film, and extended release, long-acting injectable buprenorphine formulations and injectable naltrexone) is a required activity of your grant per the terms of your grant award. Recipients are required to work with the SAMHSA Opioid-STR TA grant awarded to AAAP as the primary means of TA provision. Recipients are expected to report data as required in the Funding Opportunity Announcement (FOA) and to fully participate in the cross -site evaluation of the program. Grantees are required to track funding of activities by providers and be prepared to submit these data to SAMHSA upon request. STANDARD TERMS OF AWARD: Refer to the following SAMHSA website to access the Standard Terms applicable to your grant award for FY 2018: https://www.samhsa.gov/grants/grants-management/notice-award- Page-4 SAMHSA NGA D I Version: 6 - 06/07/2018 13.04.00 1 Generated on. 09/19/2018 12.54.51 noa/standard-terms-conditions and reference the FY 2018 Standard and New Grant Terms REPORTING REQUIREMENTS: Annual Federal Financial Report (SF425) The Federal Financial Report (FFR) (SF -425) is required on an annual basis and must be submitted no later than 90 days after the end of the budget period (by December 31, 2019). The annual FFR should reflect only cumulative actual Federal funds authorized and disbursed, any non -Federal matching funds (if identified in the Funding Opportunity Announcement (FOA)), unliquidated obligations incurred, the unobligated balance of the Federal funds for the award, as well as program income generated during the timeframe covered by the report. Additional guidance to complete the FFR can be found at http://www.samhsa.gov/grants/grantsmanagement/reporting-requirements. FFR reporting must be entered directly into the eRA Commons system. Instructions on how to submit a Federal Financial Report (FFR) via the eRA Commons is available at https://www.samhsa.gov/sites/default/files/samhsa-grantee-submit-ffr-10-22-17.pptx. Annual Performance Progress Report (PPR) The Performance Progress Report (PPR) is required on an annual basis and must be submitted no later than 90 days after the end of the budget period (by December 31, 2019) Note: Recipients must also comply with the GPRA requirements that include the collection and periodic reporting of performance data as specified in the FOA or by the Grant Program Official (GPO). This information is needed in order to comply with PL 102-62, which requires that Substance Abuse and Mental Health Services Administration (SAMHSA) report evaluation data to ensure the effectiveness and efficiency of its programs. This information will be gathered using SAMHSA's Performance Accountability and Reporting System (SPARS); access will be provided upon award. Additional information on reporting requirements is available at https://www.samhsa.gov/grants/grants-management/reporting-requirements Compliance with Terms and Conditions Failure to comply with the Terms and Conditions of the grant award may result in actions in accordance with 45 CFR 75.371, Remedies for Non -Compliance and 45 CFR 75.372 Termination. This may include withholding payment, disallowance of costs, suspension and debarment, termination of grant award or denial of future funding. Unless otherwise identified in the special terms and conditions of award and post award requests, Page -5 SAMHSA NGA D I Version'. 6-06/07/20!8 13:04:00 1 Generated on 09/1:9/2018 12-54:51 all responses to special terms and conditions of award and post award requests must be submitted through the eRA Commons system. It is essential that the Grant Number be included in the SUBJECT line of the email. SPECIAL CONDITIONS SOR Revised Budget SAMHSA recently revised its budget threshold for State Opioid Response Grants. The funding recommendation has increased resulting in an overall increase in your authorized budget amount. The administrative/infrastructure costs limits to administer this award of up to 5 percent, and up to 2 percent of the grant award for data collection and reporting, including client -level data collection and reporting are still requirements of this award. By October 31, 2018, you are required to submit a detailed budget into the Terms Tracker in eRA to release this restricted award. For more information on how to upload a document in response to a tracked term, please reference Terms and Conditions Module (TCM) in the User Guide located at: https:Hera.nih.gov/modules_user-guides_documentation.cfm The components required to resolve this restriction are: • A revised budget breakdown • A budget narrative • SF -424A • Contract, Subcontract, and Consortium detailed budgets and budget justifications must accompany each full budget. • Other Support page for Key Personnel (please provide a statement confirming that total level of effort between SOR and STR does not exceed 100% level of effort) • Clearly identified PD, A confirmation of the PD is required and will require submission of a revised HHS Checklist or revised Budget Justification, depending on the correct PD. The HHS Checklist and Budget Justification identify different individuals as the PD, and these documents must be consistent. Please revise accordingly and submit either a revised Checklist or a revised budget for consistency. The following document(s) were missing from your application and must be submitted by October 31, 2018: • SMA 170 • SF -LLL We recommend that recipients use the SAMHSA provided template for the revised budget. Marginal/Unacceptable *For the marginal section as noted in the summary statement, you must submit the requested information to the GMS and GPO by October 31, 2018 via the term tracker and an emailed copy to the GMO. Page -6 SAMHSA NGA B I Version. 6 - 06/07/2018 13,04:001 Generated on. 09/19/20z8 12.54-51 The application submitted received a marginal rating for Section C: Proposed Evidence -Based Service/Practice. Reviewers noted that the grantee: • Does not link the identified EBPs back to the specific needs of the population of focus. • Does provide a detailed description of its implementation of the evidence based strategies. • Does not identify specific psychosocial interventions. • Does not detail how or why the identified modifications are appropriate for the project. To ensure the grantee meets acceptable standards for this section, you must submit the following information to the GMS and GPO: • Describe how the identified EBPs link to the specific needs of the population of focus. • Describe your implementation of the evidence -based strategies. • Identify specific psychosocial interventions. • Describe how and why the identified modifications are appropriate for the project. Staff Contacts: Kim Thierry, Program Official Phone: (240) 276-2907 Email: kim.thierry@samhsa.hhs.gov Fax: (240) 276-2970 LeSchell D Browne, Grants Specialist Phone: 240-276-1144 Email: leschell.browne@samhsa.hhs.gov Page -7 SAMHSA NGA D I Version. 6 - 06/07/2018 13.04.00 1 Generated on. 09/19/2018 12.54:51 Attachment 5 Business Associates Agreement This BUSINESS ASSOCIATE AGREEMENT is made between the Contractor listed on page one of this aggreement (Business Associate) and the Washington State Health Care Authority (HCA). This agreement does not expire or automatically terminate except as stated in Section 5. Business Associate is or may be a "Business Associate" of HCA as defined in the HIPAA Rules. If there is a conflict between the provisions of this Agreement and provisions of other contracts, this Agreement controls; otherwise, the provisions in this Agreement do not replace any provisions of any other contracts. If the other Contract is terminated, this Agreement nonetheless continues in effect. This Business Associate Agreement supersedes any existing Business Associate Agreement the Business Associate may have with HCA. It also supersedes any "business associate" section in an underlying Contract. Definitions 1.1 ACCESS ATTEMPTS Information systems are the frequent target of probes, scans, "pings," and other activities that may or may not indicate threats, whose sources may be difficult or impossible to identify, and whose motives are unknown, and which do not result in access or risk to any information system or PHI. Those activities are "access attempts." 1.2 DAY "Day" means business days observed by Washington State government. 1.3 CATCH-ALL DEFINITIONS The following terms used in this Agreement have the same meaning as those terms in the HIPAA Rules: Breach, Business Associate, Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Secretary, Security Incident, Unsecured Protected Health Information (PHI), and Use. 1.4 CLIENTS OR INDIVIDUALS "Clients" or "individuals" are people who have health or other coverage or benefits from or through HCA. They include Medicaid clients, Public Employees Benefits Board subscribers and enrollees, and others. 1.5 CONTRACT OR UNDERLYING CONTRACT "Contract" or "underlying contract" means all agreements between Business Associate and HCA under which Business Associate is a "business associate" as defined in the Security or Privacy Washington State Page 53 of 72 #K Health Care Authority Attachment Rules. The terms apply whether there is one such agreement or more than one, and if there is more than one the terms include them all even though a singular form is used except as otherwise specified. The terms include agreements now in effect and agreements that become effective after the effective date of this Agreement. 1.6 EFFECTIVE DATE "Effective Date" means the date of the signature with the latest date affixed to the Agreement. 1.7 HIPAA RULES; SECURITY, BREACH NOTIFICATION, AND PRIVACY RULES "HIPAA Rules" means the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164, as now in effect and as modified from time to time. In part 164 of title 45 CFR, the "Security Rule" is subpart C (beginning with §164.302), the "Breach Notification Rule" is subpart D (beginning with § 164.400), and the "Privacy Rule" is subpart E (beginning with § 164.500). 1.8 PROTECTED HEALTH INFORMATION OR PHI "Protected Health Information" has the same meaning as in the HIPAA Rules except that in this Agreement the term includes only information created by Business Associate or any of its contractors, or received from or on behalf of HCA, and relating to Clients. "PHI" means Protected Health Information. 2 Obligations and Activities of Business Associate 2.1 LIMITS Business Associate will not use or disclose PHI other than as permitted or required by the Contract or this Agreement or as required by law. Except as otherwise limited in this Agreement, Business Associate may use or disclose PHI on behalf of, or as necessary for purposes of the underlying contract, if such use or disclosure of PHI would not violate the Privacy Rule if done by a Covered Entity and is the minimum necessary. 2.2 SAFEGUARDS Business Associate will use appropriate safeguards, and will comply with the Security Rule with respect to electronic PHI, to prevent use or disclosure of PHI other than as provided for by the Contract or this Agreement. Business Associate will store and transfer PHI in encrypted form. 2.3 REPORTING SECURITY INCIDENTS 2.3.1 Business Associate will report security incidents that materially interfere with an information system used in connection with PHI. Business Associate will report those security incidents to HCA within five days of their discovery by Business Associate. If such an incident is also a Breach or may be a Breach, subsection 2.4 applies instead of this provision. Washington State Page 54 of 72 #K Health Care Authority Attachment 2.3.2 Access Attempts shall be recorded in Business Associate's system logs. Access Attempts are not categorically considered unauthorized Use or Disclosure, but Access Attempts do fall under the definition of Security Incident and Business Associate is required to report them to HCA. Since Business Associate's reporting and HCA's review of all records of Access Attempts would be materially burdensome to both parties without necessarily reducing risks to information systems or PHI, the parties agree that Business Associate will review logs and other records of Access Attempts, will investigate events where it is not clear whether or not an apparent Access Attempt was successful, and determine whether an Access Attempt: a. Was in fact a "successful" unauthorized Access to, or unauthorized Use, Disclosure, modification, or destruction of PHI subject to this Agreement, or b. Resulted in material interference with Business Associate's information system used with respect to PHI subject to this Agreement, or c. Caused an unauthorized Use or Disclosure. 2.3.3 Subject to Business Associate's performance as described in 2.3.2., this provision shall serve as Business Associate's notice to HCA that Access Attempts will occur and are anticipated to continue occurring with respect to Business Associate's information systems. HCA acknowledges this notification, and Business Associate is not required to provide further notification of Access Attempts unless they are successful as described in Section 2.3.2. above, in which case Business Associate will report them in accordance with Section 2.3.1 or Section 2.4. 2.4 BREACH NOTIFICATION 2.4.1 "Breach" is defined in the Breach Notification Rule. The time when a Breach is considered to have been discovered is explained in that Rule. HCA, or its designee, is responsible for determining whether an unauthorized Use or Disclosure constitutes a Breach under the Breach Notification Rule, RCW 42.56.590 or RCW 19.255.010, or other law or rule, and for any notification under the Breach Notification Rule, RCW 42.56.590 or RCW 19.255.010, or other law or rule. 2.4.2 Business Associate will notify HCA of any unauthorized use or disclosure and any other possible Breach within five days of discovery. If Business Associate does not have full details at that time, it will report what information it has, and provide full details within 15 days after discovery. The initial report may be oral. Business Associate will give a written report to HCA, however, as soon as possible. To the extent possible, these reports must include the following: a. The identification of each individual whose PHI has been or may have been accessed, acquired, or disclosed; b. The nature of the unauthorized Use or Disclosure, including a brief description of what happened, the date of the event(s), and the date of discovery; c. A description of the types of PHI involved; Washington State Page 55 of 72 #K Health Care Authority Attachment d. The investigative and remedial actions the Business Associate or its subcontractor took or will take to prevent and mitigate harmful effects, and protect against recurrence; e. Any details necessary for a determination of the potential harm to Individuals whose PHI is believed to have been Used or Disclosed and the steps such Individuals should take to protect themselves; and f. Such other information as HCA may reasonably request. 2.4.3 If Business Associate determines that it has or may have an independent notification obligation under any state breach notification laws, Business Associate will promptly notify HCA. In any event, Business Associate will notify HCA of its intent to give any notification under a state breach notification law no fewer than ten business days before giving such notification. 2.4.4 If Business Associate or any subcontractor or agent of Business Associate actually makes or causes, or fails to prevent, a use or disclosure constituting a Breach within the meaning of the Breach Notification Rule, and if notification of that use or disclosure must (in the judgment of HCA) be made under the Breach Notification Rule, or RCW 42.56.590 or RCW 19.255.010, or other law or rule, then: a. HCA may choose to make any notifications to the individuals, to the Secretary, and to the media, or direct Business Associate to make them or any of them. b. In any case, Business Associate will pay the reasonable costs of notification to individuals, media, and governmental agencies and of other actions HCA reasonably considers appropriate to protect clients (such as paying for regular credit watches in some cases), and c. Business Associate will compensate HCA clients for harms caused to them by the Breach or possible Breach described above. 2.4.5 Business Associate's obligations regarding breach notification survive the termination of this Agreement and continue for as long as Business Associate maintains the PHI and for any breach or possible breach at any time. 2.6 SUBCONTRACTORS Business Associate will ensure that any subcontractors or agents that create, receive, maintain, or transmit PHI on behalf of the Business Associate agree to protective restrictions, conditions, and requirements at least as strict as those that apply to the Business Associate with respect to that information. Upon request by HCA, Business Associate will identify to HCA all its subcontractors and provide copies of its agreements (including business associate agreements or contracts) with them. The fact that Business Associate subcontracted or otherwise delegated any responsibility to a subcontractor or anyone else does not relieve Business Associate of its responsibilities. Washington State Page 56 of 72 #K Health Care Authority Attachment 2.6 ACCESS Business Associate will make available PHI in a designated record set to the HCA as necessary to satisfy HCA's obligations under 45 CFR § 164.524. Business Associate will give the information to HCA within five days of the request from the individual or HCA, whichever is earlier. If HCA requests, Business Associate will make that information available directly to the individual. If Business Associate receives a request for access directly from the individual, Business Associate will inform HCA of the request within three days, and if requested by HCA it will provide the access in accordance with the HIPAA Rules. 2.7 AMENDING PHI Business Associate will make any amendments to PHI in a designated record set as directed or agreed to by the HCA pursuant to 45 CFR § 164.526, or take other measures requested by HCA to satisfy HCA's obligations under that provision. If Business Associate receives a request for amendment directly from an individual, Business Associate will both acknowledge it and inform HCA within three days, and if HCA so requests act on it within ten days and inform HCA of its actions. 2.8 ACCOUNTING Business Associate will maintain and make available to HCA the information required to provide an accounting of disclosures as necessary to satisfy HCA's obligations under 45 CFR § 164.528. If Business Associate receives an individual's request for an accounting, it will either provide the accounting as required by the Privacy Rule or, at its option, pass the request on to HCA within ten days after receiving it. 2.9 OBLIGATIONS To the extent the Business Associate is to carry out one or more of HCA's obligations under the Privacy Rule, it will comply with the requirements of that rule that apply to HCA in the performance of such obligations. 2.10 BOOKS, ETC. Business Associate will make its internal practices, books, and records available to the Secretary for purposes of determining compliance with the HIPAA Rules. 2.11 MITIGATION Business Associate will mitigate, to the extent practicable, any harmful effect of a use or disclosure of PHI by Business Associate or any of its agents or subcontractors in violation of the requirements of any of the HIPAA Rules, this Agreement, or the Contract. 2.12 INDEMNIFICATION To the fullest extent permitted by law, Business Associate will indemnify, defend, and hold harmless the State of Washington, HCA, and all officials, agents and employees of the State Washington State Page 57 of 72 #K Health Care Authority Attachment from and against all claims of any kind arising out of or resulting from the performance of this Agreement, including Breach or violation of HIPAA Rules. 3 Permitted Uses and Disclosures by Business Associate 3.1 LIMITED USE AND DISCLOSURE Except as provided in this Section 3, Business Associate may use or disclose PHI only as necessary to perform the services set forth in the Contract. 3.2 GENERAL LIMITATION Business Associate will not use or disclose PHI in a manner that would violate the Privacy Rule if done by HCA. 3.3 REQUIRED BY LAW Business Associate may use or disclose PHI as required by law. 3.4 DE -IDENTIFYING Business Associate may de -identified PHI in accordance with 45 CFR § 164.514(a) -(c). 3.5 MINIMUM NECESSARY Business Associate will make uses and disclosures of only the minimum necessary PHI, and will request only the minimum necessary PHI. 3.6 DISCLOSURE FOR MANAGEMENT AND ADMINISTRATION OF BUSINESS ASSOCIATE 3.6.1 Subject to subsection 3.6.2, Business Associate may disclose PHI for the proper management and administration of Business Associate or to carry out the legal responsibilities of the Business Associate. 3.6.2 The disclosures mentioned in subsection 3.6.1 above are permitted only if either: a. The disclosures are required by law, or b. Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and that the person will notify Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached. 3.7 AGGREGATION Business Associate may use PHI to provide data aggregation services relating to the health care operations of the HCA, if those services are part of the Contract. Washington State Page 58 of 72 #K Health Care Authority Attachment 4 Activities of HCA 4.1 NOTICE OF PRIVACY PRACTICES HCA will provide a copy of its current notice of privacy practices under the Privacy Rule to Business Associate on request. HCA will also provide any revised versions of that notice by posting on its website, and will send it on request. 4.2 CHANGES IN PERMISSIONS HCA will notify Business Associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her PHI, to the extent that such changes may affect Business Associate's use or disclosure of PHI. 4.3 RESTRICTIONS HCA will notify Business Associate of any restriction on the use or disclosure of PHI that HCA has agreed to or is required to abide by under 45 CFR § 164.522, to the extent that such restriction may affect Business Associate's use or disclosure of PHI. Business Associate will comply with any such restriction. 5 Term and Termination 5.1 TERM 5.1.1 This Agreement is effective as of the earliest of: a. The first date on which Business Associate receives or creates PHI subject to this Agreement, or b. The effective date of the Contract, or if there is more than one Contract then the effective date of the first one to be signed by both parties. 5.1.2 This Agreement continues in effect until the earlier of: a. Termination of the provision of Services under the Contract or, if there is more than one Contract, under the last of the Contracts under which services are terminated, b. The termination of this Agreement as provided below, or c. The written agreement of the parties. 5.2 TERMINATION FOR CAUSE HCA may terminate this Agreement and the Contract (or either of them), if HCA determines Business Associate has violated a material term of the Agreement. The termination will be effective as of the date stated in the notice of termination. Washington State Page 59 of 72 #K Health Care Authority Attachment 6.3 OBLIGATIONS OF BUSINESS ASSOCIATE UPON TERMINATION The obligations of the Business Associate under this subsection 5.3 survive the termination of the Agreement. Upon termination of this Agreement for any reason, Business Associate will: 5.3.1 Retain only that PHI that is necessary for Business Associate to continue its proper management and administration or to carry out its legal responsibilities; 5.3.2 Return to HCA or, if agreed to by HCA, destroy the PHI that the Business Associate and any subcontractor of Business Associate still has in any form (for purposes of this subsection 5.3, to destroy PHI is to render it unusable, unreadable, or indecipherable to the extent necessary to establish it is not Unsecured PHI, and Business Associate will provide HCA with appropriate evidence of destruction within ten days of the destruction); 5.3.3 Continue to use appropriate safeguards and comply with the Security Rule with respect to electronic PHI to prevent use or disclosure of the PHI, other than as provided for in this Agreement, for as long as Business Associate retains any of the PHI (for purposes of this subsection 5.3, If the PHI is destroyed it shall be rendered unusable, unreadable or indecipherable to the extent necessary to establish it is not Unsecured PHI. Business Associate will provide HCA with appropriate evidence of destruction); 5.3.4 Not use or disclose any PHI retained by Business Associate other than for the purposes for which the PHI was retained and subject to the same conditions that applied before termination; 5.3.5 Return to HCA, or, if agreed to by HCA, destroy, the PHI retained by Business Associate when it is no longer needed by Business Associate for its proper management and administration or to carry out its legal responsibilities; and 5.3.6 Business Associate's obligations relating to providing information to the Secretary and other government survive the termination of this Agreement for any reason. 6.4 SUCCESSOR Nothing in this Agreement limits the obligations of Business Associate under the Contract regarding giving data to HCA or to a successor Business Associate after termination of the Contract. 6 Miscellaneous 6.1 AMENDMENT The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law. 6.2 INTERPRETATION Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules. Washington State Page 60 of 72 #K Health Care Authority Attachment 6.3 HCA CONTACT FOR REPORTING AND NOTIFICATION REQUIREMENTS Business Associate will address all reporting and notification communications required in this Agreement to: HCA Privacy Officer Washington State Health Care Authority 626 8th Avenue SE PO Box 42700 Olympia, WA 98504-2700 Telephone: 360-725-1116 E-mail: PrivacyOfficer@hca.wa.gov Washington State Page 61 of 72 #K Health Care Authority Attachment Schedule A Statement of Work 1. Performance Work Statement. The Contractor shall serve as the Initiation Site and be responsible for: a. Bringing MAT initiation, referral, and retention to an individual prior to his or her transfer to the Local MAT Treatment Site, ensuring MAT capacity is maintained at both the Initiation and Local MAT Treatment Site(s). b. Serving as the lead organization and recipient of funding for the development and implementation of an Opioid Treatment Network model for adults with an Opioid Use Disorder who are Medicaid eligible or low income. OTN will give priority to: (1) Individuals at highest risk of overdose and death. (2) Tribal members to address their OUD needs. (3) MAT services for Pregnant and Parenting individuals with OUD. (4) MAT services for IV drug users. c. Ensuring services at the Initiation Site and Local MAT Treatment Site(s) begin no later than February 1, 2019. d. Monitoring and ensuring MAT is initiated to a minimum of 126 unique individuals no later than September 29, 2019 at the Initiation Site. e. Holding responsibility for oversight of the OTN, and ensuring the Local MAT Treatment Site(s) are working in coordination (including participation in regularly scheduled leadership meetings and educational and technical assistance opportunities) and meet the terms of the project, contract, goals and project deliverables. f. Ensuring travel per diem, computers, office supplies, and all other supplies and tools necessary to perform defined duties are provided to staff at the Initiation Site and Local MAT Treatment Site(s) (through contract). g. Ensuring a low -barrier medication model. h. Providing both agonist and antagonist MAT medications (on-site or in relationship with a pharmacy) in order to facilitate initial inductions and ongoing treatment. Providing intensive services by developing a central Initiation Site to provide MAT, and a warm hand-off to a Local MAT Treatment Site(s) for continuity of care through the usage of a coordinated network team and processes. Local MAT Treatment Site(s) will provide referrals for other behavioral health and ancillary services necessary to address the individual's holistic medical and recovery needs, including tobacco cessation services Washington State Page 62 of 72 #K Health Care Authority Attachment when appropriate. Build, strengthen, and maintain referral relationships between Initiation Site and Local MAT Treatment Site(s). Hiring and/or contracting up to 2.0 FTEs to cover the functions listed below at the Initiation Site. Through subcontracting, provide for staffing at Local MAT Treatment Site(s). Specific staffing arrangements will be determined by Initiation Site. The following functions are required (individual staff may perform multiple functions): (1) OTN Nurse Care Manager (NCM): The NCM's primary responsibilities are to provide medical support to the prescribing physicians or other waivered practitioners. Duties of the NCM will include, but are not limited to: individual screening, MAT education, assisting with MAT inductions, taking vital signs, drug testing, lab work, medical assessments, charting, care planning, stabilization, observation and maintenance, ongoing coordination of follow-up care, relapse prevention, and support for an individual's self-management. (2) OTN Care Navigator: The Care Navigator expedites enrollment into Medicaid as necessary, conducts screenings, assessments and evaluations, provides education, and coordinates referrals for MAT (and tobacco cessation services if appropriate). Care Navigators assist with data collection requirements and facilitate referrals for infectious disease screenings, housing, employment services, withdrawal management services, transportation, referral to OUD or behavioral health counseling, and provide a warm hand-off to a MAT provider upon an individual's transfer from any current treatments. (3) OTN Data Collection Coordinator (Coordinator): The Coordinator is responsible for managing all data collection activities and serves as the liaison between the OTN, DBHR and RDA. The Coordinator must become competent in all aspects of GPRA data collection required for this project (including completion of SAMHSA GRPA training) and be available and responsive to project evaluators. (4) OTN MAT Prescriber: Continue to employ and or contract at least one prescriber and at least one back-up prescriber with a current DATA -2000 Waiver (in case of primary prescriber absence) at the Initiation Site. k. Ensuring specific tools, such as job descriptions and statements of work, are developed to ensure consistent practice throughout the OTN. Obtain Tobacco Treatment Specialist (TTS) certification by completing the 240 post - training service hours required for the certification. m. Identifying, collaborating, and subcontracting with Local MAT Treatment Site(s) that are willing to support and embrace MAT and are responsible for providing integrated care that Washington State Page 63 of 72 #K Health Care Authority Attachment includes therapy, SUD counseling, outreach, MAT education, case management, tobacco cessation services, and/or referral services. n. Ensuring policies and procedures are in place throughout the OTN to mitigate medication diversion. o. Securing and maintaining release -of -information forms that meet federal confidentiality regulations and allow the release of patient identifying information between Initiation Site and Local MAT Treatment Site(s) and to DSHS RDA for the purpose of program monitoring and performance evaluation. p. Working collaboratively with the University of Washington Alcohol and Drug Abuse Institute Technical Assistance staff to identify training needs and participate in peer-to-peer and educational learning opportunities including the utilization of EBPs. q. Meeting at a minimum, monthly (phone or in-person) with the HCA Contract Manager or SOR Project Director or Treatment Manager to discuss project contract requirements, compliance, technical assistance needs, and problem -solving. r. Ensuring the use of a certified electronic health record system, and review of the Prescription Monitoring Drug Program data, when available and appropriate. s. Ensuring patient assessments utilized for MAT treatment services are consistent and transferable across the Opioid Treatment Network. t. Data Collection Requirements shall include: (1) Government Performance and Results Act (GPRA): (a) OTNs are required to have staff collect data on all individuals receiving services at the Initiation Site (and subsequent MAT services received). The data collection consists of multiple individual interviews and a participant log. Initiation Sites are responsible for ensuring data collection for individuals prior to and after warm hand - Washington State Page 64 of 72 #K Health Care Authority Attachment offs, including coordination of data collection with Local MAT Treatment Site(s) staff. (b) Participant interviews are based on the GPRA Client Outcome Measures Tool.' OTN staff will conduct face-to-face interviews, compile answers, and enter the results into the web -based, SAMHSA Performance Accountability and Reporting System (SPARS) or alternative data collection system .2 OTN staff must collect survey data at four points for each individual served: (c) Intake: GPRA Baseline interview is to be completed as soon as possible with every individual who begins MAT at a facility in your network. (d) Three-month follow-up: completed from one month before to two months after the scheduled follow-up date—regardless of an individual's discharge status. OTNs failing to complete 80 percent of follow-up surveys must submit corrective action plans and demonstrate improved performance. (e) Six-month follow-up: completed one month before to two months after the scheduled follow-up date—regardless of individual discharge status. OTNs failing to complete 80 percent of follow-up surveys must submit corrective action plans and demonstrate improved performance. (f) Discharge: to be completed within 15 days for all individuals leaving treatment. Administrative discharges (without interviews) are required for those lost to follow- up. (g) SAMHSA's Performance Accountability and Reporting System (SPARS) accounts, online training, and survey templates will be provided to OTNs (unless an 1 https://www.samhsa.gov/sites/default/files/GPRA/sais gpra client outcome instrument final pdf A shorter version of this instrument will be used for this grant, however, it has not yet been finalized. 2 Your staff must enter surveys into SPARS within seven days. When the interview takes place, say, prior to or after induction, will depend on the setting, individuals, and workflows. Washington State Page 65 of 72 #K Health Care Authority Attachment alternative system is identified); Project Evaluation (RDA) will provide OTN staff with technical assistance as needed. (h) GPRA Client Outcome Tool Implementation Delay: There will be a delay in implementation of the GPRA tool. Sites will not be considered out of compliance during this delay period by SAMHSA. RDA and SOR Treatment Manager will inform Initiation Sites of the required start dates for GPRA data collection and training. (2) Research and Data Analysis (RDA): Maintain and submit monthly through a secure DSHS portal to RDA, a participant data log template (to be provided) from the Initiation Site only that includes, but is not limited to the following for every new MAT treatment episode: First name, last name and middle initial; date of birth; Social Security Number; gender; race; ethnicity; treatment start date (induction date); MAT drug prescribed (methadone, Bup-mono, Bup-combo, Naltrexone -Injectable; Naltrexone -Oral), transfers to Local MAT Provider, discharge date and discharge status (completed, transferred or lost to follow up). (3) DBHR: Submit a Monthly Report as detailed in the Deliverables Table with the invoice to the DBHR Contract Manager, including, but not limited to: the number of individuals inducted and successfully transferred to local MAT treatment, barriers and successes, technical assistance needs and staff changes. Promoting abstinence from tobacco products (except with regard to accepted tribal traditional practices) and integrating tobacco cessation strategies, medications and services in coordination with the Department of Health's (DOH's) Tobacco and Vapor Product Prevention and Control Program (TVPPCP). (1) Training of two (2) staff as Tobacco Treatment Specialists (TTS) to incorporate tobacco cessation as part of treatment (direct training costs will be covered by DOH, and the 240 service hours required for TTS certification are eligible for partial reimbursement through this contract). (2) General tobacco -free training of three (3) additional staff on the best practices of tobacco use screening and cessation counseling with individuals in SLID treatment, including training on cross -addiction, application of the Screening, Brief Intervention, and Referral to Treatment (SBI RT) model of SLID treatment to the Ask, Advise, and Refer model of nicotine dependence treatment. (3) Ongoing technical assistance from TVPPCP for tobacco cessation practices and implementation of tobacco -free facility policies. Washington State Page 66 of 72 #K Health Care Authority Attachment v. Participating in a pilot program in which patients are referred for tailored, augmented tobacco cessation services through the Washington State Tobacco Quitline (WAQL). This pilot program will include the following: (1) Training of staff on WAQL referral and feedback reporting processes. (2) Provision of augmented tobacco cessation services, including up to seven (7) telephone counseling calls and 12 weeks of nicotine replacement therapy, annually, per individual. (3) Reporting of patients' tobacco cessation progress. w. Assisting in the preparation of reports (e.g., SAMHSA Annual Report, SAMHSA Bi -annual Report) and other data requested by SAMHSA, their designee, or the HCA Contract Manager. x. Ensuring the utilization of third party and other revenue realized from provision of services to the extent possible and use SAMHSA grant funds only for services to individuals who are not covered by public or commercial health insurance programs, or for services that are not sufficiently covered by an individual's health insurance plan. Facilitate the health insurance application and enrollment process for eligible uninsured clients. Washington State Page 67 of 72 #K Health Care Authority Attachment 2. Deliverables Table: Deliverable Due Date Up to 1 Startup phase — copies of signed January 14, 2019 $50,000 agreements with Local MAT Treatment Site(s) (including Data Share Agreements among Initiation Local MAT Treatment Sites) 2 Required staff hired as listed in 3.j. March 1, 2019 $35,000 3 Provision of services by February 1, 2019 February 1, 2019 $60,000 4 Monthly Reports to HCA Contract Due by the second $140,000 Manager including the items listed in Wednesday of the 3.s.(2) and (3) of this contract as well as month following the updates on progress, number of unique month in which individuals served, and Monthly Reports services were to RDA, compiled data of Local MAT provided Treatment Site referrals and services including the breakdown of agonists and antagonists ($20,000 per month x 7 months = $140,000) 5 Tobacco Treatment Specialist (TTS) Due by the last day of $13,000 certification — This will partially reimburse the month following OTN contractors for provider time spent the month in which counseling clients, after completing the certification was 240 post -training service hours required received for the certification. 6 Provision of services to a minimum of 18 Due by the second $126,000 unique individuals per month, starting Wednesday of the March 2019 (18 individuals per month x 7 month following the months x $1,000= $126,000) month in which (Payment will be prorated if minimum services were numbers are not met) provided 7 Benchmark payment for serving 126 September 29, 2019 $39,000 unique individuals (an average of 18 unique individuals per month) and meet an overall individual retention of 50% over the period covered by this Contract. Note: If this benchmark payment is earned, Contractor shall also be entitled to bill, up to the maximum amount that remains available for payment under Deliverable 6, a pro rata payment of $1,000 for each unique individual whom Contractor has served but for whom payment could not be received under the payment terms applicable to Deliverable 6. In no event shall more than a total of Washington State Page 68 of 72 #K Health Care Authority Attachment $165,000 be payable under this Deliverable 7 combined with payment under Deliverable 6. TOTAL $463,000 3. Federal Award Identification (reference 2 CFR 200.331) — SOR Grant CFDA#93.788 (i) Subrecipient name (which must match the name Jefferson County associated with its unique entity identifier); (ii) Subrecipient's unique entity identifier; (DUNS) 619143741 (iii) Federal Award Identification Number (FAIN); H79TIO81705 (iv) Federal Award Date (see §200.39 Federal award 9/19/18 date); (v) Subaward Period of Performance Start and End 12/31/2018 to 09/29/2019 Date; (vi) Amount of Federal Funds Obligated by this $463,000 action; (vii) Total Amount of Federal Funds Obligated to the $463,000 subrecipient; (viii)Total Amount of the Federal Award; $21,573,093 (ix) Federal award project description, as required to Washington State Opioid Response (SOR) Grant be responsive to the Federal Funding Accountability and Transparency Act (FFATA); (x) Name of Federal awarding agency, pass-through Department of Health and Human Services, entity, and contact information for awarding Substance Abuse and Mental Health Services official, Administration, Center for Substance Abuse Treatment Washington State Health Care Authority Division of Behvavioral Health and Recovery Michael Langer, Director Post Office Box 45330 Olympia, WA 98504-5330 (xi) CFDA Number and Name; the pass-through 93.788 entity must identify the dollar amount made available under each Federal award and the CFDA number at time of disbursement; Washington State Page 69 of 72 #K Health Care Authority Attachment (xii) Identification of whether the award is R&D; and ❑ Yes ® No (xiii)Indirect cost rate for the Federal award de minimis (10%) (including if the de minimis rate is charged per §200.414 Indirect (F&A) costs). Washington State Page 70 of 72 #K Health Care Authority Attachment Exhibit A Available upon request from the HCA Contracts Administrator. Washington State Page 71 of 72 #K Health Care Authority Attachment Exhibit B Available upon request from the HCA Contracts Administrator. Washington State Page 72 of 72 #K Health Care Authority Attachment RFA EXHIBITS EXHIBIT A 3.3. Application Face Page This document can be downloaded at httos://fortress.wa.goy/ga/webs/. Please complete this two page form and submit it as the first page of your application. Applicant information Please type responses or mark selections in this column only. Community name (service area(s) Jefferson County Jail where proposed services will be Jefferson County, Clallam County, and Kitsap provided) County Applicant Organization Contact Person David Fortino j Name Applicant Organization Contact Person Jail Superintendent Title Applicant Organization Contact Person ortinoCatco.jefferson.wa.us Email Applicant Organization Contact Phone 360-344-9743�� Number Applicant Organization Name Jefferson County Sheriff's Office Applicant Organization Mailing Address 79 Elkins Road, Port Hadlock, WA 98339 Applicant Organization Organization's 619143741 DUNS number I Applicant Organization Zip code + 4 98339-9700 (assigned by the US Postal Service) Applicant Organization Applicant type Q Government agency/ Public agency i ❑ Non-profit County Jefferson HCA RFA No. K 3300 EXHIBIT B Project Narrative — 80 Points - 80% of total score 1. Overview (20 Total Points) a. Provide a brief overview of how your organization proposes to implement OTNs in your community. Identify potential Local MAT Treatment Sites, including the organization name, location, and MAT prescriber(s). (4 points) The Jefferson County Sheriff's Office proposes to establish an OTN in partnership with Olympic Peninsula Health Services (OPHS) to provide MAT to incarcerated individuals in the County Jail. The County Jail will be the `Initiation Site' for induction of incarcerated individuals who would benefit from MAT. To ensure continuity of care, OPHS will be contracted to provide both initiation site MAT in the County Jail as well as post -release MAT in the local community. This will ensure that the MAT provider has developed a rapport and relationship with the patient and will provide a seamless `warm hand-off from incarceration to community clinic setting. OPHS will provide Prescriber, Nurse Care Manager, Care Navigator, and Data Collection functions for the OTN that will be shared between the initiation site and the local MAT treatment site as detailed in the budget template. In addition to MAT, OPHS will provide tobacco cessation services and will address social service and other needs in collaboration with local organizations including Safe Harbor Recovery Center (outpatient chemical dependency counseling), Believe in Recovery (outpatient substance abuse treatment), Specialty Services (inpatient rehab and medical detox), Dove House Advocacy Service (domestic abuse shelter and counseling), Pregnancy Resource Center, and Olympic Community Action Programs (OlyCAP), as well as Jefferson County Public Health and Jefferson County Drug Court. OPHS is a new State Hub for opioid treatment as well as a Local MAT Treatment Site and operates in multiple locations in Jefferson and Clallam counties with 5 MAT prescribers. Other potential Local MAT Treatment Sites include: Jefferson Healthcare, operating out of Port Townsend, with 20 -plus MAT prescribers serving Jefferson and surrounding counties; and Sound Integrated Health, operating out of Bremerton and Tacoma, with 7 MAT prescribers serving nearby Kitsap and Pierce counties. b. Include how you will address the OUD needs of American Indians/Alaska Natives, veterans, incarcerated individuals, pregnant and parenting individuals, underinsured/uninsured individuals, and other marginalized populations. (4 points) The County Jail, as the initiation site for MAT, will connect incarcerated individuals (which includes American Indians/Alaska Natives, veterans, underinsured/ uninsured, and other marginalized populations) to effective opioid treatment. Well over half those incarcerated in the County Jail meet the criteria for drug dependence or abuse. All individuals entering the County Jail will be screened for OUD. MAT will be started with appropriate inmates during incarceration and then continued post -release in a community-based clinic setting. OPHS will provide referrals to tribal health, PCAP, VA, and agencies focused on specific demographics when appropriate. As the majority of incarcerated individuals qualify for Medicaid, OPHS Care Navigators will work with the County Jail to assure that inmates have applied for healthcare prior to release and will coordinate care during follow-up as needed. Data on veteran status and underinsured/uninsured status will be collected as part of this program. c. Briefly describe the demographics of the population and community you intend to serve. In your narrative, include DOH overdose rates by county, population and current placement of existing H&S and other available MAT services. (8 points) The proposed OTN will serve incarcerated individuals in the 57 -bed County Jail. In 2017 there were 1,258 bookings in the County Jail. The incarcerated population is predominately made up of Jefferson County residents but also includes individuals from neighboring Clallam, Kitsap, and other counties. The population of Jefferson County is 31,590 with 25% receiving Medicaid assistance. The percentage of Jefferson County Medicaid enrollees with history of OUD is similar to neighboring counties but their initiation to MAT has been found to be below average. 2.2% of the population identifies as American Indian/Alaska Native. DOH reported 15 opioid - related overdose deaths in Jefferson County for 2012-2016, a rate of 10.3 per 100,000 population. In 2017 there were 1 I hospitalizations and 3 deaths related to opioid overdose in Jefferson County. OPHS, based in Port Hadlock, is a new State Hub to serve Jefferson and Clallam counties. OPHS works closely with Sound Integrated Health which has clinics in Bremerton and Tacoma. Peninsula Community Health Services based in Bremerton is the existing State Hub operating from Kitsap County. SAMHSA currently lists 12 buprenorphine prescribers in Jefferson County. d. Describe your plans for integrating tobacco cessation into your behavioral health service milieu. (4 points) OPHS will provide tobacco cessation services for the proposed OTN and will provide intervention screening using the 5 -A's (Ask, Advise, Assess, Assist, Arrange). The Fagerstrom tool will be used to assess nicotine dependence and treatment recommendations, to include nicotine replacement therapy and medications, as appropriate. e. Describe the specific technical assistance and training you will need to implement this scope of work. (0 points) County Jail and OPHS staff will access SAMHSA resources for technical assistance and training to help understand and comply with GPRA data collection and SPARS reporting requirements. We will also reach out to other OTNs regarding lessons learned with specific emphasis on the challenges involving incarcerated individuals. 2. For Initiation Sites: Describe your ability to implement MAT coordination by December 31, 2018 (15 Total Points) a. Describe your relationships with medical providers and MAT champions in your community and network. (5 points) The County Jail currently contracts with Healthcare Delivery Systems (HDS) for medical services. Shannon Slack coordinates HDS services in the County Jail. Slack is a MAT treatment provider and recognizes the need to expand MAT access. She supports the role of the County Jail as an Initiation Site for the proposed OTN and the partnership with OPHS to provide MAT. The County Jail is closely partnering with Olympic Peninsula Health Services (OPHS), the new State Hub, to provide both initiation site MAT in the County Jail as well as post -release MAT in the local community. Communication protocols between the County Jail, HDS and OPHS are being developed to ensure coordination of care. Both the County Jail and OPHS maintain a strong working relationship with Jefferson Healthcare, another MAT provider in the community. b. Describe potential barriers to overcome in order to implement service coordination by December 31, 2018. (3 points) The biggest challenge – identification of a MAT provider for both inside the County Jail and for post -release follow-up – has been resolved through partnership with OPHS. The proposed OTN has the capacity to begin MAT inductions immediately. Other potential barriers involve modifying the workflow to incorporate OUD screening and data collection. OUD screening will be added to the booking process. Hiring qualified staff in a rural county can also be a barrier. c. Describe your ability to establish 42 CFR Part 2 -compliant Releases of Information (ROIs) with community and network service providers. (S points) During assessment in the County Jail, MAT patients will sign consent forms and 42 CFR Part 2 - compliant ROI for follow-up with community providers. If post -release follow-up is conducted through OPHS clinics, the ROI will be redundant since OPHS will be handling assessment, induction and follow-up treatment for the patient. d. What screening or assessment instruments do you plan on utilizing to identify individuals appropriate for MAT? (2 points) We will use validated tools for addiction diagnosis and assessment including NIDA Quick Screen, Fagerstrom (for nicotine), AUDIT -C, CRAFFT, and DSM -V for opioid use disorder. 3. Describe your potential MAT prescribing capacity (15 Total Points) a. List your data -waived prescribers at Initiation Site, including available capacityfor each prescriber. (S points) Initiation Site MAT prescribing will be provided by OPHS with a capacity of approximately 700. Other prescribers will be added soon. Current OPHS data -waived prescribers include: Atif Mian, MD – 275 Ronald Bergman, MD – 275 Ana Vasquez, ARNP – 30 Tina Lenson, ARNP – 30 Annie Failoni, ARNP – 100 b. For potential Local MAT Treatment Site(s), describe available MAT participant capacity, a current average monthly census, and potential for MAT capacity expansion. (S points) Local MAT Treatment Site prescribing will be provided by OPHS, located in Port Hadlock and another clinic opening soon in Port Angeles. OPHS has multiple data -waived prescribers with an available MAT participant capacity of approximately 700. Current monthly MAT prescriptions are approximately 350. Other prescribers will be added soon to increase capacity over 700. c. Describe your plan for when prescriber capacity is full—how will individuals be admitted and/or referred to other prescribers? (S points) OPHS, our MAT partner has current prescriber capacity to meet the OTN needs. OPHS capacity will increase in the next 2-3 months to accommodate future needs. Overflow patients can be transferred to other local MAT providers. We will continue to maintain a strong relationship with Jefferson Healthcare, another local provider, in case additional capacity is needed. d. What MAT medications will your proposed Initiation Site and proposed Local MAT Treatment Site(s) prescribe? (0 points) Medications for opioid dependence, including Buprenorphine, an opioid agonist, and Naltrexone, an opioid antagonist, will be available at both sites. 4. Describe collaboration approach with Local MAT Treatment Sites (15 Total Points) a. Describe referral procedure from Initiation to Local MAT Treatment Sites) specifically, the "warm hand-off' Process. (S points) To ensure continuity of care, OPHS will be contracted to provide both Initiation Site MAT in the County Jail as well as post -release MAT at their Local MAT Treatment Site in the community. This will ensure that the MAT provider has developed a rapport and relationship with the patient and will provide a seamless `warm hand-off from incarceration to community clinic setting without the usual barriers. Before release, follow-up appointments will be coordinated with the OPHS clinic and all pertinent information will be shared. Follow-up in the local clinic will be scheduled to occur the same day and no later than the day following release. At time of release, an inmate's family and friends will be enlisted to facilitate the transfer to the nearby OPHS clinic. If necessary, other transportation options can be arranged by the Care Navigator. b. Describe approach to ensure the individual's treatment continues without interruption from Initiation Site to Local MAT Treatment Site. (S points) The proposed OTN will utilize the same MAT provider (OPHS) for MAT treatment both inside the County Jail and in the community. This will ensure that the MAT provider is familiar with the patient, has developed a rapport and relationship with the patient and will provide a seamless follow up from incarceration to community clinic setting. This will also reduce 42 CFR Part 2 - compliant ROI issues. OPHS staff performing the Care Navigator function will ensure that appropriate transportation is in place for the inmate to get to the clinic following release. OPHS will induct appropriate inmates into MAT during incarceration using Vivitrol so that they have adequate MAI' prior to release and then to continue MAT for several weeks post -release. Accurate and detailed contact information will be obtained by the Care Navigator so that strong connections can be maintained with the MAT patient after their release from the County Jail. The MAT patient will receive frequent prompts to follow up in the OPHS outpatient clinic. The Care Navigator will work on identifying barriers to this follow-up and reduce or eliminate them as able. The Care Navigator will work on any pre- and post -release issues identified as well. c. Describe communication and follow-up plan between Initiation and Local MAT Treatment Sites. (S points) The proposed OTN will utilize the same MAT provider (OPHS) for MAT treatment both inside the County Jail and in the community which will streamline communication between Initiation and Local MAT Treatment Sites and provide for seamless, barrier -free follow-up. The Care Navigator will liaison with the County Jail, HDS, and OPHS to foster and maintain open channels of communication for integration of care. 5. SOR OTN Application Requirement: Data Collection (15 Total Points) a. Describe the qualifications and work effort of staff assigned to manage and oversee all data collection activities and how the OTN will ensure continuity of this resource, including your training plan for staff conducting interviews and compiling or entering data. (S points) For continuity the Prescriber, Nurse Care Manager, Care Coordinator, and Data Collection Coordinator functions will be performed for both the Initiation Site and the Local MAT Treatment Site by OPHS staff in a shared capacity as detailed in the budget template. Preliminary screening for OUD and preliminary data collection at the County Jail will be conducted by Commissioned Corrections Officers during the booking process. Incarcerated individuals who are positive on the OUD screen will be referred for initial assessment and follow-up within 12 hours of booking to an experienced RN/LPN (or similar level) Nurse Care Manager. Follow-up interviews as well as data collection and reporting will be conducted by an RN/LPN (or similar level) Care Coordinator and Data Collection Coordinator. An MD or ARNP Prescriber will conduct medical evaluations, add any additional data needed, and start incarcerated individuals on MAT if appropriate. County Jail and OPHS staff will access SAMHSA resources for technical assistance and training to help understand and comply with GPRA data collection and SPARS reporting requirements. Staff will also work with UW AIMS and UW AID center for education and training as needed. b. Describe your workflow and staffing for maintaining participant log (or logs, if multiple Local MAT Treatment Sites). Include your workflow for completing intake, 3 -month, 6 - month, and discharge surveys and entering data into SPARS. (S points) County Jail staff will conduct initial OUD screening at the time of booking. Incarcerated individuals who are positive on the OUD screen will be referred to the Nurse Care Manager for assessment and if warranted MAT induction with the Prescriber. OPHS staff performing the Care Manager and Data Collection functions will keep a log of incarcerated individuals referred for assessment as well as those started on MAT. Post -release, 3-, and 6 -month data will be collected, compiled, and entered into SPARS by County Jail and OPHS staff performing the Data Collection function. c. Describe your strategies for meeting 80 percent completion rate for 3 -month and 6 -month follow-up surveys. Describe how you will complete follow-up surveys for individuals who have left your care, including coordination with the Local MAT Treatment Site related to data collection. (S points) OPHS, the Local MAT Treatment Site for this OTN, will follow MAT patients after release from custody and will maintain solid connections during and after treatment using the detailed contact information collected pre-release by the Care Navigator. OPHS staff performing the Data Collection function will continue to track MAT patients and collect necessary data throughout and after MAT treatment, including MAT patients who have left care. EXHIBIT C Budget Narrative and Budget Template 20 Points - 20% of total score Budget Narrative: Your budget narrative should detail each element within your submitted Budget. A Budget Template is provided below. Any variations to the Budget Template must be explained thoroughly so evaluators will understand the variance and justification. Attach additional Budget Templates as necessary to describe additional Local MAT Treatment Sites. Budget Template: WA State - SOR Opioid Treatment Network Budget Annual Budget Personnel FTE % Annual Monthly Salary Salary only Benefits TOTAL Personnel -Initiation Site 1.75 Prescribers 0.5 $5,000 $60,000 $9,000 $69,000 Nurse Care Manager NCM 0.25 $1,875 $22,500 $3,375 $25,875 Care Navigators CN 0.5 $2,083 $25,000 $3,750 $28,750 Data Collection Coordinators 0.5 $2,083 $25,000 $3,750 $28,750 Personnel -Local MAT Treatment Sites 1.5 Prescribers 0.5 $5,000 $60,000 $9,000 $69,000 Nurse Care Manager CM 0.5 $3,750 $45,000 $6,750 $51,750 Care Navi ators (CN) 0.5 $2,083 $25,000 $3,750 $28,750 Personnel Subtotal 3.25 $21874 $262,500 $39,375 $301,875 Other Costs/Supplies/Travel MAT Medications Computers/Software Phone Office Supplies TOTAL $115,500 $10,000 $2,500 $2,500 $1,000 Printine,/dupticating Data entry Travel OTN Development $500 $11,125 $5,000 Other Costs/Supplies/Travel/ OTN Development Subtotal $148,125 Total $450,000 Indirect Cost 0 Grand Total $450,000 EXHIBIT D 11.4. Letters) of Commitment from Local HAAT Treatment Sites Olympic Peninsula Health Services 661 Ness Corner Road Port Hadlock, WA 98339 PH 360-912-5777 FX 206-472-6035 Olympic Peninsula Health Services PS is committing to work in collaboration with Jefferson County Jail and the Sheriff Department in evaluating and treating patients with Opioid Use disorder. We are a group of providers and ancillary staff that has been delivering MAT in Jefferson, Kitsap and Pierce County for many years and soon to be providing services in Clallam County. We are well versed with the challenges these patients face as we currently work with the legal system. We have adequate prescriber capacity to treat a high volume of patients with OUD and other addictions. We will provide MAT services in the jail to incarcerated individuals and follow them post release in our local clinic. We will provide MAT prescribers to the jail along with a nurse manager and a care navigator to assist in coordination of care for MAT patients both inside and outside the jail. Patients going to other community MAT providers will also be followed. Data will be collected for all patients at initiation, 3, 6 months for GPRA requirements. We also work with the local counselling agencies and will continue to coordinate care with them. Along with MAT we will begin screening all patients for tobacco use and provide counseling and treatment for such as needed. Annie Failoni President OPHS EXHIBIT E 3.7. Certifications and Assurances I/we make the following certifications and assurances as a required element of the proposal to which it is attached, understanding that the truthfulness of the facts affirmed here and the continuing compliance with these requirements are conditions precedent to the award or continuation of the related contract: 1. Itwe declare that all answers and statements made in the proposal are true and correct. 2. The prices and/or cost data have been determined independently, without consultation, communication, or agreement with others for the purpose of restricting competition. However, I/we may freely join with other persons or organizations for the purpose of presenting a single proposal. 3. The attached proposal is a firm offer for a period of 120 days following receipt, and it may be accepted by HCA without further negotiation (except where obviously required by lack of certainty in key terms) at any time within the 120 -day period. 4. In preparing this proposal, I/we have not been assisted by any current or former employee of the state of Washington whose duties relate (or did relate) to this proposal or prospective contract, and who was assisting in other than his or her official, public capacity. If there are exceptions to these assurances, I/we have described them in full detail on a separate page attached to this document. 5. I/we understand that HCA will not reimburse me/us for any costs incurred in the preparation of this proposal. All proposals become the property of HCA, and I/we claim no proprietary right to the ideas, writings, items, or samples, unless so stated in this proposal. 6. Unless otherwise required by law, the prices and/or cost data which have been submitted have not been knowingly disclosed by the Applicant and will not knowingly be disclosed by him/her prior to opening, directly or indirectly, to any other Applicant or to any competitor. 7. I/we agree that submission of the attached proposal constitutes acceptance of the solicitation contents and the attached sample contract and general terms and conditions. If there are any exceptions to these terms, I/we have described those exceptions in detail on a page attached to this document. 8. No attempt has been made or will be made by the Applicant to induce any other person or firm to submit or not to submit a proposal for the purpose of restricting competition. 9. I/we grant HCA the right to contact references and other, who may have pertinent information regarding the ability of the Applicant and the lead staff person to perform the services contemplated by this RFA. 10. If any staff member(s) who will perform work on this contract has retired from the State of Washington under the provisions of the 2008 Early Retirement Factors legislation, his/her name(s) is noted on a separately attached page. We (circle one) are / ren submitting proposed Contract exceptions. If Contract exceptions are being submitted, I/we have attached them to this form. On behalf of the Applicant submitting this proposal, my name below attests to the accuracy of the above statement. ff electronic, also include: We are submitting a scanned signature of this form with our proposal. r r w Signature of A icant YlV- Title Dat HCA RFA No. K 3300 EXHIBIT F 4.6 Contractor Intake Form I - Identifying Information A) Contractor Legal Name: B) DBA or Facility Name: JEFFERSON COUNY SHERIFF'S OFFICE C) WA Uniform Business Identifier (UBI) Number: D) Taxpayer Identification Number 161-001-169 (TIN): 91-6001322 E) State Wide Vendor Number (SWV#): E) Funding Amount (ALL 0002430-29 amendments included): 2 - Contractor Address 3 - ContractorNendor Primary Contact A) Full Name: B) Job Title: DAVID FORTINO JAIL SUPERINTENDENT C) Email Address: D) Phone Number: DFORTINO CO.JEFFERSON.WA.US 360 344-9743 Authorized to Sign Contracts? ❑ Yes ® No If 'no' selected — Section Four 4 is REQUIRED 4 - ContractorNendor Primary Sionatory A) Full Name: B) Job Title: ARTFRANK UNDERSHERIFF C) Email Address: D) Phone Number: AFRANK CO.JEFFERSON.WA.US 360 344-9734 5 - Additional ContractorNendor Staff to be Notified A) Full Name: B) Email Address: C) Full Name: D) Email Address: 6 - Contract Information A) Contract B) Exact Start Date: C) Exact End Date (this Number: December 2018 contract/work order/amendment RFA NO. 3300 ONLY): September 28, 2020 D) Funding Amount (this contract/work E) Funding Amount (ALL order/amendment ONLY):$450,000 amendments included): $450,000 F) Additional Instructions: j - Zd- ?,C) Completed By: I [Na ] Date: [Date] HCA RFA No. K 3300 EXHIBIT G 4.7 FFATA Form STATE OF WASHINGTON HEALTHCARE AUTHORITY Budget and Finance PO Box 45330, Olympia, WA 98504-5330 Federal Funding Accountability and Transparency Act (FFATA) YELLOW: CONTRACTOR TO COMPLETE YELLOW HIGHLIGHTED SECTIONS BLUE: DSHS PROGRAM MANAGER TO COMPLETE BLUE HIGHLIGHTED SECTIONS GRAY: DSHS CONTRACT TO COMPLETE GRAY HIGHLIGHTED SECTIONS (i) Contractor DUNS Number; (must be a 9 digit number) 619143741 YOUR DUNS # MUST MATCH BACK TO YOUR ADDRESS BELOW (ii) Contractor zip Code + 4 98339+9700 (iii) Contractor Name; JEFFERSON COUNTY (iv) Contractor doing business as; JEFFERSON COUNTY SHERIFF'S OFFICE (v) Contractor Physical Address — 1.79 ELKINS RD 1. street address; 2. PORT HADLOCK 2. city; 3.WA 3. state; 4.JEFFERSON 4. country; 5.98339+9700 S. zip +4; and 6. congressional district. 6.WA-6 Congressional District Look Up: https://www.¢ovtrack.us/congress/members/mae (vi) If applicable, the Contractor's Parent Company DUNS Number; (vii) Amount of Contract/Amendment Award —This includes any prior amendment amounts; 1. This amount should only reflect the total amount of funds for the specific grant related to this FFATA form and may or may not reflect the total amount of the contract if other funds are included in the contract. 2. If more than one Federal fund source (that requires a FFATA form) is included in the Contract, each fund source must have its' own FFATA form completed. (viii) Contract/Amendment Authorization (Date Contract/Amendment) was signed; (ix) CFDA Program Number and Program Title; Choose One (x) Description of the overall purpose and expected outcomes, OR results of the Contract, including significant deliverables and, if appropriate, associated units of measure; HCA RFA No. K 3300 NO Contractor Place of Performance — 1.79 ELKINS RD 1. street address; 2.PORT HADLOCK 2. city; 3.WA 3. state; 4.JEFFERSON 4. country; 5.98339+9700 S. zip +4; and 6. congressional district. 6.WA-6 Congressional District Look Up: httos:/Iwww.govtrack.us/`congress/members-/`map (xii) DSHS Contract Number; (xiii) As provided by the Contractor — in the contractor's business or NO organization's preceding completed fiscal year, did the business or organization (the legal entity to which the DUNS number is provided belongs) receive (1) 80 percent or more of its annual gross revenues in U.S. federal contracts, sub- contracts, loans, grants, subgrants, and/or cooperative agreement; and (2) $25,000,000 or more in annual gross revenues from U.S. federal contracts, sub -contracts, loans grants, subgrants, and or cooperative agreements?; If No, you do not need to complete xiv. And xv. (xiv) As provided by the contractor — does the public have access to information about the compensation of the executives in the contractor's business or organization (the legal entity to which the DUNS number it provided belongs) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986?; If No, proceed to section xv. (xv) if answer to xiv is no; provide the names and Total 1. Compensation of the Top 5 Employees for the contractor. 2 3. 4. 5. PRIME GRANT RECIPIENTS awarded a new Federal grant greater than or equal to $25,000 as of October 1,2010 are subject to FFATA sub -award reporting requirements as outlined in the Office of Management and Budgets guidance issued August 27, 2010. Subawardee (Prime Contractor) Information Template (Note — This is based on information in Section 5 of FFATA Grants Reporting Template) HCA RFA No. K 3300 4.9 Application Checklist Is your application complete? Please check box indicating that your application includes the following: ® Application Face Page ® Project Narrative ® Budget and Budget Narrative Letter(s) of commitment from Local MAT Treatment Sites (j Certifications and Assurances © Contractor Intake Form ® FFATA Form ® The individual with Contractor signature authority, as indicated on the Contractor Intake Form, is has reviewed this application and has authorized submission of this application. Please copy this individual in the email when submitting the application materials. I, ART FRANK, certify that, on behalf of the applicant agency, I am authorized to submit this application to provide the described services. Signature: Date: - l i' - z L) 8 HCA RFA No. K 3300 Regular Agenda JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: David Fortino, Jail Superintendent DATE: January 14, 2019 SUBJECT: Agenda Item — WA State Health Care Authority Opiate Treatment Network Grant Contract and Service Agreement with Olympic Peninsula Health Services STATEMENT OF ISSUE: Jefferson County Sheriff's Office is requesting Board approval of the professional services contract with the WA State Health Care Authority for Opiate Treatment Networks 4K3285; December 31, 2018 — September 29, 2019 and for Board approval of the Service Agreement with Olympic Peninsula Health Services to cooperatively administer the OTN Contract. ANALYSIS: This contract and service agreement establishes the Jefferson County Jail as an initiation site for Medicated Assisted Treatment as well as establishes an Opiate Treatment Network with Olympic Peninsula Health Services (OPHS) to provide wrap around services for those individuals with Opiate Use Disorder (OUD), including education and induction into MAT program, Care Navigation and establishment with social services if qualified. The OTN will enhance services within the Jefferson County Jail for those individual with OUDs. FISCAL IMPACT: Reimbursement for services provided are based on the Deliverables Table within the HCA contract to include startup costs, provision of services, and performance based reimbursement established by benchmark goals. The maximum reimbursement allowed is $463,000 to be disbursed according to the Service Agreement with OPHS. RECOMMENDATION: The Jefferson County Sheriff's Office request approval of the professional services contract with HCA #K3285, and the Service agreement with OPHS. REVIEWED BY: Philip e ministrator Date