HomeMy WebLinkAbout100719_ca04615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
DATE: 0&bzl a, :� , I)o I 1 i
Consent Agenda
September 5, 2019
SUBJECT: Agenda Item — Agency Agreement — Division of Behavioral Health and
Recovery with WA State Health Care Authority; July 1, 2019 — June 30,
2021; $354,595
STATEMENT OF ISSUE:
Jefferson County Public Health is requesting Board approval of the Agency Agreement — Division
of Behavioral Health and Recovery (DBHR) with Washington State Health Care Authority (HCA), July 1, 2019
— June 30, 2021; $354,595
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This ongoing contract with DBHR provides Federal and State funding to coordinate and implement
prevention programs designed to prevent or delay the misuse and abuse of alcohol, marijuana, tobacco,
and other drugs among youth up to age 18 and adults ages 18-25. The DBHR contract funds the
Community Prevention and Wellness Initiatives and Community Coalition activities including coordination,
prevention, and training based on evidence -based practices as identified in the Excellence in Prevention
Strategies List.
FISCAL IMPACT/COST BENEFIT ANALYSIS•
$294,005 is provided through federal funding and $60,590 is provided through the state, for a total of
$345,595.
RECOMMENDATION:
JCPH management request approval of the Agency Agreement — Division of Behavioral Health
and Recovery with WA HCA, July 1, 2019 — June 30, 2021; $354,595
RE ED BY:
=� p Morle , oun Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
'Washington StateINTERAGENCY AGREEMENT HCContract Number: K3921
for Contractor/Vendor Contract Number:
Heat Carehfoh'00711 CPWI Prevention Services
THIS CONTRACT is made by and between Washington State Health Care Authority (HCA) and
Contractor.
CONTRACTOR NAME
Jefferson County
CONTRACTOR DOING BUSINESS AS (DBA)
CONTRACTOR ADDRESS i Street City State Zip Code
615 Sheridan St. Port Towsend WA 98368
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS
Denise Banker 360-385-9438 dbanker@co.jefferson.wa.us
Is Contractor a Subrecipient under this Contract?
®YES ❑ NO
CFDA NUMBER(S): FFATA Form Required
93.959, 93.243, 93.788 1 ® YES ❑ NO
HCA PROGRAM
DBHR
HCA DIVISION/SECTION
Prevention
HCA CONTACT NAME AND TITLE
HCA CONTACT ADDRESS
Rose Quinby, Martha Williams, Agreement Manager
Health Care Authority
621 81'Avenue SE
Olympia, WA 98504
HCA CONTACT TELEPHONE
HCA CONTACT E-MAIL ADDRESS
360-725-1129
rose.quinby@hca.wa.gov
CONTRACT START DATE I CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT
7/1/2019 1 6/30/2021 1 $354,595
PURPOSE OF CONTRACT:
Obtaining CPWI Prevention Services in order to increase capacity to implement direct and environmental substance use
prevention services in high need communities qualified to immediately implement identified evidence -based practices
and programs to prevent and reduce the misuse and abuse of alcohol, tobacco, marijuana, opioids, and other drugs.
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.
CONTRACTOR SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Kate Dean, Chair
Jefferson Co. Board of Commissioners
HCA SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Kerry J. Breen, Acting Contracts Administrator
Division of Legal Affairs
A roved a to rnt only:
• ov Date: -14,11f
Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney
Jefferson County Prosecuting Attorney's Office
Washington State Page 1 HCA Contract No. K3921
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TABLE OF CONTENTS
Recitals............................................................................................................................................ 5
1. STATEMENT OF WORK (SOW)................................................................................................. 5
2. DEFINITIONS............................................................................................................................. 5
3. SPECIAL TERMS AND CONDITIONS......................................................................................10
3.1 PERFORMANCE EXPECTATIONS.................................................................................. 10
3.2 TERM....................................................................... .... 11
3.3 COMPENSATION...................................................................................... 12
3.4 INVOICE AND PAYMENT................................................................................................. 12
3.5 CONTRACTOR and HCA AGREEMENT MANAGERS...................................................... 14
3.6 LEGAL NOTICES............................................................................................................. 15
3.7 SAMHSA Award Terms.................................................................................................... 16
3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE... ................ .... 17
3.9 INSURANCE.................................................................................................................... 18
4. GENERAL TERMS AND CONDITIONS.................................................................................... 18
4.1
ACCESS TO DATA...........................................................................................................
18
4.2
ADVANCE PAYMENT PROHIBITED................................................................................
19
4.3
AMENDMENTS................................................................................................................
19
4.4
ASSIGNMENT..................................................................................................................19
4.5
ATTORNEYS' FEES.........................................................................................................
19
4.6
CHANGE IN STATUS.......................................................................................................
19
4.7
CONFIDENTIAL INFORMATION PROTECTION..............................................................
19
4.8
CONFIDENTIAL INFORMATION SECURITY....................................................................
20
4.9
CONFIDENTIAL INFORMATION BREACH - REQUIRED NOTIFICATION .......................
20
4.10
CONTRACTOR'S PROPRIETARY INFORMATION.........................................................
21
4.11
COVENANT AGAINST CONTINGENT FEES...................................................................
21
4.12
DEBARMENT...................................................................................................................22
4.13
DISPUTES.......................................................................................................................
22
4.14
ENTIRE AGREEMENT.....................................................................................................
23
4.15
FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) ..................
23
4.16
FORCE MAJEURE...........................................................................................................
23
4.17
FUNDING WITHDRAWN, REDUCED OR LIMITED..........................................................
24
4.18
GOVERNING LAW.........................................................................................................................24
4.19
HCA NETWORK SECURITY................................................................................... .....
25
Washington State
Page 2 HCA Contract No. K3921
Health Care Authority
4.20
INDEMNIFICATION................................................................................. .........
25
4.21
INDEPENDENT CAPACITY OF THE CONTRACTOR.......................................................
25
4.22
INDUSTRIAL INSURANCE COVERAGE.........................................................................
25
4.23
LEGAL AND REGULATORY COMPLIANCE.....................................................................
25
4.24
LIMITATION OF AUTHORITY...........................................................................................
26
4.25
NO THIRD -PARTY BENEFICIARIES................................................................................
26
4.26
NONDISCRIMINATION....................................................................................................
26
4.27
OVERPAYMENTS TO CONTRACTOR.............................................................................26
4.28
PAY Equity.......................................................................................................................
26
4.29
PUBLICITY.......................................................................................................................27
4.30
RECORDS AND DOCUMENTS REVIEW..........................................................................
27
4.31
REMEDIES NON-EXCLUSIVE.........................................................................................
28
4.32
RIGHT OF INSPECTION ............................. .....................................................................
28
4.33
RIGHTS IN DATA/OWNERSHIP.......................................................................................
28
4.34
RIGHTS OF STATE AND FEDERAL GOVERNMENTS....................................................
29
4.35
SEVERABILITY....................................................................,............................................29
4.36
SITE SECURITY...............................................................................................................
30
4.37
SUBCONTRACTING........................................................................................................
30
4.38
SUBRECIPIENT...............................................................................................................31
4.39
SURVIVAL........................................................................................................................
33
4.40
TAXES.............................................................................................................................
33
4.41
TERMINATION.................................................................................................................33
4.42
TERMINATION PROCEDURES.......................................................................................
35
4.43
WAIVER............................................................................................................................
36
4.44
WARRANTIES..................................................................................................................36
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: HIPAA Compliance
Attachment 5: SAMSHA Award Terms
Washington State Page 3 HCA Contract No. K3921
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Schedule A:
Exhibit A:
Exhibit B:
Exhibit C:
Exhibit D:
Exhibit E:
Exhibit F:
Statement of Work (SOW) CPWI Prevention Services Expansion Project
DBHR-SUD Fiscal Policies Standards for Reimbursable Costs
Federal Award Identification for Subreceipients
Data Security Requirements
Awards and Revenues
SOR CBO (attached if applicable)
PSF NCE (attached if applicable)
Washington State Page 4 HCA Contract No. K3921
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Agreement #K3921 for Washington State Community Prevention and Wellness Initiative
(CPWI) Prevention Services Project
Recitals
NOW THEREFORE, HCA awards to Jefferson County this Agreement, the terms and conditions
of which will govern Contractor's providing to HCA the coordination and implementation of
prevention programs and strategies designed to prevent or delay the misuse and abuse of
alcohol, marijuana, tobacco, opioids, and other drugs, increase mental health promotion and
prevent suicide in support of the CPWI Prevention Services Project.
IN CONSIDERATION of the mutual promises as set forth in this Agreement, the parties agree
as follows:
UNW
G i1 ► 4 e a• i A
The Contractor will furnish the necessary personnel, equipment, material,
and/or service(s) and otherwise do all things necessary for or incidental to the
performance of work set forth in Schedule A, Statement of Work, attached and
incorporated herein.
UN "ID
"Authorized Representative" means a person to whom signature authority has been
delegated in writing acting within the limits of his/her authority.
"Awards" means the total funding of all individual awards HCA allocates to the Contractor,
and the total of all awards in this Agreement's Maximum Amount, which is itemized in
Exhibit D.
"Awards and Revenues" or "A&R" details the Contractor's Awards and Revenues
attached as Exhibit D.
"Budget, Accounting, and Reporting System" or "BARS" means the "Fiscal/Program
Requirements". See below, which replaces BARS document.
"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,
Washington State Page 5 HCA Contract No. K3921
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or directors.
"Business Days and Hours" means Monday through Friday, 8:00 a.m. to 5:00 p.m.,
Pacific Time, except for holidays observed by the state of Washington.
"Certified Prevention Professional" or "CPP" means the Prevention Specialist
certification recognized by the International Credentialing and Reciprocity Consortium
(IC&RC) and supported by the Prevention Specialist Certification Board of Washington,
www.pscbw.com.
"CFR" means the Code of Federal Regulations. All references in this Agreement to CFR
chapters or sections include any successor, amended, or replacement regulation. The CFR
may be accessed at http://www.ecfr.gov/pAi-bin/ECFR?page=browse,
"Coalition" means a formal arrangement for cooperation and collaboration between
groups or sectors of a community. Each participant in the Coalition retains their identity, but
all agree to work together toward a common goal of building a safe, healthy, and drug-free
community.
"Community" means an approved geographic area within school district boundaries, or
within High School Attendance Areas (HSAA) and their feeder schools.
"Community Prevention and Wellness Initiative" or "CPWI" means the HCA substance
use disorder prevention delivery system that focuses prevention services in high -need
communities in Washington State as selected by Contractor and approved by HCA.
"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" or "Agreement" or "Interagency Agreement" means this Agreement
document and all schedules, exhibits, attachments, incorporated documents and
amendments.
"Contractor" means the named contractor contact on the cover sheet, its employees and
agents. Contractor additionally includes any firm, provider, organization, individual or other
entity performing services under this Agreement. It also includes any Subcontractor
retained by Contractor as permitted under the terms of this Agreement.
Washington State Page 6 HCA Contract No. K3921
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"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.
"CSAP" means SAMHSA's Center for Substance Abuse Prevention. CSAP works with
federal, state, public, and private organizations to develop a comprehensive prevention
system.
"Data" means information produced, furnished, acquired, or used by Contractor in meeting
requirements under this Agreement.
"DBHR" means the Division of Behavioral Health and Recovery or its successor.
"DEA" means United Stated Drug Enforcement Agency.
"Dedicated Marijuana Account" or "DMA" means revenue generated by the taxation of
retail marijuana as a result of the implementation of Initiative 502 (1-502) as authorized by
the Washington State Legislature in 2E2SHB 2136.
"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 Agreement 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 Agreement.
"EPA" means the Environmental Protection Agency.
"Evidence -Based Program" or "EBP" means a program that has been tested in
heterogeneous or intended populations that can be implemented with a set of procedures
to all successful replication in Washington. An EBP has had multiple randomized and/or
statistically -controlled evaluations, or one large multiple -site randomized and/or
statistically -controlled evaluations, and the weight of the evidence from a systematic
review demonstrates sustained improvements in at least one of the desired outcomes.
"Fiscal/Program Requirements" means the Supplementary Instructions and Fiscal Policy
Standards for Reimbursable Costs otherwise known as the Billing Guide for Substance Use
Disorder Prevention and Mental Health Promotion and is located at:
https://www.hca.wa.govlbillers-providers partnerslprior-authorization-claims-and-
billing/provider-billingguides-and-fee-schedules#t.
"General Fund State" or "GFS" means the administrative allocation awarded
for Substance Abuse Block Grant.
Washington State Page 7 HCA Contract No. K3921
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"HCA Agreement Manager" means the individual identified on the cover page of this
Agreement who will provide oversight of the Contractor's activities conducted under this
Agreement.
"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)
"Innovation Program" means a program that does not fall into the other categories of
Evidenced -based, Research -based, or Promising.
"Media materials and publications" means (1) News Release: A brief written
announcement the agency provides to reporters highlighting key events, research, results,
new funding and programs, and other news; (2) Paid Media: Any advertising space/time
that is purchased for prevention/coalition messages )printed publications/newspapers,
online, outdoor, on-screen, TV and radio); (3) Earned Media: Published news stories (print,
broadcast or online) resulting from the Contractor's Agreements with reporters; (4) Donated
Media, including public service announcements. Any free advertising space or time from
broadcast, print, outdoor, online, and other advertising vendors; (5) Social Media: Also
referred to as new media: messaged posted online of Facebook, Twitter, YouTube,
Instagram, Snapchat and similar sites.
"Overpayment" means any payment or benefit to the Contractor in excess of that to which
the Contractor is entitled by law, rule, or this Agreement, including amounts in dispute.
"Partnership for Success" or "PFS" means the Federal Substance Abuse and Mental
Health Services Administration (SAMHSA) Grant 2013 and 2018, CFDA number 93.243.
"Promising Program" means a program that is based on statistical analyses or a well-
established theory of change, shows potential for meeting the "evidence -based" or
"research- based" criteria, and could include the use of a program that is evidenced -based
for outcomes other than the alternative use.
Washington State Page 8 HCA Contract No. K3921
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"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).
"Prevention Activity Data" means information input to the "Substance Use Disorder
Prevention Mental Health Promotion Online Reporting System: or "Minerva" to record all
active prevention services including outcome measures. This information will be used to
verify services identified in A-19 invoices prior to payment and must be entered into
Minerva by the close of business of the fifteenth (15th) of each month for prevention
activities provided during the previous month.
"Prevention System Manager" or "PSM" means the designee assigned to manage day
to day responsibilities associated with this Agreement.
"Regular Annual Schedule" means consistent, reliable services with a pattern of
implementation intervals throughout the year.
"Research -Based Program" means a program that has been tested with a single
randomized and/or statistically controlled evaluation, demonstrates sustained desirable
outcomes; or where the weight of the evidence from a systematic review supports
sustained outcomes as identified in the term "evidence -based," but does not meet the full
criteria for "evidence -based." For the purposes of this project, only programs from the list in
Exhibit A are to be considered Research -based.
"RCW" means the Revised Code of Washington. All references in this Agreement to RCW
chapters or sections include any successor, amended, or replacement statute. Pertinent
RCW chapters can be accessed at: http://api2s.leg.wa.gov/rcw/.
"Substance Abuse Block Grant" or "SABG" means Federal Substance Abuse Block
Grant funded by the Substance Abuse and Mental Health Services Administration
(SAMHSA), CFDA number 93.959.
"SAMHSA" means the Substance Abuse and Mental Health Services Administration.
Washington State Page 9 HCA Contract No. K3921
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"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 Agreement,
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) Grant, CFDA number 93.788.
"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 Agreement 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.
"Substance Use Disorder Prevention and Mental Health Promotion Online Reporting
System" or "Minerva" means the management information system maintained by HCA
that collects planning, demographic, and prevention service data.
"USC" means the United States Code. All references in this Agreement to USC chapters
or sections shall include any successor, amended, or replacement statute. The USC may
be accessed at l-ittp:/luscode.house.ctov/
3.1 Performance expectations expected performance under this agreement includes, but
is not limited to, the following:
3.1.1 Knowledge of applicable state and federal laws and regulations pertaining to
subject of Agreement;
3.1.1.1 21 CFR Food and Drugs
Chapter 1, Subchapter C, Drugs: General
hftps://www.law.cornell.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_
littps://www.law.cornell. edu/cfr/textl45/pati-96/subl2art-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.Iaw.cornell.edu/cfr/texti2/part-200
Washington State Page 10 HCA Contract No. K3921
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httgs://www.law.comell.edu/cfr/text/45/gart-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;
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 Agreement 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 Agreement will commence on July 1, 2019, and continue
through June 30, 2021, unless terminated sooner as provided herein.
3.2.2 This Agreement maybe extended in whatever time increments HCA deems
appropriate.
3.2.3 Work performed without an Agreement 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 an Agreement or any subsequent
amendment(s) is fully executed.
3.3 COMPENSATION
3.3.1 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 $354,595 and additional Exhibits as
applicable to Contractor, and includes any allowable expenses. Paymentfor
Washington State Page 11 HCA Contract No. K3921
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satisfactory performance of the work will not exceed this amount unless the
parties mutually agree to a higher amount.
3.3.1.1 The fund sources and maximums for this Contract are $354,595.
3.3.2 Contractor's compensation for services rendered will be based on the amounts
listed in the Exhibit D, A&R and/or in accordance with the terms outlined in the
Fiscal/Program Requirements and Invoices and Payments. In addition, the
Contractor must meet the schedule set forth in Schedule A, Statement of Work
and additional Exhibits as applicable to the Contractor.
3.3.2.1 Total compensation payable to Contractor for satisfactory
performance of the work under this Agreement is $354,595.
The fund sources and maximums for this Agreement are up to
$159,410 from the Substance Abuse Block Grant (SABG) Block
Grant, CFDA #93.959; $13,862 for General Fund State; $46,728
Dedicated Marijuana Account (DMA) Funds; $51177 Partnership
for Success (PFS) 2018 CFDA #93.243; $83,418 State Opioid
Response (SOR) and/or SOR supplemental CFDA #93.788; $0
State Targeted Response (STR) no cost extension CFDA
#93.788; and $0 Partnership for Success (PFS) 2013 no cost
extension CDFA #93.243.
3.3.3 Federal funds disbursed through this Agreement were received by HCA.
3.3.3.1 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: A-19DBIIR@hca.wa.goy not more than monthly unless
approved by HCA. Contractor may bill for cost reimbursement for month of
service if appropriate service data is provided in Minerva. The Contractor must
include the HCA Agreement number in the subject line of the email, followed by
the Prevention System Naming Convention and cc the Agreement Manager or
designee 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 HCA shall not be obligated to reimburse the Contractor for any services or
activities performed prior to having a fully executed copy of this Contract.
Washington State Page 12 HCA Contract No. K3921
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3.4.4 The Contractor assures that work performed and invoiced does not duplicate
work to be charged to the State of Washington under any other Contract or
agreement with the Contractor.
3.4.5 If the Contractor claims and HCA reimburses for expenditures under this
Contract which HCA later finds were claimed in error and/or not allowable costs
under the terms of this Contract, HCA shall recover these costs and the
Contractor shall fully cooperate with the recovery.
3.4.6 Contractor must submit properly itemized invoices to include thefollowing
information, as applicable:
3.4.6.1 HCA Agreement number K3921;
3.4.6.2 Contractor name, address, phone number;
3.4.6.3 Description of Services;
3.4.6.4 Date(s) of delivery;
3.4.6.5 Net invoice price for each item;
3.4.6.6 Applicable taxes;
3.4.6.7 Total invoice price; and
3.4.6.8 Payment terms and any available prompt payment discount.
3.4.7 HCA will return incorrect or incomplete invoices to the Contractor for correction
and reissue. The Agreement Number must appear on all invoices, bills of
lading, packages, and correspondence relating to this Agreement.
3.4.8 In order to receive payment for services or products provided to a state agency,
Contractor must register with the Statewide Payee Desk at_
htt //des.wa. ov/services/Contractin Purchasin /Business/VendorPa /Pa es/d
efa ult.aspx.
3.4.9 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.
3.4.10 Upon expiration of the Agreement, any claims for payment for costs due and
payable under this Agreement that are incurred prior to the expiration date
must be submitted by the Contractor to HCA within sixty (60) calendar days
after the Agreement expiration date. HCA is under no obligation to pay any
claims that are submitted sixty-one (61) or more calendar days after the
Agreement 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.
Washington State Page 13 HCA Contract No. K3921
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3.4.10.1 Submit final billing for services provided within forth -five (45)
days after the end of the State Fiscal Year (June 30).
3.4.10.2 Submit final billing for services for SOR and PFS within forty-five
(45) days after the end of each Federal Fiscal Year (September
29).
3.4.10.3 Submit final billing for services for STR within forty-five (45) days
after the end of the fiscal period for STR (April 30).
3.4.11 The Contractor shall ensure all expenditures for services and activities under
the Agreement are submitted on the A-19 invoice appropriate for Minerva data
entry. In the event the Contractor or a subcontractor fails to maintain reporting
obligations under this Agreement, HCA reserves the right to withhold
reimbursements to the Contractor until the obligations are met.
3.4.12 Administrative costs shall be billed separately from direct prevention services
as indicated on the A-19 invoice.
3.4.12.1 Administrative costs are defined in the Fiscal/Program
Requirements.
3.4.12.2 The Contractor shall use no more than eight percent 8% of the
SOR, PFS, STR, and/or DMA allocation for administrative costs.
3.4.12.3 No SABG funds allocated in this contract shall be used for
administrative costs. Admin for SABG is allocated as GFS.
3.4.13 HCA reserves the right to reduce the Prevention funds awarded in the
Agreement if the Contractor expenditures are below 60% of expected levels
during the fiscal quarter. Expenditures will be reviewed quarterly.
3.4.14 SOR, PFS, STR, and DMA funds may not be carried forward from year toyear,
based upon their respective fiscal year.
3.4.15 Based upon Exhibit D, Awards and Revenue (A&R), the source of funds in this
contract may include, as applicable, Substance Abuse Block Grant (SABG)
CFDA 94.959, the Washington State Dedicated Marijuana Account Fund
(DMA), General Fund State (GFS), the State Opioid Response (SOR) Grant
CFDA 93.788, the State Targeted Response (STR) Grant CFDA 93.788, and/or
the Partnerships for Success (PFS) Grant CFDA 93.243.
3.5 CONTRACTOR AND HCA AGREEMENT MANAGERS
3.5.1 Contractor's Agreement Manager or designee will have prime responsibility
and final authority for the services provided under this Agreement and be the
principal point of contact for the HCA Agreement Manager for all business
matters, performance matters, and administrative activities.
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3.5.2 HCA's Agreement Manager or designee is responsible for monitoring the
Contractor's performance and will be the contact person for all communications
regarding Agreement performance and deliverables. The HCA Agreement
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 Health Care Authority
Contract Manager Information Contract Manager Information
Name: Name: Rose Quinby, Martha
Williams
Title:
Title:
Address:
Agreement Manager
621 8th Avenue SE
Olympia, WA 98504
360-725-1129
rose.quinby@hca.wa.gov
Address:
Phone:
Phone:
Email:
Email:
3.6 LEGAL NOTICES
Any notice or demand or other communication required or permitted to be given under this
Agreement 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:
Attention:
3.6.2 In the case of notice to HCA:
Attention: Contracts Administrator
Health Care Authority
Division of Legal Services
PO Box 42702
Olympia, WA 98504-2702
3.6.3 Notices are effective upon receipt or four (4) Business Days after mailing,
whichever is earlier.
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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, STR, and PFS grants, and SABG.
3.7.1.2 Comply with RCW 69.50.540 Dedicated Marijuana Account
Appropriations.
3.7.1.3 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;
3.7.1.4 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;
3.7.1.5 Comply with requirements of Charitable Choice (42 USC 300x-
65 and 42 CFR Section 54);
3.7.1.5.1 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.
3.7.1.5.2 If the Contractor subcontracts with FBOs, the
Contractor shall require the FBO to meet the
requirements of 42 CFR Part 54 as follows:
3.7.1.5.3 Applicants/recipients for/of services shall be provided
with a choice of prevention providers.
3.7.1.5.4 The FBO shall facilitate a referral to an alternative
provider within a reasonable time frame when
requested by the recipient of services.
3.7.1.5.5 The FBO shall report to the Contractor all referrals
made to alternative providers.
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3.7.1.5.6 The FBO shall provide recipients with a notice of their
rights.
3.7.1.5.7 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;
3.7.1.6 Incorporate 2 CFR Part 200, Subpart F audit requirements into
all agreements between the Contractor and its Subcontractors
who aresubrecipients;
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_
www,oip.usdoLgov/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 Agreement. 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, HCA Agreement Number K3921;
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
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Collection Form;
3.8.9 Schedule A: Statement of Work;
3.9 INSURANCE
3.9.1 HCA certifies that it is self-insured under the State's self-insurance liability
program, as provided by RCW 4.92.130, and shall pay for losses for which is
found liable.
3.9.2 The Contractor certifies by signing this Agreement that either:
3.9.2.1 The Contractor is self-insured or insured through a risk pool and
shall pay for losses for which it is found liable, or
3.9.2.2 The Contractor maintains the types and amounts of insurance
identified below and shall, if requested by HCA; provide
certificates of insurance to that effect to the HCA contact on
page one of the Agreement.
3.9.2.2.1 Commercial General Liability Insurance Policy — to
include coverage for bodily injury, property damage,
and contractual liability, with the following minimum
limits: Each occurrence - $1,000,000; General
Aggregate - $2,000,000. The policy shall include
liability arising out of premises, operations,
independent contractors, products -completed
operations, personal injury, advertising injury, and
liability assumed under an insured agreement. The
state of Washington, HCA, its elected and appointed
officials, agents, and employees shall be named as
additional insureds. Additionally, Contractor is
responsible for ensuring that any Subcontractors
provide adequate insurance coverage for the
activities arising out of subcontracts.
3.9.2.2.2 Professional Liability (PL) Insurance. The Contractor
shall maintain Professional Liability Insurance or
Errors & Omissions insurance, including coverage for
losses caused by errors and omissions, with the
following minimum limits: Each Occurrence -
$1,000,000; Aggregate - $2,000,000.
3.10 BACKGROUND CHECKS (RCW 43.43, WAC 388-877 &388-877B)
Contractor shall follow the requirements below and ensure this information is included in all
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subcontracts:
a) Contractor shall ensure a criminal background check is conducted for all staff members,
including but not limited to, treatment staff members, prevention staff members, case
managers, outreach staff members, etc. or volunteers who have unsupervised access to
children, adolescents, vulnerable adults, and persons who have developmental disabilities;
and
b) When providing services to youth, Contractor shall ensure that requirements of WAC 388-
06-0170 are met.
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 Agreement 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
Agreement.
4.3 AMENDMENTS
This Agreement 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 Agreement or
any of its rights hereunder, or delegate any of its duties hereunder, except
delegations as set forth in Section 4.37, 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 Agreement 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 Agreement will be
null and void.
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4.4.2 HCA may assign this Agreement 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 Agreement 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 Agreement, each
party agrees to bear its own attorneys' fees and costs.
4.6 CHANGE IN STATUS
In the event of any substantive change in its legal status, organizational structure, or fiscal
reporting responsibility, Contractor will notify HCA of the change. Contractor must provide
notice as soon as practicable, but no later than thirty (30) calendar days after such a change
takes effect.
4.7 CONFIDENTIAL INFORMATION PROTECTION
4.7.1 Contractor acknowledges that some of the material and information that may
come into its possession or knowledge in connection with this Agreement 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
Agreement, to release it only to authorized employees or Subcontractors
requiring such information for the purposes of carrying out this Agreement, 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.
4.7.2 Contractor agrees to implement physical, electronic, and managerial
safeguards to prevent unauthorized access to Confidential Information (See
Attachment 1: Confidential Information Security Requirements).
4.7.3 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).
4.7.4 HCA reserves the right to monitor, audit, or investigate the use of Confidential
Information collected, used, or acquired by Contractor through this Agreement.
Violation of this section by Contractor or its Subcontractors may result in
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termination of this Agreement and demand for return of all Confidential
Information, monetary damages, or penalties.
4.7.5 The obligations set forth in this Section will survive completion, cancellation,
expiration, or termination of this Agreement.
4.8 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 Agreement
and appropriate portions of the Washington OCIO Security Standard, 141.10
(htt s:/Iocio.wa. ovl olicies/141-securin -information-technol -assets/14110-securin -
i nform ati on-tec hn of oqy-assets].
4.9 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION
4.9.1 Contractor must notify the HCA Privacy Officer
(HCAPrivacyOffcer6Dhca.wa.gov) within five Business Days of discovery of
any Breach or suspected Breach of Confidential Information.
4.9.2 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.
4.9.3 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:
4.9.3.1 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.
4.9.3.2 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).
4.9.3.3 Contractor will compensate HCA clients for harms caused to them
by any Breach or possible Breach.
4.9.4 Any breach of this clause may result in termination of the Agreement and the
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demand for return or disposition (Attachment 1, Section 6) of all Confidential
Information.
4.9.5 Contractor's obligations regarding Breach notification survive the termination of
this Agreement and continue for as long as Contractor maintains the
Confidential Information and for any breach or possible breach at anytime.
4.10 CONTRACTOR'S PROPRIETARY INFORMATION
Contractor acknowledges that HCA is subject to chapter 42.56 RCW, the Public Records
Act, and that this Agreement 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.
4.11 COVENANT AGAINST CONTINGENT FEES
Contractor warrants that no person or selling agent has been employed or retained to solicit
or secure this Agreement 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
Agreement without liability or, in its discretion, to deduct from the Agreement price or
consideration or recover by other means the full amount of such commission, percentage,
brokerage or contingent fee.
4.12 DEBARMENT
By signing this Agreement, 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 Agreement, Contractor becomes debarred. HCA may
immediately terminate this Agreement by providing Contractor written notice, if Contractor
becomes debarred during the term hereof.
4.13 DISPUTES
The parties will use their best, good faith efforts to cooperatively resolve disputes and
problems that arise in connection with this Agreement. Both parties will continue without
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delay to carry out their respective responsibilities under this Agreement while attempting to
resolve any dispute. When a genuine dispute arises between HCA and the Contractor
regarding the terms of this Agreement or the responsibilities imposed herein and it cannot
be resolved between the parties' Agreement Managers, either party may initiate the
following dispute resolution process.
4.13.1 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.
4.13.2 A party's request for a dispute resolution must:
4.13.2.1 Be in writing;
4.13.2.2 Include a written description of the dispute;
4.13.2.3 State the relative positions of the parties and the remedy sought;
4.13.2.4 State the Agreement Number and the names and contact
information for the parties;
4.13.3 This dispute resolution process constitutes the sole administrative remedy
available under this Agreement. The parties agree that this resolution process
will precede any action in a judicial or quasi-judicial tribunal.
4.14 ENTIRE AGREEMENT
HCA and Contractor agree that the Agreement is the complete and exclusive statement of
the agreement between the parties relating to the subject matter of the Agreement and
supersedes all letters of intent or prior Agreements, oral or written, between the parties
relating to the subject matter of the Agreement, except as provided in Section 4.44
Warranties.
4.15 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA)
4.15.1 This Agreement 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.
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4.15.2 To comply with the act and be eligible to enter into this Agreement, 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.
4.15.3 Information about Contractor and this Agreement 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 Agreement and must be completed
and returned along with the Agreement.
4.16 FORCE MAJEURE
A party will not be liable for any failure of or delay in the performance of this Agreement 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.
4.17 FUNDING WITHDRAWN, REDUCED OR LIMITED
If HCA determines in its sole discretion that the funds it relied upon to establish this
Agreement have been withdrawn, reduced or limited, or if additional or modified conditions
are placed on such funding after the effective date of this Agreement but prior to the normal
completion of this Agreement, then HCA, at its sole discretion, may:
4.17.1 Terminate this Agreement pursuant to Section 4.41.1, TERMINATION DUE TO
CHANGE IN FUNDING;
4.17.2 Renegotiate the Agreement under the revised funding conditions; or
4.17.3 Suspend Contractor's performance under the Agreement 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
Agreement.
4.17.3.1 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.
4.17.3.2 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
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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.
4.17.3.3 If the Contractor's proposed resumption date is not acceptable to
HCA and an acceptable date cannot be negotiated, HCA may
terminate the Agreement by giving written notice to Contractor. The
parties agree that the Agreement 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 Agreement for
services rendered prior to the retroactive date of termination.
4.18 GOVERNING LAW
This Agreement 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 Agreement will be
construed as a waiver by HCA of the State's immunity under the 11thAmendment to the
United States Constitution.
4.19 HCA NETWORK SECURITY
Contractor agrees not to attach any Contractor -supplied computers, peripherals or software
to the HCA Network without prior written authorization from HCA's Chief Information Officer.
Unauthorized access to HCA networks and systems is a violation of HCA Policy and
constitutes computer trespass in the first degree pursuant to RCW 9A.52.110. Violation of
any of these laws or policies could result in termination of the Agreement and other
penalties.
Contractor will have access to the HCA visitor Wi-Fi Internet connection while on site.
4.20 INDEMNIFICATION
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 4.7 Confidential Information Protection and Section 4.8 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 Agreement.
4.21 INDEPENDENT CAPACITY OF THE CONTRACTOR
The parties intend that an independent contractor relationship will be created by this
Agreement. Contractor and its employees or agents performing under this Agreement are
not employees or agents of HCA. Contractor will not hold itself out as or claim to be an
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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.
4.22 INDUSTRIAL INSURANCE COVERAGE
Prior to performing work under this Agreement, 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 Agreement.
4.23 LEGAL AND REGULATORY COMPLIANCE
4.23.1 During the term of this Agreement, Contractor must comply with all local, state,
and federal licensing, accreditation and registration requirements/standards,
necessary for the performance of this Agreement and all other applicable
federal, state and local laws, rules, and regulations.
4.23.2 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.
4.23.3 Failure to comply with any provisions of this section may result in Agreement
termination.
4.24 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 Agreement. Furthermore, any
alteration, amendment, modification, or waiver or any clause or condition of this Agreement
is not effective or binding unless made in writing and signed by the HCA Authorized
Representative.
4.26 NO THIRD -PARTY BENEFICIARIES
HCA and Contractor are the only parties to this Agreement. Nothing in this Agreement gives
or is intended to give any benefit of this Agreement to any third parties.
4.26 NONDISCRIMINATION
During the performance of this Agreement, 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
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any nondiscrimination law, regulation or policy, this Agreement 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 Agreements with HCA.
4.27 OVERPAYMENTS TO CONTRACTOR
In the event that overpayments or erroneous payments have been made to the Contractor
under this Agreement, 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 4.13 Disputes.
4.28 PAY EQUITY
4.28.1 Contractor represents and warrants that, as required by Washington state law
(Laws of 2017, Chap. 1, § 147), during the term of this Agreement, 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.
4.28.2 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.
4.28.3 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.
4.28.4 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.
4.28.5 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 HCA's request for such evidence, HCA may suspend or terminate
this Agreement.
4.29 PUBLICITY
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4.29.1 The award of this Agreement 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.
4.29.2 Contractor agrees to submit to HCA, all advertising, sales promotion, and other
publicity materials relating to this Agreement 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.
4.30 RECORDS AND DOCUMENTS REVIEW
4.30.1 The Contractor must maintain books, records, documents, magnetic media,
receipts, invoices or other evidence relating to this Agreement 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 Agreement. At no
additional cost, these records, including materials generated under this
Agreement, 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].
4.30.2 The Contractor must retain such records for a period of six (6) years after the
date of final payment under this Agreement.
4.30.3 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.
4.31 REMEDIES NON-EXCLUSIVE
The remedies provided in this Agreement are not exclusive, but are in addition to all other
remedies available under law.
4.32 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 Agreement.
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4.33 RIGHTS IN DATA/OWNERSHIP
4.33.1 HCA and Contractor agree that all data and work products (collectively "Work
Product") produced pursuant to this Agreement will be considered a work for
hire under the U.S. Copyright Act, 17 U.S.C. §101 of 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.
4.33.2 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.
4.33.3 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.
4.33.4 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.
4.33.5 Material that is delivered under this Agreement, 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.
4.33.6 Contractor must identify all Preexisting Material when it is delivered under this
Agreement and must advise HCA of any and all known or potential
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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 Agreement.
4.34 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 Agreement; (iii) the copyright in any work developed under
this Agreement; and (iv) any rights of copyright to which Contractor purchases ownership
under this Agreement.
4.35 SEVERABILITY
If any provision of this Agreement 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 Agreement that can be given effect without the invalid provision, and to
this end the provisions or application of this Agreement are declared severable.
4.36 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 breach of this provision. Upon reassignment or
termination of any Contractor staff, Contractor agrees to promptly notify HCA.
4.37 SUBCONTRACTING
4.37.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for
any of the work contemplated under this Agreement 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.
4.37.2 Any agreement between Contractor and a Subcontractor shall include the
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terms and conditions that meet or exceed all requirements and conditions in
this Agreement that the Contractor is required to meet when providing services
to patients, clients, or persons seeking assistance, including but not limited to:
(1) identification of funding sources; (b) DUNS number and zip code +4 of
subcontractor; (c) determination of eligible clients; (d) payment or
reimbursement arrangement in compliance with the Fiscal/Program
Requirements; (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) Contractor rights in the
event of termination of a subcontract to ensure all data on services provided
have been entered into the Substance Use Disorder Prevention and Mental
Health Promotion Online Reporting System ("Minerva"); (g) 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; (h) audit requirements in compliance with OMB 2, Part
200, Subpart F (A-133); (i) authorizing Contractor to conduct an inspection of
any and all subcontractor facilities where services are provided; 0) requiring
Subcontractor to perform background checks on its employees and
independent contractors used to perform the services; (k) representation and
warranty that Subcontractor is not has not been debarred or suspended by any
state or the federal government; (1) Business Associate Agreement in
compliance with the requirements of HIPAA; (m) protection of the Confidential
Information and restrictions on the providing and sharing of data; and (n)
identifying unallowable uses of federal funds.
4.37.3 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.
4.37.4 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 Agreement, nor be the basis for additional charges to HCA.
4.37.5 Contractor shall submit a subcontract monitoring plan to Agreement Manager
or designee fifteen (15) days prior of entering into first subcontract during
Agreement period for review and HCA approval to include a plan for (a) an
annual onsite review of each subcontract providing services monitoring the
subcontractor's contractual, fiscal, and programmatic compliance; (b)
preparation of written documentation of each on-site visit and delivery of such
documentation to HCA; (c) ensuring subcontractors have entered services
funded under this Agreement in the Minerva database; and (d) ensuring
records of additional monitoring activities in the Contractor's subcontractor file
are kept and making them available to HCA upon request, including any audit
and any independent documentation. Additionally, in the event of subcontractor
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termination or closure, the Contractor shall withhold final payment of any
subcontract until all required Minerva reporting is complete.
4.37.6 The Contractor shall ensure that subcontractors have entered services funded
under this contract in Minerva. The Contractor may not require subcontractor to
enter duplicate prevention service data that is entered into Minerva into an
additional system. The Contractor shall ensure the proper training of staff and
designated back-up staff for Minerva data entry to meet report due dates.
4.37.7 The Contractor shall maintain records of additional monitoring activities in the
Contractor's subcontractor file and make them available to HCA upon request
including any audit and any independent documentation.
4.38 SUBRECIPIENT
4.38.1 General
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:
4.38.1.1 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;
4.38.1.2 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;
4.38.1.3 Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
4.38.1.4 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;
4.38.1.5 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;
4.38.1.6 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
4.38.1.7 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
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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://oip.gov/about/offices/ocr.htrn for additional information and
access to the aforementioned Federal laws and regulations.)
4.38.2 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:
4.38.2.1 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 75.501, reports required by the program -specific audit
guide (if applicable), and a copy of any management letters issued
by the auditor;
4.38.2.2 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."
4.38.3 Overpayments
4.38.3.1 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 4.27 Overpayments to Contractors.
4.39 SURVIVAL
The terms and conditions contained in this Agreement that, by their sense and context, are
intended to survive the completion, cancellation, termination, or expiration of the Agreement
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 Governments will
survive the termination of this Agreement. The right of HCA to recover any overpayments
will also survive the termination of this Agreement.
4.40 TAXES
All payments accrued on account of payroll taxes, unemployment contributions, any other
taxes, insurance, or other expenses for the Contractor or its staff is the sole responsibility of
the Contractor.
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4.41 TERMINATION
4.41.1 TERMINATION DUE TO CHANGE IN FUNDING
4.41.1.1 If the funds that HCA relied upon to establish any Agreement are
withdrawn, reduced, or limited, or if additional modified conditions
are placed on such funding, and such changes materially affect the
ability of HCA to provide funds or to perform under the Agreement,
HCA will notify and consult with the Contractor as soon as practical
and, as a last resort, may terminate this Agreement by providing at
least fifteen (15) calendar days written notice to the Contractor.
4.41.1.2 If funds are available, HCA will pay the Contractor for its reasonable
costs that directly relate to termination of the Agreement. The
parties may identify and agree upon such costs. Such costs may
include, but are not limited to, closeout costs, unemployment costs,
severance pay, retirement benefits, reasonable profits, and
termination costs associated with any approved subcontract.
4.41.2 TERMINATION FOR CONVENIENCE
4.41.2.1 Either party may terminate the agreement for Convenience by giving
the other party at least thirty (30) days written notice.
4.41.2.2 The Contract must address such notices to:
Health Care Authority Contract Services
Post Office Box 42702
Olympia, Washington 98504-2702
4.41.2.3 HCA must direct such notices to the Contract contact named on the
first page of the Agreement.
4.41.2.4 If either party terminates the Agreement for convenience, the
terminating party may pay an amount agreed to by the parties for
actual costs incurred by the non -terminating party in performance of
or in reliance on the Agreement.
4.41.3 TERMINATION FOR DEFAULT
4.41.3.1 The Contracts Administrator may terminate the Agreement for
Default, in whole or in part, by written notice to the Contractor if HCA
has a reasonable basis to believe the Contract has:
4.41.3.1.1 Failed to meet or maintain any requirement for
contracting in this Agreement with HCA:
4.41.3.1.2 Failed to perform under any provision of the
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Agreement;
4.41.3.1.3 Negligently failed to ensure the health or safety of
any client for whom services ae being provided under
the Agreement;
4.41.3.1.4 Violated any applicable law, regulation, rule, or
ordinance related to the Agreement; and/or
4.41.3.1.5 Otherwise breached any provision or condition of the
Agreement.
4.41.3.2 The Contracts Administrator must give the Contractor at least ten
(10) business days' notice of HCAs intent to terminate the
Agreement, along with a summary of the facts supporting such
termination.
4.41.3.2.1 The Contractor must have a least ten (10) business
days in which to cure the default provided that it will
reasonably take longer than ten (10) business days
to cure the default, the cure period will be a
reasonable period agreed by the parties.
4.41.3.2.2 In the event of a continuing pattern of default, the
Contracts Administrator will not be required to
provide a cure period.
4.41.3.2.3 The Contract Administrator is not required to offer a
cure period if a client's health or safety is at risk. This
provision does not apply if the alleged default is an
activity related to Contractor law, custom, or practice.
4.41.3.3 The Contractor may terminate this Agreement for default, in whole
or in part, by written notice to HCA if the Contractor has a
reasonable basis to believe that HCA has:
4.41.3.3.1 Failed to meet or maintain any requirement for
contracting with the Contractor:
4.41.3.3.2 Failed to perform under any provision of the
Agreement;
4.41.3.3.3 Violated any law, regulation, rule, or ordinance
applicable to work performed under the Agreement;
and/or
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4.41.3.3.4 Otherwise breached any provision or condition of the
Agreement.
4.41.3.4 Before the Contractor may terminate the Agreement for default, the
Contract must provide HCA at least ten (10) business days written
notice of the Contractor's intent to terminate the Agreement, along
with a summary of the facts supporting such termination. HCA must
have at least ten (10 business days in which to cure the default
provided that it will reasonably take longer than ten (10) business
days to cure the default, the cure period must be a reasonable
period agreed by the parties.
4.41.4 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 Agreement and
prior to normal completion, HCA may immediately terminate this Agreement in
whole or in part, 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 Agreement 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. This section must not so as to permit HCA to terminate this
Agreement in order to acquire similar services from a third party.
4.42 TERMINATION PROCEDURES
The following provisions must survive and be binding on the parties in the event the
Agreement is terminated:
4.42.1 The Contract must cease to perform any services required by the Agreement
as of the effective date of termination and must comply with all reasonable
instructions contained in the notice of termination.
4.42.2 If requested by HCA within ten (10) business days of termination, the Contactor
must, within a period not to exceed thirty (30) business days, deliver to HCA all
HCA assets or property in its possession. If the Contractor does not return HCA
property within thirty (30) business days of the Agreement termination, the
Contractor will be charged with all reasonable costs of recovery, including
transportation and attorney's fees. The Contractor must protect and preserve
any property of HCA that is in the possession of the Contractor pending return
to H CA.
4.42.3 HCA will be liable for an will pay for those services authorized and provided
through the date of termination. HCA may pay an amount agreed to by the
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parties for partially completed work and services, if work products are useful to
or useable by HCA.
4.42.4 If the Contracts Administrator terminates the Agreement for default, HCA may
withhold a sum from the final payment to the Contractor that is reasonable and
necessary to protect HCA against reasonably anticipated loss or liability. HCA
must provide the Contractor with written notice of the amount withheld and the
nature of the reasonable anticipated loss or liability. If it is later determined that
the Contractor wan to in default, HCA must pay the amount withheld to the
Contractor within ten (10) business days of determines that the Contractorwas
not in default.
4.43 WAIVER
Waiver of any breach of any term or condition of this Agreement will not be deemed a
waiver of any prior or subsequent breach or default. No term or condition of this Agreement
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 Agreement on behalf of HCA.
4.44 WARRANTIES
4.44.1 Contractor represents and warrants that it will perform all services pursuant to
this Agreement 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.
4.44.2 Contractor represents and warrants that it shall comply with all applicable Iocal,
State, and federal licensing, accreditation and registration requirements and
standards necessary in the performance of the Services.
4.44.3 Any written commitment by Contractor within the scope of this Agreement 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 Agreement. 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 Agreement.
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Attachment 1
Confidential Information Security Requirements
Definitions
In addition to the definitions set out in Section 2 of this Agreement K3921 for CPWI
Prevention Services, 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 aminimum
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).
"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.
f. "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,
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DHL) which offer tracking and receipt confirmation; and (4) the Washington State
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.
2. 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//ublications/PubsSPs.htm_l). This includes transmission over the
public internet.
b. When transmitting HCA's Confidential Information via paper documents, the Receiving
Party must use a Trusted System.
3. 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 keyswill
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:
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1. Encrypting with NIST 800 -series approved algorithms. Encryption
keys will be stored and protected independently of the data;
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.
4. 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
in a logical container on electronic media, such as a partition or folder
dedicated to HCA'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.
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b. When it is not feasible or practical to segregate HCA Confidential Information from
non -HCA data, then both the HCA Confidential Information and the non -HCA data
with which it is commingled must be protected as described in this Attachment.
5. 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.
6. 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
(http://csrc.nist.gov/publications/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 3, 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 41 HCA Contract No. K3921
Health Care Authority
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 11. 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: Alicia Hughes for SOR, or Sarah Mariani for
PFS.
a. Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number 1H79TIO81705-01 (SOR), 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
93.778 an amount to $83,418. The sub-awardee is responsible for tracking and reporting the
cumulative amount expended under HCA Contract No. K3921.
Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number 1 H79SP080980-01 (PFS 2018), the full and complete terms and provisions of which are
hereby incorporated into this agreement can be found by reference in Attachment 5. Federal funds to
support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number
93.243 and amount to $51,177. The sub-awardee is responsible for tracking and reporting
the cumulative amount expended under HCA Contract No. K3921.
Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number T1010057 (SABG), the full and complete terms and provisions of which are hereby
incorporated into this agreement can be found by reference in Attachment 5. Federal funds to
support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number
94.959 and amount to $159,410. The sub-awardee is responsible for tracking and reporting the
cumulative amount expended under HCA Contract No. K3921.
Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number 6H79T1026803-02M001 (STR NCE), the full and complete terms and provisions of which are
hereby incorporated into this agreement can be found by reference in Attachment 5. Federal funds to
support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number
93.788 and amount to $0. The sub-awardee is responsible for tracking and reporting the
cumulative amount expended under HCA Contract No. K3921.
Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number 7U79SP02301 1 -01 (PFS 2013 NCE), the full and complete terms and provisions of which are
hereby incorporated into this agreement can be found by reference in Attachment 5. Federal funds to
Washington State Page 42 HCA Contract No. K3921
Health Care Authority
support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number
93.243 and amount to $0. The sub-awardee is responsible for tracking and reporting the
cumulative amount expended under HCA Contract No. K3921.
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 1 H79TI081705-01,
1H79SP080980-01, T1010057, 6H79TI026803-02M001, and/or 7U79SP02301 1 -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 CFR200.501
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.
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 arenot
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.
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 Care 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 constituteallowable
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.
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Health Care Authority
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:ilwww.hhs.govlocr/civilrights
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
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, Longview School District 122. The
federal Circulars which provide the applicable administrative requirements, cost principles and audit
requirements are identified by sub-awardee organization type.
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
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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:
a) are not presently debarred, suspended,
proposed for debarment, declared
ineligible, or voluntarily excluded from
covered transactions by any Federal
Department or agency;
b) have not within a 3 -year period preceding this
contract been convicted of or had a
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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 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
d) have not within a 3 -year period preceding
this contract had one or more public
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Health Care Authority
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 CFRPart
76.
2. CERTIFICATION REGARDING DRUG-
FREE WORKPLACE REQUIREMENTS
The undersigned (authorized official signing
for the contracting organization) certifiesthat
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,
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
(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;
e) Notifying the agency in writing within ten
calendar days after receiving notice
under paragraph (d)(2) from an
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employee or otherwise receiving
actual
Washington State Page 47 HCA Contract No. K3921
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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
WA State Health Care Authority
PO Box 42700
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Health Care Authority
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
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
Washington State Page 48 HCA Contract No. K3921
Health Care Authority
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.)
(3) The undersigned shall require that the
language of this certification be included
in the award documents for all
subcontracts at all tiers (including
subcontracts, subcontracts, and
contracts under grants, loans and
cooperative agreements) and that all
sub -recipients shall certify and disclose
accordingly.
This certification is a material representation of fact
upon which reliance was placed when this
transaction was made or entered into. Submission
of this certification is a prerequisite for making or
entering into this transaction imposed by Section
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.
Washington State Page 49 HCA Contract No. K3921
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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
contracted for by an entity and used routinely
or regularly for the provision of health, day
care, early childhood development services,
education or library services to children
under the age of 18, if the services are
funded by Federal programs either directly or
through State or local governments, by
Federal grant, contract, loan, or loan
guarantee. The law also applies tochildren's
services that are provided in indoor facilities
that are constructed, operated, or maintained
with such Federal funds. The law does not
apply to children's services provided in
private residence, portions of facilities used
for inpatient drug or alcohol treatment,
service providers whose sole source of
applicable Federal funds is Medicare or
Washington State Page 48 HCA Contract No. K3921
Health Care Authority
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.
6. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS
INSTRUCTIONS FOR CERTIFICATION
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
Washington State Page 50 HCA Contract No. K3921
Health Care Authority
this covered transaction. The
learns that its certification was erroneous
prospective contractor shall submit
when submitted or has become erroneous by
an explanation of why it cannot
reason of changed circumstances.
provide the certification set out
5) The terms covered transaction, debarred,
below. The certification or
suspended, ineligible, lower tier covered
explanation will be considered in
transaction, participant, person, primary
connection with the department or
covered transaction, principal, proposal, and
agency's determination whether to
voluntarily excluded, as used in this clause,
enter into this transaction. However,
have the meanings set out in the Definitions
failure of the prospective contractor
and Coverage sections of the rules
to furnish a certification or an
implementing Executive Order 12549. You
explanation shall disqualify such
may contact the person to whom this contract
person from participation in this
is submitted for assistance in obtaining a
transaction.
copy of those regulations.
3) The certification in this clause is a
6) The prospective contractor agrees by
material representation of fact upon
submitting this contract that, should the
which reliance was placed when the
proposed covered transaction be entered
department or agency determined to
into, it shall not knowingly enter into any lower
enter into this transaction. If it is later
tier covered transaction with a person who is
determined that the prospective
debarred, suspended, declared ineligible, or
contractor knowingly rendered an
voluntarily excluded from participation in this
erroneous certification, in addition to
covered transaction, unless authorized by
other remedies available to the
Authority.
Federal Government, the
7) The prospective contractor further agrees by
department or agency may
submitting this contract that it will include the
terminate this transaction for cause
clause titled "Certification Regarding
of default.
Debarment, Suspension, Ineligibility and
4) The prospective contractor shall
Voluntary Exclusion -- Lower Tier Covered
provide immediate written notice to
Transaction," provided by HHS, without
the department or agency to whom
modification, in all lower tier covered
this contract is submitted if at any
time the prospective contractor
Washington State Page 51 HCA Contract No. K3921
Health Care Authority
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
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
Washington State Page 52 HCA Contract No. K3921
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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.
Washington State Page 53 HCA Contract No. K3921
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CONTRACTOR SIGNATURE REQUIRED
Washington State Page 54 HCA Contract No. K3921
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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
https://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
S�di6son coun
�*Zv*q D
Principle Place of Performance
3a. Congressional District
13,.
�.0 1�5- S1n.e'i1 & 0 &�Cz-e�
3c. State
3b. City
3d. Zip+4 G
q0��
3e. Country
34
4. Are you registered in CCR (httos://www.Eiscoritractorregistration.comi); YES (skip to page 2. Sign, date
and return) ONO
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; Aad
b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements; Aad
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
2�INO (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,
Washington State Page 55 HCA Contract No. K3921
Health Care Authority
3.
4.
Washington State Page 56 HCA Contract No. K3921
Health Care Authority
Note: "Total compensation" means the cash and noncash dollar value earned by the executive during the sub-
recir)ieni's imst fiscal vear of the following (for more information see 17 CFR 229.402
By signing this document, the Contractor Authorized Representative attests to the
information.
Signature of Contractor Authorized Representative Date
HCA will not endorse the Contractor's subaward until this form is completed and
returned.
FOR HEALTH CARE AUTHORITY USE ONLY
HCA Contract Number: K3921
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:
Increase Healthy Behaviors: Educational Services District XYZ will provide training and
technical assistance to chemical dependency centers to assist the centers to integrate
Washington State Page 57 HCA Contract No. K3921
Health Care Authority
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 58 HCA Contract No. K3921
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ATTACHMENT 4
HIPAA Qgtpl2fiance
Preamble: This section of the Contract is the Business Associate Agreement as required by
H I PAA.
1. Definitions.
a. "Business Associate," as used in this Contract, means the "Contractor" and generally
has the same meaning as the term "business associate" at 45 CFR 160.103. Any
reference to Business Associate in this Contract includes Business Associate's
employees, agents, officers, Subcontractors, third party contractors, volunteers, or
directors.
b. "Business Associate Agreement" means this HIPAA Compliance section of the Contract
and includes the Business Associate provisions required by the U.S. Department of
Health and Human Services, Office for Civil Rights.
c. "Breach" means the acquisition, access, use, or disclosure of Protected Health
Information in a manner not permitted under the HIPAA Privacy Rule which
compromises the security or privacy of the Protected Health Information, with the
exclusions and exceptions listed in 45 CFR 164.402.
d. "Covered Entity" means DSHS, a Covered Entity as defined at 45 CFR 160.103, in its
conduct of covered functions by its health carecomponents.
e. "Designated Record Set" means a group of records maintained by or for a Covered
Entity, that is: the medical and billing records about Individuals maintained by or for a
covered health care provider; the enrollment, payment, claims adjudication, and case or
medical management record systems maintained by or for a health plan; or Used in
whole or part by or for the Covered Entity to make decisions about Individuals.
f. "Electronic Protected Health Information (EPHI)" means Protected Health Information
that is transmitted by electronic media or maintained in any medium described in the
definition of electronic media at 45 CFR 160.103.
g. "HIPAX means 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) (HITECHAct).
K "HIPAA Rules" means the Privacy, Security, Breach Notification, and Enforcement
Rules at 45 CFR Parts 160 and Part 164.
i. "Individual(s)" means the person(s) who is the subject of PHI and includes a person
who qualifies as a personal representative in accordance with 45CFR 164.502(8).
i. "Minimum Necessary" means the least amount of PHI necessary to accomplish the
purpose for which the PHI is needed.
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k. "Protected Health Information (PHI)" means individually identifiable health information
created, received, maintained or transmitted by Business Associate on behalf of a
health care component of the Covered Entity 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 the past, present, or future payment for provision of health care to an
Individual. 45 CFR 160.103. PHI includes demographic information that identifies the
Individual or about which there is reasonable basis to believe can be used to identify
the Individual. 45 CFR 160.103. PHI is information transmitted or held in any form or
medium and includes EPHI. 45 CFR 160.103. PHI does not include education records
covered by the Family Educational Rights and Privacy Act, as amended, 20 USCA
1232g(a)(4)(B)(iv) or employment records held by a Covered Entity in its role as
em ployer.
I. "Security Incident" means the attempted or successful unauthorized access, use,
disclosure, modification or destruction of information or interference with system
operations in an information system.
m. "Subcontractor" as used in this HIPAA Compliance section of the Contract (in addition
to its definition in the General Terms and Conditions) means a Business Associate that
creates, receives, maintains, or transmits Protected Health Information on behalf of
another Business Associate.
n. "Use" includes the sharing, employment, application, utilization, examination, or
analysis, of PHI within an entity that maintains such information.
2. Compliance. Business Associate shall perform all Contract duties, activities and tasks in
compliance with HIPAA, the HIPAA Rules, and all attendant regulations as promulgated by
the U.S. Department of Health and Human Services, Office of Civil Rights.
3. Use and Disclosure of PHI. Business Associate is limited to the following permitted and
required uses or disclosures of PHI:
a. Duty to Protect PHI. Business Associate shall protect PHI from, and shall use
appropriate safeguards, and comply with Subpart C of 45 CFR Part 164 (Security
Standards for the Protection of Electronic Protected Health Information) with respect to
EPHI, to prevent the unauthorized Use or disclosure of PHI other than as provided for
in this Contract or as required by law, for as long as the PHI is within its possession and
control, even after the termination or expiration of this Contract.
b. Minimum Necessary Standard. Business Associate shall apply the HIPAA Minimum
Necessary standard to any Use or disclosure of PHI necessary to achieve the purposes
of this Contract. See 45 CFR 164.514 (d)(2) through (d)(5).
c. Disclosure as Part of the Provision of Services. Business Associate shall only Use or
disclose PHI as necessary to perform the services specified in this Contract or as
required by law, and shall not Use or disclose such PHI in any manner that would
violate Subpart E of 45 CFR Part 164 (Privacy of Individually Identifiable Health
Information) if done by Covered Entity, except for the specific uses and disclosuresset
forth below.
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d. Use for Proper Management and Administration. Business Associate may Use PHI for
the proper management and administration of the Business Associate or to carry out
the legal responsibilities of the Business Associate.
e. Disclosure for Proper Management and Administration. 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, provided the disclosures
are required by law, or 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 the person notifies the Business Associate of any
instances of which it is aware in which the confidentiality of the information has been
Breached.
f. Impermissible Use or Disclosure of PHI. Business Associate shall report to DSHS in
writing all Uses or disclosures of PHI not provided for by this Contract within one (1)
business day of becoming aware of the unauthorized Use or disclosure of PHI,
including Breaches of unsecured PHI as required at 45 CFR 164.410 (Notification by a
Business Associate), as well as any Security Incident of which it becomes aware. Upon
request by DSHS, Business Associate shall mitigate, to the extent practicable, any
harmful effect resulting from the impermissible Use or disclosure.
g. Failure to Cure. If DSHS learns of a pattern or practice of the Business Associate that
constitutes a violation of the Business Associate's obligations under the terms of this
Contract and reasonable steps by DSHS do not end the violation, DSHS shall terminate
this Contract, if feasible. In addition, If Business Associate learns of a pattern or
practice of its Subcontractors that constitutes a violation of the Business Associate's
obligations under the terms of their contract and reasonable steps by the Business
Associate do not end the violation, Business Associate shall terminate the Subcontract,
if feasible.
h. Termination for Cause. Business Associate authorizes immediate termination of this
Contract by DSHS, if DSHS determines that Business Associate has violated a material
term of this Business Associate Agreement. DSHS may, at its sole option, offer
Business Associate an opportunity to cure a violation of this Business Associate
Agreement before exercising a termination for cause.
i. Consent to Audit. Business Associate shall give reasonable access to PHI, its internal
practices, records, books, documents, electronic data and/or all other business
information received from, or created or received by Business Associate on behalf of
DSHS, to the Secretary of DHHS and/or to DSHS for use in determining compliance
with HIPAA privacy requirements.
j. Obligations of Business Associate Upon Expiration or Termination. Upon expiration or
termination of this Contract for any reason, with respect to PHI received from DSHS, or
created, maintained, or received by Business Associate, or any Subcontractors, on
behalf of DSHS, Business Associate shall:
(1) Retain only that PHI which is necessary for Business Associate to continue its
proper management and administration or to carry out its legal responsibilities;
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(2) Return to DSHS or destroy the remaining PHI that the Business Associate or any
Subcontractors still maintain in any form;
(3) Continue to use appropriate safeguards and comply with Subpart C of 45 CFR Part
164 (Security Standards for the Protection of Electronic Protected Health
Information) with respect to Electronic Protected Health Information to prevent Use
or disclosure of the PHI, other than as provided for in this Section, for as long as
Business Associate or any Subcontractors retain the PHI;
(4) Not Use or disclose the PHI retained by Business Associate or any Subcontractors
other than for the purposes for which such PHI was retained and subject to the
same conditions set out in the "Use and Disclosure of PHI" section of this Contract
which applied prior to termination; and
(5) Return to DSHS or destroy the PHI retained by Business Associate, or any
Subcontractors, when it is no longer needed by Business Associate for its proper
management and administration or to carry out its legal responsibilities.
k. Survival. The obligations of the Business Associate under this section shall survive the
termination or expiration of this Contract.
4. Individual Rights.
a. Accounting of Disclosures.
(1) Business Associate shall document all disclosures, except those disclosures that
are exempt under 45 CFR 164.528, of PHI and information related to such
disclosures.
(2) Within ten (10) business days of a request from DSHS, Business Associate shall
make available to DSHS the information in Business Associate's possession that is
necessary for DSHS to respond in a timely manner to a request for an accounting
of disclosures of PHI by the Business Associate. See 45 CFR 164.504(e)(2)(ii)(G)
and 164.528(b)(1).
(3) At the request of DSHS or in response to a request made directly to the Business
Associate by an Individual, Business Associate shall respond, in a timely manner
and in accordance with HIPAA and the HIPAA Rules, to requests by Individuals for
an accounting of disclosures of PHI.
(4) Business Associate record keeping procedures shall be sufficient to respond to a
request for an accounting under this section for the six (6) years prior to the date on
which the accounting was requested.
b. Access
(1) Business Associate shall make available PHI that it holds that is part of a
Designated Record Set when requested by DSHS or the Individual as necessary to
satisfy DSHS's obligations under 45 CFR 164.524 (Access of Individuals to
Protected Health Information).
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(2) When the request is made by the Individual to the Business Associate or if DSHS
asks the Business Associate to respond to a request, the Business Associate shall
comply with requirements in 45 CFR 164.524 (Access of Individuals to Protected
Health Information) on form, time and manner of access. When the request is
made by DSHS, the Business Associate shall provide the records to DSHS within
ten (10) business days.
c. Amendment.
(1) If DSHS amends, in whole or in part, a record or PHI contained in an Individual's
Designated Record Set and DSHS has previously provided the PHI or record that is
the subject of the amendment to Business Associate, then DSHS will inform
Business Associate of the amendment pursuant to 45 CFR 164.526(c)(3)
(Amendment of Protected Health Information).
(2) Business Associate shall make any amendments to PHI in a Designated Record
Set as directed by DSHS or as necessary to satisfy DSHS's obligations under 45
CFR 164.526 (Amendment of Protected Health Information).
5. Subcontracts and other Third Party Agreements. In accordance with 45 CFR
164.502(e)(1)(ii), 164.504(e)(1)(i), and 164.308(b)(2), Business Associate shall ensure that
any agents, Subcontractors, independent contractors or other third parties that create,
receive, maintain, or transmit PHI on Business Associate's behalf, enter into a written
contract that contains the same terms, restrictions, requirements, and conditions as the
HIPAA compliance provisions in this Contract with respect to such PHI. The same
provisions must also be included in any contracts by a Business Associate's Subcontractor
with its own business associates as required by 45 CFR 164.314(a)(2)(b) and
164.504(e)(5) .
6. Obligations. To the extent the Business Associate is to carry out one or more of DSHS's
obligation(s) under Subpart E of 45 CFR Part 164 (Privacy of Individually Identifiable Health
Information), Business Associate shall comply with all requirements that would apply to
DSHS in the performance of such obligation(s).
7. Liability. Within ten (10) business days, Business Associate must notify DSHS of any
complaint, enforcement or compliance action initiated by the Office for Civil Rights based
on an allegation of violation of the HIPAA Rules and must inform DSHS of the outcome of
that action. Business Associate bears all responsibility for any penalties, fines or sanctions
imposed against the Business Associate for violations of the HIPAA Rules and for any
imposed against its Subcontractors or agents for which it isfound liable.
8. Breach Notification.
a. In the event of a Breach of unsecured PHI or disclosure that compromises the privacy
or security of PHI obtained from DSHS or involving DSHS clients, Business Associate
will take all measures required by state or federal law.
b. Business Associate will notify DSHS within one (1) business day by telephone and in
writing of any acquisition, access, Use or disclosure of PHI not allowed by the
provisions of this Contract or not authorized by HIPAA Rules or required by law of
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which it becomes aware which potentially compromises the security or privacy of the
Protected Health Information as defined in 45 CFR 164.402 (Definitions).
c. Business Associate will notify the DSHS Contact shown on the cover page of this
Contract within one (1) business day by telephone or e-mail of any potential Breach of
security or privacy of PHI by the Business Associate or its Subcontractors or
agents. Business Associate will follow telephone or e-mail notification with a faxed or
other written explanation of the Breach, to include the following: date and time of the
Breach, date Breach was discovered, location and nature of the PHI, type of Breach,
origination and destination of PHI, Business Associate unit and personnel associated
with the Breach, detailed description of the Breach, anticipated mitigation steps, and the
name, address, telephone number, fax number, and e-mail of the individual who is
responsible as the primary point of contact. Business Associate will address
communications to the DSHS Contact. Business Associate will coordinate and
cooperate with DSHS to provide a copy of its investigation and other information
requested by DSHS, including advance copies of any notifications required for DSHS
review before disseminating and verification of the dates notifications were sent.
d. If DSHS determines that Business Associate or its Subcontractor(s) or agent(s) is
responsible for a Breach of unsecured PHI:
(1) requiring notification of Individuals under 45 CFR § 164.404 (Notification to
Individuals), Business Associate bears the responsibility and costs for notifying the
affected Individuals and receiving and responding to those Individuals' questions or
requests for additional information;
(2) requiring notification of the media under 45 CFR § 164.406 (Notification to the
media), Business Associate bears the responsibility and costs for notifying the
media and receiving and responding to media questions or requests for additional
information;
(3) requiring notification of the U.S. Department of Health and Human Services
Secretary under 45 CFR § 164.408 (Notification to the Secretary), Business
Associate bears the responsibility and costs for notifying the Secretary and
receiving and responding to the Secretary's questions or requests for additional
information; and
(4) DSHS will take appropriate remedial measures up to termination of thisContract.
9. Miscellaneous Provisions.
a. Regulatory References. A reference in this Contract to a section in the HIPAA Rules
means the section as in effect or amended.
b. Interpretation. Any ambiguity in this Contract shall be interpreted to permit compliance
with the HIPAA Rules.
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ATTACHMENT 5
1. SAMHSA Award Terms.
a. This grant is subject to the terms and conditions, included directly, or incorporated by
reference on the Notice of Award (NoA).
b. Grant funds cannot be used to supplant current funding of existing activities.
c. By law, none of the funds awarded can be used to pay the salary of an individual at a
rate in excess of the Executive Level 1, which is $199,700 annually.
d. Awardees and sub -recipients must maintain records which adequately identify the
source and application of funds provided for financially assisted activities. These
records must contain information pertaining to grant or sub -grant awards and
authorizations, obligations, unobligated balances, assets, liabilities, outlays or
expenditures, and income. SAMHSA or its designee may conduct a financial
compliance audit and on-site program review of grants with significant amounts of
Federal funding.
e. Per 45 CFR 74.36 and 45 CFR 92.34 and the HHS Grants Policy Statement, any
copyrighted or copyrightable works developed under this cooperative
agreement/grant shall be subject to royalty -free, nonexclusive and irrevocable
license to the government to reproduce, publish, or otherwise use them and to
authorize others to do so for General Government purposes. Income earned from
any copyrightable work developed under this grant must be used as program
income.
Program income accrued under this award must be used in accordance with the
additional costs alternative described in 45 CFR 74.24(b)(1) or 45 CFR 92.25(g)(2)
as applicable. Program income must be used to further the grant objectives and
shall only be used for allowable costs as set forth in the applicable OMB circulars A-
102 and A-110.
g. No part of any appropriation contained in this Act shall be used, other than for normal
and recognized executive -legislative relationships, for publicity or propaganda
purposes, for the preparation, distribution, or use of any kit, pamphlet, booklet,
publication, radio, television, or video presentation designed to support or defeat
legislation pending before the Congress, except in presentation to the Congress itself
or any State legislature.
h. No part of any appropriation contained in this Act shall be used to pay the salary or
expenses of any grant or contract recipient, or agency acting for such recipient,
related to any activity designed to influence legislation or appropriations pending
before the Congress or any State legislature.
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Where a conference is funded by a grant or cooperative agreement the recipient
must include the following statement on all conference materials (including
promotional materials, agenda, and internet sites): "Funding for this conference was
made possible (in part) by Grant SP20155, TM010056 and T1080249 from
SAMHSA. The views expressed in written conference materials or publications and
by speakers and moderators do not necessarily reflect the official policies of the
Department of Health and Human Services; nor does mention of trade names,
commercial practices, or organizations imply endorsement by the U.S. Government."
j. If federal funds are used by the Contractor to attend a meeting, conference, etc. and
meal(s) are provided as part of the program, then the per diem applied to the Federal
travel costs (M&IE allowance) must be reduced by the allotted meal cost(s
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Schedule A
Statement of Work
The Contractor shall ensure services, and staff, and otherwise do all things necessary for or
incidental to the performance of work, as set forth below. Prevention programs and services
include, but are not limited to:
1. Coordination of Prevention Services.
The Contractor shall ensure:
a. The provision of CPWI services in accordance with the CPWI Community
Coalition Guide located on the Athena Forum website_
https://www,theathenaforum_orgl_pwi-community-coalition-guide which outlines
the minimal standards to participate in the CPWI. Contractor shall plan to reach
the ideal benchmarks related to the community coalition's efforts and staffing to
include:
(1) Hire or identify a minimum of one part-time (0.5 FTE) staff member to
serve as the qualified Community Coalition Coordinator upon contract
execution. Full-time employment (1.0 FTE) for the Community Coalition
Coordinator is allowable and strongly recommended in order to meet the
scope of the project.
(a) Ensure Community Coalition Coordinator(s) meet required position
qualifications and workstation requirements found in the CPWI
Community Coalition Guide.
(b) Confirm an office space in the designated community for the
Community Coalition Coordinator.
(c) Contractor shall submit a completed Community Coalition Coordinator
Qualification Checklist to Agreement Manager or designee for review.
HCA shall review and respond within five business days.
(2) Ensure Community Coalition Coordinators are Certified Prevention
Professionals (CPP).
(a) Ensure currently certified Community Coalition Coordinator(s)
maintain CPP credential status, and
(b) Ensure Certified Prevention Professional (CPP) certification within
eighteen (18) months of new Community Coalition Coordinator start
date.
(c) HCA reserves the right to require Contractor to develop a Community
Coalition Coordinator training plan if candidate does not meet required
qualifications.
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b. Contractor contact on page one of this Contract and primary fiscal staff or their
designee(s) shall attend annual contractor training that will be scheduled forfour
(4) hours in duration. Date and location will be announced by DBHR at least 30
days prior to the training.
c. Contractor shall ensure that a regular annual schedule of direct prevention
services for public dissemination is established.
(1) Regular annual schedule shall take into account items including, but not
limited to: implementation times that maximize participation and service
outcomes; local needs and gaps; leveraged resources; and, other locally
identified factors that influence service delivery throughout the year.
(2) Regular annual schedule and community dissemination plan shall be
identified as part of the CPWI Action Plan and Budget Update and
submitted to Agreement Manager or designee for HCA review annually in
accordance with the timeline in the CPWI Community Coalition Guide.
(a) Submit an annual Action Plan and Budget with projected
expenditures, including salary and benefits for HCA funded prevention
staff, program costs, training and travel to the Contract Manager or
designee, by June 15, 2020 and June 15, 2021 according to the
CPWI Community Coalition Guide, or within thirty (30) days upon
request. For cohort 6, an updated Action Plan and Budget are due
August 1, 2020. A template will be provided at least 30 days prior to
due date.
k. Budget adjustments that are ten percent (10%) or more of the total of the
approved Contractor and/or CPWI coalition budget shall submit a budget revision
for approval to Agreement Manager or designee at least fifteen (15) days prior to
expending adjusted budget items. Approval must be granted prior to expending
funds.
I. Enter approved programs, based on the priorities, goals and objectives described
in the approved Strategic Plan, into the Minerva within thirty (30) days of Action
Plan approval or as directed by PSM.
m. Ensure sixty percent (60%) of programs supported by HCA funds will be
replications or adaptations of "Evidence -based Practice" substance abuse
prevention programs as identified in the list provided by DBHR. Ensure that all of
the programs supported by HCA meet the Center for Substance Abuse
Prevention's (CSAP) Principles of Substance Abuse Prevention, found on the
Athena Forum Website: www.TheAthenaForum.oi�g/CSAPprinciples.
n. Food costs are generally unallowable during program implementation except
within the following parameters:
(1) Light refreshment costs for training events and meetings lasting longer
than two (2) hours in duration are allowable.
(2) Ensure that light refreshment costs do not exceed $3.00 per person.
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(3) Meals may be provided for participants using SABG and DMA funds only
if:
(a) The training is four (4) hours or more in duration; or
(b) The program is a recurring, direct service in the family domain, lasting
two (2) hours or more in duration and must be approved in the
strategic plan.
(4) Meals are not allowable costs with either the PFS, STIR, or SOR funds.
(5) Contractor shall adhere to current state per -diem rates for meals
accessible at www.ofm.wa.gov/policy/10.90.htm.
(6) No more than a total of $1,000 may be spent on food or light
refreshments per CPWI Coalition per year.
o. Dedicated Marijuana Account Funds (DMA) shall be used for program and
strategy training and implementation.
(1) All programs planned and implemented with DMA shall be programs
selected from the current DBHR provided youth marijuana use prevention
and reduction program list.-
www.TlieAthenaForum.org/1502PreventionPlanimplementation
(a) No less than eighty-five percent (85%) of DMA funds shall be
expended on evidence -based or research -based programs on the
identified program list.
(b) Up to fifteen percent (15%) of DMA funds may expended on
Promising programs on the identified program list.
p. Contractor is encouraged to collaborate and partner with community-based
organizations that operate within or serve the CPWI community.
q. If funding permits the Contractor to provide Community Based Coordination
services in addition to meeting CPWI requirements, (i.e., Counties with
communities that each have at least $110,000 per community of DBHR funding
budgeted for CPWI implementation, annually) services may be provided at the
County level. Services shall reflect work of the Contractor staff coordinating,
organizing, building capacity, and providing education and information related to
prevention initiatives at the County level with a goal to expand CPWI
communities.
(1) If applicable to Contractor, develop plan for services listed above and
submit to Contract Manager or designee for review and approval within
sixty (60) days of contract execution.
2. Prevention Training.
a. The Contractor shall participate in all required training events identified by HCA
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and listed in the CPWI Community Coalition Guide.
b. Non -Required Training in CPWI
(1) In the absence of trainings identified in the approved strategic plan, all
additional (non -required) training paid for by HCA shall be approved by
Agreement Manager or designee prior to training and meet the approved
goals and objectives in approved Strategic Plan.
(2) The Contractor shall ensure any requests for training in addition to the
approved training in the Strategic plan are requested in writing and sent
directly to the Agreement Manager or designee, a minimum of ten (10)
working days before the date of the proposed training. Trainings shall
relate to one (1) of the following four (4) categories:
(a) Coalition building and community organization.
(b) Capacity building regarding prevention theory and practice.
(c) Capacity building for Evidence -based Practice and environmental
strategy implementation, related to the goals and objectives of the
coalition's approved strategic plan.
(d) Capacity building in non-CPWI communities to expand CPWI efforts
and meets overall goals and objectives of CPWI may be approved by
Agreement Manager or designee upon request.
(3) The Contractor shall ensure training paid for by HCA that requires travel
follows state travel reimbursement guidelines and rates accessible at-
www.ofm.wa.gov/12olicyllo.90.htm.
(4) The Contractor shall bill for training events on an A-19 per billing code
according to the Program/Fiscal Requirements and record training events
in the HCA Substance Use Disorder Prevention and Mental Health
Promotion Online Reporting Systems or Minerva in accordance with the
monthly reporting requirements described in Section 3 c., Prevention
Report Schedule/Due Dates.
3. Media Materials.
a. HCA must be cited as the funding source in news releases, publications, and
advertising messages created with or about HCA funding. The funding source
shall be cited as: Washington State Health Care Authority. The HCA logo may
also be used in place of the above citation.
b. Media materials and publications developed with HCA funds, including
messaging specifically directed to youth, shall be submitted to the Agreement
Manager or designee for approval prior to publication (HCA will respond within
five (5) working days).
(1) Exceptions: The Contractor does not need to submit the following items to
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Agreement Manager or designee:
(a) Newsletters and fact sheets.
(b) News coverage resulting from interviews with reporters. This includes
online news coverage.
(c) Newspaper editorials or letters to the editor.
(d) Posts on Facebook, YouTube, Tumblr, Twitter, Instagram, Snapchat
and other social media sites.
(e) When a statewide media message is developed by HCA, is localized,
and if the only change is the local coalition information and funding
source acknowledgment from coalition or public health entities.
(f) When a national prevention media campaign is developed by
SAMHSA, is localized, and if the only change is the local coalition
information and funding source acknowledgement from coalition or
public health entities.
4. Secure Prescription Take -Back and Lock Box project.
Contractors who implement a Secure Prescription Take -Back and/or Lock Box project must
ensure the following additional requirements:
a. The Secure Prescription Take -Back and/or Lock Box project must align with the
community needs assessment and will increase local capacity to address
prescription drug misuse and abuse by reducing social availability of
prescriptions in the community.
b. The Contractor shall provide the services and staff, and otherwise do all things
necessary for or incidental to the Secure Prescription Take -Back and/or Lock
Box project as set forth below:
(1) Enhance community capacity to practice safe disposal of medications by
promoting permanent secure drop box in the location where community
readiness has been established. (Installation and disposal must follow all
DEA rules and all federal and state laws and regulations).
(2) Collaborate with community partners to maintain and/or enhance policies
and procedures necessary to maintain a permanent secure medicine
take -back drop box.
(3) Overtime wages for law enforcement officers and staff as outlined in
strategic plan and outside of normal duties and other real costs (including
mileage reimbursement) associated with transporting and properly
disposing of collected medicines at EPA approved locations may be
permitted depending upon source of funds and must be approved by the
Contract Manager in advance.
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(4) Create, utilize and disseminate public education information materials to
increase awareness of the secure medicine take -back project, local
treatment resources, naloxone information and medical response (Good
Samaritan law) cards.
(5) Disseminate public information including information on local treatment
resources, naloxone information and medical response cards and
posters. (Print ready materials are available online at
www stopoverdose. org).
(6) Utilize publications already available through HCA/DBHR and other
websites. (i.e., SAMHSA Opioid Overdose Toolkit, and
downloadable/printable materials on www. stop overdose.or and
www. takeh ac kyou rm ed s. org.
(7) Submit locally -developed educational and informational materials to
HCA/DBHR for approval at least ten (10) business days prior to
publication.
(8) Prior to purchasing home medication lock boxes or bags the Contractor
will submit to HCA/DBHR in writing a plan for the purchase and
distribution of home medication storage device including the cost and
source of the home storage devices, the number of devices to be
purchased, a clear plan for distribution, and method for tracking the use of
the devices. The Contractor must also demonstrate how the distributed
home medication devices will be altered (by engraving, indelible ink, or
other means) to have no cash value.
(9) Create and submit Secure Medicine Tack -back and/or Lock Box project in
the Minerva reporting system within 30 days of approval of this project.
(10) Track and report in Minerva:
(a) The number of new policies developed and adopted to support a
sustained drop box.
(b) The number of educational and/or informational materials developed.
(c) The number of outreach materials developed and distributed including
news publications.
(d) The number of pharmacies involved in information dissemination
efforts.
(e) The number of health care providers involved in information
dissemination efforts.
(f) Pounds of medicine collected monthly once a secure medicine take -
back box is in place.
(g) The number of home medication storage devices purchased and
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distributed including a pre/post survey for those that received the
home storage devices to be approved by HCA/DBHR.
(h) Coalition coordinator time spent on the project in the "direct" and
"indirect" staff time related to the project.
6. Reporting Requirements.
a. Prevention Reporting Requirements
The Contractor shall report on all requirements as identified in the HCA Substance
Use Disorder Prevention and Mental Health Promotion Online Reporting System or
Minerva. HCA reserves the right to add reporting requirements based on
requirements of grants.
b. Prevention Activity Data Reports
The Contractor shall:
(1) Ensure that monthly prevention activities are reported in the HCA Minerva
in accordance with the requirements and timelines set forth.
(2) Ensure accurate and unduplicated reporting.
(3) Ensure proper training of staff and designated staff for back-up Minerva
data entry to meet report due dates.
(4) If special circumstances arise and Contractor is unable to enter the data
by the reporting deadline(s), the Contractor shall ensure any requests for
extensions to reporting deadlines are requested in writing and sent
directly to the PSM via email five (5) working days before the report due
date.
(5) The maximum extension request permitted is ten (10) working days.
(6) Monthly invoices submitted with active data entry extensions will be
denied and may be re -submitted by Contractor once data for the month(s)
in question is complete.
(7) Contractors with three (3) or more consecutive months of data entry
extensions or late reporting or four (4) or more program data entry
extensions or late reporting within a six (6) month period shall be required
to submit a Corrective Action Plan to HCA.
(a) Extensions granted due to Minerva technical issues will be excluded
from this count.
(8) Ensure all required demographic information is provided for individual
participant; population reach; aggregate; environmental and mentoring or
1 -to -1 services in Minerva.
(9) Report Community Coalition Coordination Staff Hours in Minerva for each
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month of the calendar year.
(10) Complete prevention reporting, according to the Schedule/Due Dates
below:
Reporting
Reporting Period Report(s) Report Due Dates System
Enter programs listed on
Annually approved Strategic Action
Plan by HCA into Minerva.
As requested GPRA Measures,
Monthly
Quarterly
As requested
Prevention activity data input
for all active services including
community coalition
coordination staff hours and
efforts, services, participant
information, training,
evaluation tools and
assessments.
Within 30 days of
Strategic Action Plan
approval
As requested
15th of each month
for activities from the
previous month
CPWI Quarterly Reporting. October 15, January
15, April 15, July 15
As required by SAMHSA. As requested
c. Outcome Measures
Minerva
Minerva
Minerva
Minerva
Minerva or as
req u red
(1) The Contractor shall report on all required evaluation tools (i.e., pre/post-
tests) identified in Minerva that measure primary program objective.
(2) Special situations and exceptions regarding evaluation tools identified in
the Minerva include, but are not limited to, the following:
(a) The Contractor may negotiate with the Agreement Manager or
designee to reduce multiple administrations of surveys to individual
participants.
(b) Participants in recurring program groups in which the majority of
participants are younger than ten (10) years old on the date of that
group's first service.
d. Performance Work Statement/Evaluation-
(1) The Contractor shall ensure program results show positive outcomes for
Washington State Page 74 HCA Contract No. K3921
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at least half of the participants in each program group as determined by
Activity Log with individual participant sessions.
(a) "Positive outcomes" means that at least half of the participants in a
group report positive improvement or maintenance as determined by
the program measurable objective between pre and post-tests.
(b) Positive outcomes will be determined using the pre-test and post-test
data reported in Minerva.
(c) Evaluation of Minerva data will occur on the 15th of the month
following the final date of service for each group.
(2) HCA shall use the following protocol for evaluation:
(a) Matched pre-test and post-test pairs will be used in the analysis.
(b) To allow for normal attendance drop-off, a 20% leeway will be given
for missing post-tests.
(c) If there are missing post-tests for entered pre-tests in excess of 20%
of pre-tests, missing post-test will be counted as a negative outcome.
Example: there are ten (10) pre-tests and seven (7) post-tests. The
denominator would be eight (8) and the maximum numerator would
be seven (7).
(3) Different groups, as determined by Activity Logs, receiving the same
program will be clustered by school district.
(a) In cases where multiple providers are serving the same school district,
groups will be clustered by school district and provider.
(b) The results of one (1) provider in a given school district will not impact
another provider in the same district.
In cases where the survey instrument selected for a given
program includes more than one scale, the scale that is most
closely aligned with the measurable objective linked to the
program in Minerva will be used.
ii. Results for groups, as determined by Activity Logs, with services
that span two (2) contracting periods will be analyzed in the
contracting period that the post-test was administered.
(c) If fewer than half of the participants in a group, as determined by
Activity Log, within a given school district, report positive change in
the intended outcome:
i. The Contractor shall submit a Performance Improvement Plan
(PIP) for the non-compliant program to the Agreement Manager or
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designee or designee within forty-five (45) days of notice by HCA.
ii. Reimbursement for the CSAP Category row on the A-19 for that
program will be held until the PIP is approved by the Agreement
Manager or designee or their designee.
iii. If a second group, as determined by Activity Log, within that same
school district has fewer than half of the participants report
positive change in the intended outcome, then the following steps
will be taken:
(A) In cases where there is no active non-compliant program, the
Contractor shall discontinue implementation of that program
within the specified geography.
(B) In cases where the same programs as the non-compliant
program are active and continuing in the same school district,
those groups, as determined by Activity Logs, will be allowed
to complete the expected number of sessions. No new groups,
as determined by Activity Logs, will be started.
(C) Following the conclusion of all groups, as determined by
Activity Logs, completing the program, results will be reviewed
for those groups.
(D) If the results do not show positive change for each groups, as
determined by Activity Logs, the Contractor shall take the
following action:
I. In cases where the program is being delivered by a single
provider in the specified geography, the Contractor shall
discontinue implementation of that program in the specified
geography.
II. In cases where the program is being delivered by multiple
providers in the specified geography, the Contractor shall
discontinue implementation of that program by the
underperforming provider in the specified geography.
(d) A program that resulted in the need for a Performance Improvement
Plan and Plan during this contract period will not carry that record
forward into the July 1, 2021 - June 30, 2023 contract period.
(e) Implement and monitor prevention programs and reporting to assure
compliance with these guidelines.
6. Requirements.
a. Background Checks.
(1) The Contactor shall ensure a criminal background check is conducted for
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all staff members, case managers, outreach staff members, etc. or
volunteers who have unsupervised access to children, adolescents,
vulnerable adults, and persons who have developmental disabilities.
(2) When providing services to youth, the Contractor shall ensure that
requirements of WAC 388-06-0170 are met.
b. Services and Activities to Ethnic Minorities and Diverse Populations.
The Contractor shall:
(1) Ensure all services and activities provided by the Contractor or
subcontractor under this Contract shall be designed and delivered in a
manner sensitive to the needs of all diverse populations.
(2) Initiate actions to ensure or improve access, retention, and cultural
relevance of prevention or other appropriate services, for ethnic minorities
and other diverse populations in need of prevention services as identified
in their needs assessment.
(3) Take the initiative to strengthen working relationships with other agencies
serving these populations. The Contractor shall require its subcontractors
to adhere to these requirements.
c. Continuing Education.
Ensure that continuing education is provided for employees of any entity
providing prevention activities in accordance with42 USC 300x -28(b) and 45 CFR
96.132(b).
d. Single Source Funding.
(1) The Contractor shall ensure all subcontractors that Single Source
Funding means that a subcontractor can use only one source of funds at
any given time.
(2) Each cost reimbursement Prevention service provided must be billed only
one (1) time through the source selected for funding this expense. At no
time may the same expense be billed through more than one (1) funding
source.
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EXHIBIT A - DBHR-SUD FISCAL POLICIES
STANDARDS FOR REIMBURSABLE COSTS
The following Standards for Reimbursable Costs represents a compilation of definitions and principles from the
State of Washington Office of Financial Management's State Administrative and Accounting Manual (SAAM),
the federal Office of Management and Budget's Circular A-122 Cost Principles for Non -Profit Organizations,
and Circular A-87 Cost Principles for State, Local, and Indian Tribal Governments. These standards are
provided solely as technical assistance and are not intended to circumvent the Contractor's need to follow the
referenced rules.
DEFINITIONS
The following terms and phrases shall have the meanings indicated when used in this exhibit, except where
the context clearly requires otherwise.
(1) "Acquisition cost" shall mean the net cost of equipment, including the costs for modifications, attachments,
accessories, or auxiliary apparatus necessary to make the equipment useable for the purpose for which it was
acquired.
(2) "Arm's length transaction" shall mean a transaction resulting from good faith bargaining between a buyer
and a seller, where the parties have adverse positions in the marketplace.
(3) "Contractor or subcontractor property" shall mean property used in performance of a contract which is not
departmental property.
(4) "Cost" shall mean the historical amount of money involved in a transaction which decreases an asset or
increases a liability, whether recognized on a cash or accrual basis. Cost shall not include repayments of
borrowing, expenditures to acquire assets, distributions to owners, and corrections to prior periods.
Corrections to prior periods are included as costs in that prior period.
(5) "Cost related or cost reimbursement" shall mean a contract or subcontract where the amount of payment
being made is related to the actual costs of the subcontractor or a class of subcontractors to perform the
contract, subject to ceilings, allowances, limitations and conditions adopted by the Department, but without
regard to the method of payment.
(6) "Cost related subcontractor" shall mean a subcontractor that has a cost related subcontract.
(7) "Customary charge" shall mean the average charge for a similar service, activity or procedure for non -
departmental clients or purchasers by providers whose training and experience is similar to the contractor
or subcontractor and are located in the same area. The area considered in determining customary charge
shall be as large as necessary to provide a reasonable measure of the market for such services, activities
or procedures.
(8) "Department" shall mean the Department of Social and Health Services.
(9) "Departmental clients" shall mean individuals who receive or benefit from services or activities for which the
contractor was reimbursed in part or entirely by the Department.
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(10) "Departmental funds" shall mean any funds paid by the Department to a contractor, including funds
passed through to subcontractors without regards to the source of those funds. Departmental funds include
federal funds which pass through the Department.
(11) "Departmental property" shall mean property owned by the Department, and property for which title is
vested in the Department.
(12) "Equipment" means an article of non -expendable tangible personal property having a useful life of more
than one year and an acquisition cost of $5,000 or more per unit. Items not meeting this definition shall not be
classified as equipment. Purchase of equipment must be approved in advance by the contract manager.
(13) "Fee for Service" shall mean a contract or subcontract where the amount of reimbursement is a negotiated
fixed rate of pay based on performance of defined unit of service such as per treatment, per hour or per
session.
(14) "Personal property" shall mean property of any kind except real property, either tangible or intangible.
(15) "Price related " shall mean a contract or subcontract where the amount of reimbursement is related to
market prices for services, and without consideration of the contractor's or subcontractor's actual or anticipated
costs.
(16) "Real property" shall mean land, land improvements, structures, and appurtenances thereto, but excluding
movable machinery and equipment.
(17) "Subcontract" shall mean any agreement for compensation between the contractor and a subcontractor,
or between a subcontractor and another subcontractor, to provide property, services or construction needed in
performance of the contract.
(18) "Subcontractor" shall mean any person, partnership, corporation, association or organization, not in the
employment of the contractor, who has a subcontract agreement directly with the contractor or a subsequent
tier subcontract agreement with an intermediate subcontractor.
(19) "Supplies" shall mean tangible personal property other than equipment.
(20) "Third party" shall mean an individual or organization other than the Department, the contractor, any
subcontractor or any departmental client.
(21) "Usual charge" shall mean the charge which the contractor or subcontractor most frequently charges non -
departmental clients or purchasers for a similar service, activity orprocedure.
(22) "Working capital" shall mean a fund balance accumulated and maintained for a period of more than twelve
months, or remaining at the termination or expiration of a contract, which is not segregated in a reserve
account and is used primarily to maintain the entity's cash flow.
REIMBURSABLE COSTS
(1) Reimbursable costs shall include costs which are necessary for the proper and efficient performance of the
contract, are reasonable and allocable to the contract and are allowable under the provisions of this exhibit.
(2) Reimbursable costs include costs incurred in paying subcontractors for fulfilling or assisting the contractor to
fulfill the contractor's obligations to the Department.
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(a) If the subcontract is price related, the reimbursable cost of the subcontract shall be the share of
payments to the subcontractor which equals the usual charge or the customary charge, whichever is
less. If the subcontractor has only departmental clients, the reimbursable cost shall be the share of
payments to the subcontractor which equal the customary charge.
(b) If the subcontract is cost related, the reimbursable cost of the subcontract shall be the share of
payments to the subcontractor for subcontractor costs which are necessary for the proper and efficient
performance of the contract, are reasonable and allocable to the subcontract and are allowable under
the provisions of this exhibit. If the cost -related subcontractor is a for-profit entity, reimbursable costs
may also include payments for ordinary profit, provided such profit is computed on a basis other than a
percentage of contract costs. Costs used to determine subcontract payments may be either actual
costs during the contract period or estimated costs for the contract period based on actual costs in a
prior period, and may be either costs of the subcontractor or costs of a class or subclass of facilities
providing similar services, activities or procedures.
(c) If the subcontract is fee for service, the reimbursable cost of the subcontract shall be the share of the
payments based on an established rate structure set by laws, regulation or policy, or may be based on
cost information provided by the contractor during a competitive solicitation or contract negotiations.
REASONABLENESS
(1) A cost is reasonable if, in its nature and amount, it does not exceed that which would be incurred by a prudent
and reasonable person under circumstances prevailing at the time the decision was made to incur the cost.
(2) In determining the reasonableness of a given cost, the following shall be given careful consideration:
(a) Whether the cost is of a type generally recognized as ordinary and necessary for the operation of
the contractor or the performance of the contract.
Whether the cost was incurred after the contractor complied with sound business practices, including
arm's length bargaining.
(b) Whether the contractor acted with prudence in the circumstances considering its responsibilitiesto the
organization, its members, employees, clients, the public at large, and the Department.
(c) Whether the contractor deviated from established practices of the contractor, which may
unjustifiably increase the cost.
ALLOCABLE COSTS
(1) A cost is allocable to the contract if all of the following conditions aremet:
(a) It is assignable or chargeable to the contract in accordance with the relative benefit received
because either:
(i) It was incurred specifically and solely for the performance of the contract; or
(ii)It benefits both contract and non -contract objectives and can be distributed between them in
reasonable proportion to the benefits received; or
(iii) It is necessary for the overall operation of the contractor even if a direct relationship to the
contract cannot be shown.
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(b) It is not allocable to or included as a cost of any other contract, grant, agreement or program in either
the present or any prior period, or used as cost-sharing or matching for another contract or grant,
except when the contract specifically authorizes such duplicate allocation.
(c) It is accorded consistent treatment with costs of a similar nature.
(2) Contract -Specific Direct Costs: If a cost is allocable to the contract pursuant to subsection (1)(a)(i) of this
section, the entire amount may be charged to thecontract.
(3) Shared Direct Costs: If a cost is allocable to the contract pursuant to subsection (1)(a)(ii) of this section, the
charge shall be considered to be in reasonable proportion to the benefits received if the charge is based on
time distribution records, random moment time samples, equivalent work units, or space utilization. Other
equitable methods may be used with the prior approval of the Department. Allocation of charges based on
revenue distribution is not an acceptable method.
(4) Indirect Costs: If a cost is allocable to the contract pursuant to subsection (1)(a)(iii) of this section, the charge
shall be considered to be in proportion to benefits received if it is based on the total distribution of costs
allocated pursuant to subsections (2) and (3) of this section, or if it is based on staff time directly spent in
contract and non -contract activities. Other equitable methods may be used with the prior, written approval of
the Department.
(5) Contractors and cost -related subcontractors shall maintain a current cost allocation plan describing how
costs are allocated.
(6) Department approvals required in subsections (3) and (4) of this section shall be obtained by submitting a cost
allocation plan to the contract manager. The cost allocation plan shall identify the period of time covered by the
plan, the cost items to be allocated, the allocation method, the program areas to which costs are allocated, and
the resulting allocations using budgeted costs. Copies of indirect cost allocation plans submitted for federal
grant purposes may be used to apply for Department approval under subsection (4) of this section.
ALLOWABLE COSTS
A cost is allowable if:
(1) It is authorized or not prohibited by federal, state, or local laws and regulations.
(2) It conforms to any limitations or exclusions set forth in the contract terms and approved budget, or in
applicable state or federal law or regulation.
(3) It is approved in advance and in writing by the Department, if it is a cost requiring approval.
(4) It is not an unallowable cost.
(5) It is consistent with policies, regulations, directives, and procedures of the contractor.
(6) It is accorded consistent treatment through application of generally accepted accounting principles.
(7) It is adequately documented in source records such as payroll registers and invoices.
(8) It is the net of all applicable credits, such as purchase discounts, rebates, and allowances.
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COSTS ALLOWABLE WITH PRIOR APPROVAL
Costs described in this section are allowable only if they are approved in advance by the Department. Approval
shall be deemed given if the cost is specifically identified in the contract budget or other clause or attachment to
the contract. Approval of costs not specifically identified in the contract shall be made by letter or other
document which sets forth the nature and amount of the approved cost and the contract for which it is allowed.
(1) Client cash payments: Any direct cash payments to departmental clients are allowable only with prior
written approval of the Department.
(2) Capital expenditures: Cost of acquiring by purchase or capitalized lease land, buildings, or equipment and
cost of repair, remodeling, renovation, or improvements which would materially increase the value or useful life
of buildings are allowable only with the prior written approval of the Department.
(3) Training and education: Cost of training which requires staff to be relieved of regular duties for more than
ten working days per training event is allowable only upon prior written approval of the Department.
(4) Purchase of equipment must be approved in advance by the contract manager. Title to equipment shall vest in
the Department of Social and Health Services unless otherwise determined by the contract manager at the
time of purchase.
INTEREST EXPENSE
(1) Interest on borrowed funds is treated differently depending on the source of funds reimbursing the cost.
(a) Costs incurred for interest on borrowed capital or temporary use of endowment funds, however
represented, are unallowable as reimbursable costs against a federal grant.
(b) Interest on borrowed funds is allowable against state funding if the interest expense meets the
applicable requirements of this section.
(2) Interest on borrowed funds used to purchase equipment or real property is allowable against state funding
with the prior written approval of the Department.
(3) Interest on borrowed funds used to create, replenish, or maintain working capital is allowable against state
funding, if the following conditions are met:
(a) Working capital is depleted due to unusual cash flow, such as abnormally high costs or delays in
reimbursement; or working capital has been insufficient for an extended period of time, because the
contractor or subcontractor has insufficient eligible income in excess of expenses to accumulate
adequate working capital.
(b) The borrowed funds are not used to supplant funds which otherwise would be available to finance
working capital. Borrowed funds shall be considered to supplant contractor working capital if a decision
to deplete working capital is evident, whether the working capital is depleted before or after the
arrangements to borrow funds are made.
(c) The working capital in aggregate does not exceed ninety days cash flow.
(d) The interest expense is approved in advance and in writing by the Department.
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(4) Approval shall be deemed given if the interest cost is specifically identified in the contract budget or other
clause or attachment to the contract. Approval of interest cost not specifically identified in the contract shall be
made by letter or other document which sets forth the nature and amount of the approved cost and the contract
under which it is allowed.
UNALLOWABLE COSTS
The following costs are unallowable, whether incurred directly by the contractor or any cost related
subcontractor:
(1) Bad debts: Any losses arising from uncollectible accounts and other claims and related costs are unallowable.
In double entry accounting systems, write-offs of client fees deemed uncollectible shall be treated as
adjustments to revenue.
(2) Chief executive: The salaries and expenses of the chief executive of a political subdivision are unallowable.
(3) Contingencies: Contributions to a contingency reserve or any similar provision for unforeseen events.
(4) Contributions and donations: Costs of a contractor or subcontractor in the form of contributions and
donations to other organizations, including costs of donated services and property, are unallowable.
(5) Depreciation of state financed property: Costs of depreciation of departmental property are unallowable.
(6) Entertainment: Costs of amusements, social activities, and incidental costs relating thereto such as meals,
beverages, lodging, rentals, transportation, and gratuities are unallowable, except for costs of entertainment
specifically for departmental clients and necessary expenses of staff who supervise departmental clients on
contractor or subcontractor sponsored activities.
(7) Fines and penalties: Costs resulting from violations of or failure to comply with federal, state, and local laws
and regulations are unallowable.
(8) First class air accommodations: The difference in cost between first class air accommodations and less -
than -first class air accommodations is unallowable, except when less -than -first class air accommodations are
not reasonably available.
(9) Fund raising: Costs of organized fund raising are unallowable.
(10) Legal fees to bring suit against federal or state government: The cost of legal expenses for the
prosecution or defense of claims by or against the federal or state government is unallowable.
(11) Legislative expenses: The salaries and other expenses of county councilmen or councilwomen,
supervisors, commissioners, etc., whether incurred for the purposes of the legislation or executive direction,
are unallowable.
(12) Lobbying expenses: The cost of attempting to influence legislation pending before any federal or state
legislative body is unallowable except as provided for in RCW 42.17.190.
(13) Losses: Costs of actual losses which could have been covered either by insurance or by contributions to a
self-insurance reserve are unallowable, except for losses not covered under nominal deductible insurance
coverage and minor losses not covered by insurance which occur in the ordinary course of operations, such as
spoilage and breakage.
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(14) Memberships: Costs of memberships for individuals in civic, business, technical or professional
organizations are unallowable. Costs of contractor or subcontractor memberships in any organization whose
predominate activity is influencing legislation are unallowable.
(15) Under -recovery of costs in other contract agreements: Any costs incurred in excess of the federal and
state contribution under any other contract agreement is unallowable.
UNALLOWABLE COSTS; FEDERAL ALCOHOL, DRUG ABUSE, and MENTAL HEALTH SERVICES BLOCK
GRANT
(1) Unless an explicit and specific federal waiver is obtained, the following costs are unallowable under any
contract which includes federal alcohol, drug abuse and mental health services block grant funds:
(a) Costs of hospital inpatient services;
(b) Cash payments to departmental clients;
(c) Cost of purchase or permanent improvement of land or facilities, other than minor remodeling;
(d) Cost of purchase of major medical equipment, with an acquisition cost in excess of $5,000;
(e) Costs used as cost-sharing or matching for other federal funds requiring nonfederal matching funds;
(f) Costs of financial assistance to any entity which is not either public or nonprofit; or
(g) Costs that in effect supplant or otherwise reduce the amount of state or local funds that would have
been used for alcoholism, drug abuse or mental health programs in the absence of federal block grant
funding. For the purposes of this section, supplantation shall be deemed to occur if the amount of state
or local funds used is less than the amount expended during federal fiscal year ending September 30,
1981.
(h) Carry out any program of distributing sterile needles for the hypodermic injection of any illegal drug or
distributing bleach for the purpose of cleansing needles for such hypodermic injection.
(i) Carry out any testing for the etiologic agent for acquired immune deficiency syndrome (AIDS), unless
such testing is accompanied by appropriate pre-test counseling and appropriate post-test counseling.
(j) EXCESS SALARY: By law, none of the funds awarded can be used to pay salary of an individual at a
rate in excess of the Executive Level I, which is $181,100 annually.
(k) Youth tobacco enforcement.
(2) The use of federal funds to influence or attempt to influence the award of, or amendment to, any federal
contract, grant, loan, or cooperative agreement is prohibited.
(a) The use of funds other than federal funds for such purposes shall require the contractor to submit all
required federal and state forms disclosing such lobbying activity.
(b) The contractor must include this language in any contracts resulting from this agreement and that all
subrecipients understand and agree to these terms.
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(3) Costs that are unallowable under subsection (1) of this section are allowable using state funds
if all of the following conditions are met:
(a) The contract includes state funds at least equal to the total amount of all items of
cost under consideration;
(b) If the costs are incurred by a subcontractor, the subcontract document clearly indicates
only state funds are included in the subcontract; and
(c) The cost is otherwise allowed.
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Exhibit B
Federal Award Identification for Subrecipients (reference 2 CFR 200.331)
WA -PFS 2018
(i) Subrecipient name (which must match the name
associated with its unique entity identifier);
(ii) Subrecipient's unique entity identifier; (DUNS)
(iii) Federal Award Identification Number (FAIN);
(iv) Federal Award Date (see §200.39 Federal award
date);
(v) Subaward Period of Performance Start and End
Date;
(vi) Amount of Federal Funds Obligated by this action;
(vii) Total Amount of Federal Funds Obligated to the
subrecipient;
(viii) Total Amount of the Federal Award;
(ix) Federal award project description, as required to be
responsive to the Federal Funding Accountability
and Transparency Act (FFATA);
(x) Name of Federal awarding agency, pass-through
entity, and contact information for awarding official,
(A) CFDA Number and Name; the pass-through entity
must identify the dollar amount made available
under each Federal award and the CFDA number at
time of disbursement;
(xii) Identification of whether the award is R&D; and
(xiii) Indirect cost rate for the Federal award (including if
the de minimis rate is charged per §200.414 Indirect
(F&A) costs).
Washington State Page 86
Health Care Authority
Jefferson County
184826790
SP020155
9/13/2018
9/30/18-9/29/23
$51177
$51177
$11,300,000 (9/30/18-9/29/23)
State Incentive Grant -Strategic Prevention
Framework — prevention services
SAMHSA
WA State Health Care Authority
Keri Waterland, Assistant Director DBHR
626 8th Ave SE; Olympia, WA 98504-5330
keri. waterlandO-hca, wa.gov
93.243
D
Yes ® No
de minimis (10%)
HCA Contract No. K3921
Federal Award Identification for Subrecipients (reference 2 CFR 200.331)
State Targeted Response (STR)
(i) Subrecipient name (which must match the name
Jefferson County
associated with its unique entity identifier);
184826790
(ii) Subrecipient's unique entity identifier; (DUNS)
(iii) Federal Award Identification Number (FAIN);
H79T1026803
4/14/2019
(iv) Federal Award Date (see §200.39 Federal award
date);
7/1/19 to 4/30/2020
(v) Subaward Period of Performance Start and End
Date;
(vi) Amount of Federal Funds Obligated by this action;
$0
(vii) Total Amount of Federal Funds Obligated to the
$0
subrecipient;
(xiii) Total Amount of the Federal Award;
$11,790,256
WA-STR addresses the Opiate Epidemic
(ix) Federal award project description, as required to be
responsive to the Federal Funding Accountability
and Transparency Act (FFATA);
(x) Name of Federal awarding agency, pass-through
SAMHSA
entity, and contact information for awarding official,
WA State Health Care Authority
Keri Waterland, Assistant Director
DBHR
626 8thAve SE; Olympia, WA 98504-5330
93.788
(A) CFDA Number and Name; the pass-through entity
must identify the dollar amount made available
under each Federal award and the CFDA number at
time of disbursement;
(xii) Identification of whether the award is R&D; and
❑ Yes ® No
de minimis (10%)
(xiii) Indirect cost rate for the Federal award (including if
the de minimis rate is charged per §200.414 Indirect
(F&A) costs).
Washington State Page 87 HCA Contract No. K3921
Health Care Authority
Federal Award Identification for Subrecipients (reference 2 CFR 200.331)
Substance Abuse Block Grant
(i) Subrecipient name (which must match the name
associated with its unique entity identifier);
(ii) Subrecipient's unique entity identifier; (DUNS)
Jefferson County
184826790
(iii) Federal Award Identification Number (FAIN); —I TM010056
(iv) Federal Award Date (see §200.39 Federal award
date);
(v) Subaward Period of Performance Start and End
Date;
(vi) Amount of Federal Funds Obligated by this action;
(vii) Total Amount of Federal Funds Obligated to the
subrecipient;
(xiii) Total Amount of the Federal Award;
(ix) Federal award project description, as required to be
responsive to the Federal Funding Accountability
and Transparency Act (FFATA);
(x) Name of Federal awarding agency, pass-through
entity, and contact information for awarding official,
(A) CFDA Number and Name; the pass-through entity
must identify the dollar amount made available
under each Federal award and the CFDA number at
time of disbursement;
(xii) Identification of whether the award is R&D; and
09/27/2018
7/1/19 to 6/30/21
$159410
$159410
FY17 $37,785,106
FY18 $38,053,643
Substance Abuse Prevention and
Treatment Block Grant
SAMHSA
WA State Health Care Authority
Keri Waterland, Assistant Director DBHR
626 8th Ave SE; Olympia, WA 98504-5330
Kers. waterl andahca. wa. gvy
93.959
❑ Yes ® No
(xiii) Indirect cost rate for the Federal award (including if 5%
the de minimis rate is charged per §200.414 Indirect
(F&A) costs).
Washington State Page 88 HCA Contract No. K3921
Health Care Authority
Federal Award Identification for Subrecipients (reference 2 CFR 200.331)
WA-SOR
(i) Subrecipient name (which must match the name
associated with its unique entity identifier);
(ii) Subrecipient's unique entity identifier; (DUNS)
(iii) Federal Award Identification Number (FAIN);
(iv) Federal Award Date (see §200.39 Federal award
date);
(v) Subaward Period of Performance Start and End
Date;
(vi) Amount of Federal Funds Obligated by this action;
(vii) Total Amount of Federal Funds Obligated to the
subrecipient;
(viii) Total Amount of the Federal Award;
(ix) Federal award project description, as required to be
responsive to the Federal Funding Accountability
and Transparency Act (FFATA);
Jefferson County
184826790
TI081705
9/19/18
7/1/19-9/29/20
$83418
$83418
$21,573,093
WA-SOR addresses the Opiate Epidemic
by increasing treatment and prevention
activities
(x) Name of Federal awarding agency, pass-through SAMHSA
entity, and contact information for awarding official, WA State Health Care Authority
Keri Waterland, Assistant Director DBHR
626 8th Ave SE; Olympia, WA 98504-5330
keri.waterland hca.wa. ov
(A) CFDA Number and Name; the pass-through entity
must identify the dollar amount made available
under each Federal award and the CFDA number at
time of disbursement;
(xii) Identification of whether the award is R&D; and
(xiii) Indirect cost rate for the Federal award (including if
the de minimis rate is charged per §200.414 Indirect
(F&A) costs).
93.788
us- �F13m
de minimis (10%)
Washington State Page 89 HCA Contract No. K3921
Health Care Authority
Federal Award Identification for Subrecipients (reference 2 CFR 200.331) — PFS 2013
(i) Subrecipient name (which must match the Jefferson County
name associated with its unique entity
identifier);
(ii) Subrecipient's unique entity identifier; (DUNS) 184826790
(iii) Federal Award Identification Number (FAIN);
(iv) Federal Award Date (see §200.39 Federal
award date);
(v) Subaward Period of Performance Start and
End Date;
(vi) Amount of Federal Funds Obligated by this
action;
(vii) Total Amount of Federal Funds Obligated to
the subrecipient;
(viii) Total Amount of the Federal Award;
SP020155
06/12/2015
7/1/19 — 9/29/29
$0
$0
$2,103,524 FY 17 (07/01/18 — 09/29/19)
(ix) Federal award project description, as required Washington State Strategic Prevention Framework
to be responsive to the Federal Funding Partnerships for Success Project
Accountability and Transparency Act (FFATA);
(x) Name of Federal awarding agency, pass-
through entity, and contact information for
awarding official,
(xi) CFDA Number and Name; the pass-through
entity must identify the dollar amount made
available under each Federal award and the
CFDA number at time of disbursement;
(xii) Identification of whether the award is R&D; and
(xiii) Indirect cost rate for the Federal award
(including if the de minimis rate is charged per
§200.414 Indirect (F&A) costs).
SAMSHA
Washington State DSHS
Chris Imhoff, Director
PO Box 45330
Olympia, WA 98504-5330
IMFIOFC@dshs.wa.gov
93.243
❑ Yes ® No
de minimis (10%)
Washington State Page 90 HCA Contract No. K3921
Health Care Authority
Exhibit C
Data Security Requirements
Definitions. The words and phrases listed below, as used in this Exhibit, shall each
have the following definitions:
a. "Authorized User(s)" means an individual or individuals with an authorized business
requirement to access HCA Confidential Information.
b. "Hardened Password" means a string of at least eight characters containing at least
one alphabetic character, at least one number and at least one special character
such as an asterisk, ampersand or exclamation point.
c. "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.
2. Data Transport. When transporting HCA Confidential Information electronically,
including via email, the Data will be protected by:
a. Transporting the Data within the (State Governmental Network) SGN or OPSI's
internal network, or;
b. Encrypting any Data that will be in transit outside the SGN or Contractor's
internal network. This includes transit over the public Internet.
3. Protection of Data. Contractor agrees to store Data on one or more of the following
media and protect the Data as described:
a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data
will be restricted to Authorized User(s) by requiring logon to the local workstation
using a Unique User ID and Hardened Password or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart
cards.
b. Network server disks. Data stored on hard disks mounted on network servers and
made available through shared folders. Access to the Data will be restricted to
Authorized Users through the use of access control lists which will grant access only
after the Authorized User has authenticated to the network using a Unique User ID
and Hardened Password or other authentication mechanisms which provide equal or
greater security, such as biometrics or smart cards. Data on disks mounted to such
servers must be located in an area which is accessible only to authorized personnel,
with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
For HCA Confidential Information stored on these disks, deleting unneeded Data is
sufficient as long as the disks remain in a Secured Area and otherwise meet the
requirements listed in the above paragraph. Destruction of the Data as outlined in
Section 5. Data Disposition may be deferred until the disks are retired, replaced, or
otherwise taken out of the Secured Area.
Washington State Page 91 HCA Contract No. K3921
Health Care Authority
Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided
by HCA on optical discs which will be used in local workstation optical disc drives
and which will not be transported out of a Secured Area. When not in use for the
contracted purpose, such discs must be locked in a drawer, cabinet or other
container to which only Authorized Users have the key, combination or mechanism
required to access the contents of the container. Workstations which access HCA
Data on optical discs must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key,
combination lock, or comparable mechanism.
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data
provided by HCA on optical discs which will be attached to network servers and
which will not be transported out of a Secured Area. Access to Data on these discs
will be restricted to Authorized Users through the use of access control lists which
will grant access only after the Authorized User has authenticated to the network
using a Unique User ID and Hardened Password or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data on discs attached to such servers must be located in an area which is
accessible only to authorized personnel, with access controlled through use of a key,
card key, combination lock, or comparable mechanism.
e. Paper documents. Any paper records must be protected by storing the records in a
Secured Area which is only accessible 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.
Remote Access. Access to and use of the Data over the State Governmental
Network (SGN) or Secure Access Washington (SAW) will be controlled by HCA staff
who will issue authentication credentials (e.g. a Unique User ID and Hardened
Password) to Authorized Users on Contractor staff. Contractor will notify HCA staff
immediately whenever an Authorized User in possession of such credentials is
terminated or otherwise leaves the employ of Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires
access to perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, HCA Data shall not be stored by
Contractor on portable devices or media unless specifically authorized within the
terms and conditions of the Contract. If so authorized, the Data shall be given
the following protections:
(a) Encrypt the Data with a key length of at least 128 bits
(b) Control access to devices with a Unique User ID and Hardened Password or
stronger authentication method such as a physical token or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to
lock automatically after a period of inactivity, if this feature is available.
Maximum period of inactivity is 20 minutes.
Washington State Page 92 HCA Contract No. K3921
Health Care Authority
Physically Secure the portable device(s) and/or media by
(d) Keeping them in locked storage when not in use
(e) Using check-in/check-out procedures when they are shared, and
(f) Taking frequent inventories
(2) When being transported outside of a Secured Area, portable devices and media
with HCA Confidential Information must be under the physical control of
Contractor staff with authorization to access the Data.
(3) Portable devices include, but are not limited to; smart phones, tablets, flash
memory devices (e.g. USB flash drives, personal media players), portable hard
disks, and laptop/notebook/netbook computers if those computers may be
transported outside of a Secured Area.
(4) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs),
magnetic media (e.g. floppy disks, tape), or flash media (e.g. CompactFlash, SD,
MMC).
h. Data stored for backup purposes.
(1) HCA data may be stored on portable media as part of Contractor's existing,
documented backup process for business continuity or disaster recovery
purposes. Such storage is authorized until such time as that media would be
reused during the course of normal backup operations. If backup media is retired
while HCA Confidential Information still exists upon it, such media will be
destroyed at that time in accordance with the disposition requirements in Section
5. Data Disposition
(2) HCA Data may be stored on non-portable media (e.g. Storage Area Network
drives, virtual media, etc.) as part of Contractor's existing, documented backup
process for business continuity or disaster recovery purposes. If so, such media
will be protected as otherwise described in this exhibit. If this media is retired
while HCA Confidential Information still exists upon it, the data will be destroyed
at that time in accordance with the disposition requirements in Section 5. Data
Disposition.
4. Data Segregation.
a. HCA Data must be segregated or otherwise distinguishable from non -HCA data.
This is to ensure that when no longer needed by Contractor, all HCA Data can be
identified for return or destruction. It also aids in determining whether HCA Data has
or may have been compromised in the event of a security breach. As such, one or
more of the following methods will be used for data segregation.
b. HCA Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will
contain no non -HCA data. And/or,
Washington State Page 93 HCA Contract No. K3921
Health Care Authority
c. HCA Data will be stored in a logical container on electronic media, such as a partition
or folder dedicated to HCA Data. And/or,
d. HCA Data will be stored in a database which will contain no non -HCA data. And/or,
e. HCA Data will be stored within a database and will be distinguishable from non -HCA
data by the value of a specific field or fields within database records.
f. When stored as physical paper documents, HCA Data will be physically segregated
from non -HCA data in a drawer, folder, or other container.
g. When it is not feasible or practical to segregate HCA Data from non -HCA data, then
both the HCA Data and the non -HCA data with which it is commingled must be
protected as described in this exhibit.
5. Data Disposition. When the contracted work has been completed or when no longer
needed, except as noted in Section 3. Protection of Data b. Network Server Disks
above, Data shall be returned to HCA or destroyed. Media on which Data may be stored
and associated acceptable methods of destruction are as follows:
Data stored on:
Server or workstation hard disks, or
Removable media (e.g. floppies, USB flash
drives, portable hard disks) excluding optical
discs
Paper documents with sensitive or
Confidential Information
Paper documents containing Confidential
Information requiring special handling (e.g.
protected health information
Optical discs (e.g. CDs or DVDs)
Will be destroyed by:
Using a "wipe" utility which will overwrite the
Data at least three (3) times using either
random or single character data, or
Degaussing sufficiently to ensure that the
Data cannot be reconstructed, or
Physically destroying the disk
Recycling through a contracted firm provided
the contract with the recycler assures that the
confidentiality of Data will be protected.
On-site shredding, pulping, or incineration
Incineration, shredding, or completely
defacing the readable surface with a coarse
abrasive
Magnetic tape Degaussing, incinerating or crosscut
shredding
6. Notification of Compromise or Potential Compromise. The compromise or potential
compromise of HCA shared Data must be reported to the HCA Contact designated in
the Contract within one (1) business day of discovery. If no HCA Contact is designated
in the Contract, then the notification must be reported to the HCA Privacy Officer at-
HCAprivacyoffcer(&HCA.wa.gov. Contactor must also take actions to mitigate the risk
of loss and comply with any notification or other requirements imposed by law or HCA.
Washington State Page 94 HCA Contract No. K3921
Health Care Authority
7. Data shared with Subcontractors. If HCA Data provided under this Contract is to be
shared with a subcontractor, the Contract with the subcontractor must include all of the
data security provisions within this Contract and within any amendments, attachments,
or exhibits within this Contract. If Contactor cannot protect the Data as articulated within
this Contract, then the contract with the sub -Contractor must be submitted to the HCA
Contact specified for this contract for review and approval.
Washington State Page 95 HCA Contract No. K3921
Health Care Authority
Exhibit D
AWARD AND REVENUES
2019-2021 Biennium
CONTRACTOR NAME: Jefferson County
CONTRACT NUMBER: K3921
COUNTY: Jefferson
COMMUNITY/COALITION: Chimacum Coalition
The above named Contractor is hereby awarded the following amounts Jar the purposes listed.
REVENUE
SOURCE CODE: TYPE OF SERVICE AWARD AMOUNTS
SFY20 SFY21 Total 19-21
Biennium
333.99.59 SABG Prevention (7.1.19-6.30.21) $79,705 $79,705 $159,410
334.04.6X GF -State- Admin (for SABG Prevention) $6,931 $6,931 $13,862
334.04.6X Dedicated Marijuana Account -Fund 315 -State $23,364 $23,364 $46,728
333.92.43
2018 PFS -Total
$
$
$
Year 1 FFY19 (7.1.19-9.29.19)
$
Year 2 FFY20 (9.30.19-9.29.20)
$
$
333.92.43
2013 PFS No Cost Extension (7.1.19-9.29.19)
$
$
$
333.37.88
SOR-Total
$
$
$
Year 1 FFY19 (7.1.19-9.29.19)
$
Year 2 FFY20 (9.30.19-9.29.20)
$
$
333.37.88
SOR Supplemental -Total
$
$
$
Year 1 FFY19 (7.1.19-9.29.19)
$
Year 2 FFY20 (9.30.19-9.29.20)
$
$
333.37.88
STR No Cost Extension -Total (8.15.19-4.30.20)
$
$
$
Total Federal Funds
$79,705
$79,705
$159,410
Total State Funds
TOTAL ALL AWARDS
$30,295
$30,295
$60,590
$220,000
$110,000
$110,000
Federal CFDA:
Substance Abuse Block Grant (SABG), CFDA 93.959, Substance Abuse and Mental Health Services Administration (SAMHSA)
Funding period(s): 7.1.19-6.30.21; Funds may be used in SFY 20 or 21 up to the total biennium award as indicated above.
General Fund State (GF -S), Admin (for SABG Prevention)
Funding period(s): 7.1.19-6.30.20 (SFY 20) and 7.1.2G-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above.
Dedicated Marijuana Account (DMA) Fund 315 State.
Funding period(s): 7.1.19-6.30.20 (SFY20) and 7.1.20-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above.
2018 Partnerships for Success (PFS), CFDA 93.243, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used only in the FFY in which they are awarded as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
2013 PFS, Partnerships for Success (PFS) No Cost Extension
Funding period 7.1.19-9.29.19; Funds must be used in this time period
State Opioid Response (SOR), CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
State Oploid Response (SOR) Supplemental, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
State Targeted Response (STR) to the Oploid Crisis No Cost Extension, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Funding period 8.15.19-4.30.20; Funds must be used in this time period.
AWARD AND REVENUES
2019-2021 Biennium
CONTRACTOR NAME: Jefferson County
CONTRACT NUMBER: K3921
COUNTY: Jefferson
COMMUNITY/COALITION: Port Townsend
The above named Contractor is hereby awarded the following amounts for the purposes listed.
REVENUE
SOURCE CODE:
TYPE OF SERVICE
AWARD AMOUNTS
333.99.59
334.04.6X
334.04.6X
SFY20
SFY21
Total 19-21
Biennium
SABG Prevention (7.1.19-6.30.21)
GF -State- Admin (for SABG Prevention)
$
$
$
$
$
$
$
Dedicated Marijuana Account -Fund 315 -State
$
$
333.92.43
2018 PFS -Total
$40,677
$10,500
$51,177
Year 1 FFY19 (7.1.19-9.29.19)
$9,327
Year 2 FFY20 (9.30.19-9.29.20)
$31,350
$10,500
333.92.43
2013 PFS No Cost Extension (7.1.19-9.29.19)
$
$
$
333.37.88
SOR-Total
$66,368
$17,050
$83,418
Year 1 FFY19 (7.1.19-9.29.19)
$15,218
Year 2 FFY20 (9.30.19-9.29.20)
$51,150
$17,050
333.37.88
SOR Supplemental -Total
$
$
$
Year 1 FFY19 (7.1.19-9.29.19)
$
Year 2 FFY20 (9.30.19-9.29.20)
$
$
333.37.88
STR No Cost Extension -Total (8.15.19-4.30.20)
$
$
$
Total Federal Funds
$107,045
$27,550
$134,595
Total State Funds
$0
$0
$0
TOTAL ALL AWARDS
$107,045
$27,550
$134,595
Federal CFDA:
Substance Abuse Block Grant (SABG), CFDA 93.959, Substance Abuse and Mental Health Services Administration (SAMHSA)
Funding period(s): 7.1.19-6.30.21; Funds may be used in SFY 20 or 21 up to the total biennium award as indicated above.
General Fund State (GF -S), Admin (for SABG Prevention)
Funding period(s): 7.1.19-6.30.20 (SFY 20) and 7.1.20-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above.
Dedicated Marijuana Account (DMA) Fund 315 State.
Funding period(s): 7.1.19-6.30.20 (SFY20) and 7.1.20-6.30.21 (SFY 21); Funds must be used only in the SFY in which they are awarded as indicated above.
2018 Partnerships for Success (PFS), CFDA 93.243, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used only in the FFY in which they are awarded as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
2013 PFS, Partnerships for Success (PFS) No Cost Extension
Funding period 7.1.19-9.29.19; Funds must be used in this time period
State Opioid Response (SOR), CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
State Opioid Response (SOR) Supplemental, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Year 1 funding period: 7.1.19-9.29.19; Year 2 funding period: 9.30.19-9.29.20; Funds must be used in the FFY in which they are awarded, as indicated above.
Beginning 9.30.19, funds in year 1 may be used in SFY 20 or SFY 21, until 9.29.20.
State Targeted Response (STR) to the Opioid Crisis No Cost Extension, CFDA 93.788, Substance Abuse and Mental Health Services Administration (SAMHSA)
Funding period 8.15.19-4.30.20; Funds must be used in this time period.