HomeMy WebLinkAboutWashington State Health Care Authority, Amendment No. 1 - 092319DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
WHEREAS, HCA and Contractor previously entered into a Contract for Opioid Treatment Networks, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to add funds, extend the
contract term, and add deliverables;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Section 3.2, Term: The term on the contract is extended from September 29, 2019 to September 29, 2020.
2. Section 3.3 Compensation: The maximum compensation is increased by $417,764 from $463,000 to
$880,764.
3. Section 3.3 Compensation, Subsection 3.3.2 is amended to read as follows:
3.3.2 Contractors compensation for services rendered will be based on the amounts listed in Schedules A
and B, Statements of Work, in the deliverable tables.
4. Section 3.4 Invoice and Payment, Subsection 3.4.1 is amended to read as follows:
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:
aniy.duraLi)hca.wa.Qov. Include the HCA Contract number in the subject line of the email and cc
the Contract Manager when submitting the invoice.
5. Schedule A, Statement of Work for December 31, 2018 to September 29, 2019 subsections 1.1, u, and v
are deleted in their entirety.
All remaining subsections are subsequently renumbered.
HCA Contract No. K3285-01 Page 1 of 10
HCA Contract No.: K3285
Washington State
CONTRACT
Amendment No.: 01
Health Care uthority
AMENDMENT
THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority
and the party whose name appears below, and is effective as of the date set forth below.
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Jefferson County
Sheriff's Office
CONTRACTOR ADDRESS
WASHINGTON UNIFORM BUSINESS IDENTIFIER
79 Elkins Rd.
(UBI)
Port Hadlock, WA 98339-9700
161- 6401- /69
WHEREAS, HCA and Contractor previously entered into a Contract for Opioid Treatment Networks, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to add funds, extend the
contract term, and add deliverables;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Section 3.2, Term: The term on the contract is extended from September 29, 2019 to September 29, 2020.
2. Section 3.3 Compensation: The maximum compensation is increased by $417,764 from $463,000 to
$880,764.
3. Section 3.3 Compensation, Subsection 3.3.2 is amended to read as follows:
3.3.2 Contractors compensation for services rendered will be based on the amounts listed in Schedules A
and B, Statements of Work, in the deliverable tables.
4. Section 3.4 Invoice and Payment, Subsection 3.4.1 is amended to read as follows:
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:
aniy.duraLi)hca.wa.Qov. Include the HCA Contract number in the subject line of the email and cc
the Contract Manager when submitting the invoice.
5. Schedule A, Statement of Work for December 31, 2018 to September 29, 2019 subsections 1.1, u, and v
are deleted in their entirety.
All remaining subsections are subsequently renumbered.
HCA Contract No. K3285-01 Page 1 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
6. Schedule A Statement of Work for December 31, 2018 to September 29, 2019, a new subsection v. is
added as follows:
l .v Assisting in the preparation of reports (e.g., SAMHSA Annual Report, SAMHSA Bi -annual
Report) and other data requested by SAMHSA, their designee, or the HCA Contract Manager
7. Schedule A, Statement of work for December 31, 2018 to September 29,2019, Section 2, Deliverables
table: Deliverable 5 is deleted, reducing the total Deliverables table to $450,000
8. Schedule A, Statement of work for December 31, 2018 to September 29,2019, Section 2, Federal Award
Identification table, line items (vi) and (vii) are amended as follows:
(vi) $450,000
(vii) $450,000
9. A new Schedule B, Statement of Work for September 30, 2019 through September 29, 2020 is added and
attached below.
10. This Amendment will be effective September 30, 2019 ("Effective Date").
11. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract.
12. All other terms and conditions of the Contract remain unchanged and in full force and effect.
The parties signing below warrant that they have read and understand this Amendment and have authority to
execute the Amendment. This Amendment will be binding on HCA only upon signature by HCA.
CONTRACTOR SIGNATURE
PRINTED NAME AND TITLE
DATE
SIGNED
HCA SIGNATURE
PRINTED NAME AND TITLE
DATE
SIGNED
DocuSignedby:
Kerry J. Breen
IbAl
Contracts Administrator
10/1/2019
BD077DDFC59444E...
Aps�pvedas
�!• ., Date: At�
Philip C. Hu sucker, Chief Civil Deputy Prosesec ting ttamey
Jefferson County Prosecuting Attorney's Office
HCA Contract No. K3285-01 Page 2 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
Schedule B
Statement of Work
September 30, 2019 to September 29, 2020
Performance Work Statement. The Contractor shall serve as the Initiation Site and be responsible for:
a. Bringing Medication Assisted Treatment (MAT) initiation, referral, and retention to an individual
prior to his or her transfer to the Local MAT Treatment Site, ensuring MAT induction goal is
maintained at both the Initiation and Local MAT Treatment Site(s).
b. Serving as the lead organization and recipient of funding for the development and implementation of
an Opioid Treatment Network (OTN) model for adults with an Opioid Use Disorder (OUD) who are
Medicaid eligible or low income. OTN will give priority to:
(1) Individuals at highest risk of overdose and death.
(2) Tribal members to address their OUD needs.
(3) MAT services for pregnant and parenting individuals with OUD.
(4) MAT services for IV drug users.
c. Continuing to monitor MAT is initiated to a minimum of 15 unique individuals no later than
September 29, 2020 at the Initiation Site.
d. Holding responsibility for oversight of the OTN, and ensuring the Local MAT Treatment Site(s) are
working in coordination (including participation in regularly scheduled leadership meetings and
educational and technical assistance opportunities) and meet the terms of the project, contract, goals
and project deliverables.
e. Ensuring travel per diem, computers, office supplies, and all other supplies and tools necessary to
perform defined duties are provided to staff at the Initiation Site and Local MAT Treatment Site(s)
(through Subcontractor's contracts).
f. Ensuring a low -barrier medication model.
g. Providing both agonist and antagonist MAT medications (on-site or in relationship with a pharmacy)
in order to facilitate initial inductions and ongoing treatment.
HCA Contract No. K3285-01 Page 3 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
h. Providing intensive services by continuing a central Initiation Site to provide MAT, and a warm hand-
off to continued care to a Local MAT Treatment Site(s) for continuity of care through the usage of a
coordinated network team and processes. Local MAT Treatment Site(s) will provide referrals for
other behavioral health and ancillary services necessary to address the individual's holistic medical
and recovery needs, including tobacco cessation services when appropriate. Build, strengthen, and
maintain referral relationships between Initiation Site and Local MAT Treatment Site(s).
i. Maintaining up to 2.0 FTEs to cover the required functions listed below at the Initiation Site
(individual staff may perform multiple functions. Subcontracting can be sued to provide staffing at
Local MAT Treatment Site(s). Specific staffing arrangements will be determined by Initiation Site.
(1) OTN Nurse Care Manager (NCM): The NCM's primary responsibilities are to provide medical
support to the prescribing physicians or other waivered practitioners. Duties of the NCM will
include, but are not limited to: individual screening, MAT education, assisting with MAT
inductions, taking vital signs, drug testing, lab work, medical assessments, charting, care planning,
stabilization, observation and maintenance, ongoing coordination of follow-up care, relapse
prevention, and support for an individual's self-management.
(2) OTN Care Navigator: The Care Navigator expedites enrollment into Medicaid as necessary,
conducts screenings, assessments and evaluations, provides education, and coordinates referrals for
MAT (and tobacco cessation services if appropriate). Care Navigators assist with data collection
requirements and facilitate referrals for infectious disease screenings, housing, employment
services, withdrawal management services, transportation, referral to OUD or behavioral health
counseling, and provide a warm hand-off to a MAT provider upon an individual's transfer from
any current treatments.
(3) OTN Data Collection Coordinator (Coordinator): The Coordinator is responsible for managing all
data collection activities and serves as the liaison between the OTN, HCA/DBHR and The
Department of Social and Health Services Research and Data Analysis Division (DSHS/RDA).
The Coordinator must become competent in all aspects of GPRA data collection required for this
project (including completion of SAMHSA GRPA training), through RDA offered trainings, and
be available and responsive to project evaluators.
(4) OTN MAT Prescriber: Continue to employ and or contract at least one prescriber and at least one
back-up prescriber with a current DATA -2000 Waiver (in case of primary prescriber absence) at
the Initiation Site.
HCA Contract No. K3285-01 Page 4 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
j. Ensuring specific tools, such as job descriptions and statements of work, are developed to ensure
consistent practice throughout the OTN.
k. Obtaining Tobacco Treatment Specialist (TTS) certification by 2 individual staff members completing
the 240 post -training service hours required for the certification.
Continuing to Identify, collaborate, and subcontract with Local MAT Treatment Site(s) that are willing
to support and embrace MAT and are responsible for providing integrated care that includes therapy,
SUD counseling, outreach, MAT education, case management, tobacco cessation services, and/or
referral services.
m. Ensuring policies and procedures are in place throughout the OTN to mitigate medication diversion.
DBHR has the discretion to review the policies and procedures upon request.
n. Securing and maintain release -of -information forms that meet federal confidentiality regulations and
allow the release of patient identifying information between Initiation Site and Local MAT Treatment
Site(s) and to DSHS RDA for the purpose of program monitoring and performance evaluation.
o. Working collaboratively with the University of Washington Alcohol and Drug Abuse Institute
Technical Assistance staff to identify training needs and participate in peer-to-peer and educational
learning opportunities including the utilization of EBPs.
p. Meeting, at a minimum, monthly (phone or in-person) with the HCA Contract Manager, SOR Project
Director, or Treatment Manager to discuss project contract requirements, compliance, technical
assistance needs, and problem -solving.
q. Ensuring the use of a certified electronic health record system, and review of the Prescription
Monitoring Drug Program data, when available and appropriate. DBHR may review this system upon
site visit(s).
r. Ensuring patient assessments utilized for MAT treatment services are consistent and transferable
across the Opioid Treatment Network (OTN).
HCA Contract No. K3285-01 Page 5 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
s. Data Collection Requirements shall include:
(1) Government Performance and Results Act (GPRA):
(a) OTNs are required to have staff collect data on all individuals receiving services at the
Initiation Site (and subsequent MAT services received). The data collection consists of
multiple individual interviews and a participant log. Initiation Sites are responsible for
ensuring data collection for individuals prior to and after warm hand-offs, including
coordination of data collection with Local MAT Treatment Site(s) staff.
(b) Participant interviews are based on the GPRA Client Outcome Measures Tool.' OTN staff will
conduct face-to-face interviews, compile answers, and enter the results into the web -based,
SAMHSA Performance Accountability and Reporting System (SPARS) or alternative data
collection system.' OTN staff must collect survey data at four points for each individual
served:
(c) Intake: GPRA Baseline interview is to be completed as soon as possible with every individual
who begins MAT at a facility in your network.
(d) Six-month follow-up: completed one month before to two months after the scheduled follow-
up date—regardless of individual discharge status. OTNs failing to complete 80 percent of
follow-up surveys must submit corrective action plans and demonstrate improved performance.
(e) Discharge: to be completed within 15 days for all individuals leaving treatment.
Administrative discharges (without interviews) are required for individuals lost to follow-up.
(f) SAMHSA's Performance Accountability and Reporting System (SPARS) accounts, online
training, and survey templates will be provided to OTNs (unless an alternative system is
identified); Project Evaluation (RDA) will provide OTN staff with technical assistance as
needed.
(g) GPRA Client Outcome Tool Implementation Delay: There will be a delay in implementation
of the GPRA tool. Sites will not be considered out of compliance during this delay period by
SAMHSA. RDA and SOR Treatment Manager will inform Initiation Sites of the required start
dates for GPRA data collection and training.
1 hWs:/iwww samhsa gov/sites/ lefaultlfiles/GPRA/sais acsra client outcome instrument final odf A shorter version of this instrument
will be used for this grant, however, it has not yet been finalized.
Z Your staff must enter surveys into SPARS within seven days. When the interview takes place, say, prior to or after induction, will depend
on the setting, individuals, and workflows.
HCA Contract No. K3285-01 Page 6 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
(2) DSHS Research and Data Analysis (DSHSRDA: Maintain and submit monthly through a secure
DSHS portal to RDA, a participant data log template (to be provided) from the Initiation Site only
that includes, but is not limited to the following for every new MAT treatment episode:
First name, last name and middle initial; date of birth; Social Security Number; gender; race;
ethnicity; treatment start date (induction date); MAT drug prescribed (methadone, Bup-mono,
Bup-combo, Naltrexone -Injectable; Naltrexone -Oral), transfers to Local MAT Provider, discharge
date and discharge status (completed, transferred or lost to follow up).
(3) HCA/DBHR: Submit a Monthly Report as detailed in the Deliverables Table with the invoice to
the HCA/DBHR Contract Manager, including, but not limited to: the number of individuals
inducted and successfully transferred to local MAT treatment, barriers and successes, technical
assistance needs and staff changes.
t. Promoting abstinence from tobacco products (except with regard to accepted tribal traditional
practices) and integrating tobacco cessation strategies, medications and services in coordination with
the Washington State Department of Health's (DOH's) Tobacco and Vapor Product Prevention and
Control Program (TVPPCP).
(1) Training of two (2) staff as Tobacco Treatment Specialists (TTS)s to incorporate tobacco cessation
as part of treatment (direct training costs will be covered by DOH, and the 240 service hours
required for TTS certification are eligible for partial reimbursement through this contract).
(2) General tobacco -free training of three (3) additional staff on the best practices of tobacco use
screening and cessation counseling with individuals in SUD treatment, including training on cross -
addiction, application of the Screening, Brief Intervention, and Referral to Treatment (SBIRT)
model of SUD treatment to the Ask, Advise, and Refer model of nicotine dependence treatment.
(3) Ongoing technical assistance from TVPPCP for tobacco cessation practices and implementation of
tobacco -free facility policies.
u. Participating in a pilot program in which patients are referred for tailored, augmented tobacco
cessation services through the Washington State Tobacco Quitline (WAQL). This pilot program will
include the following:
(1) Training of staff on WAQL referral and feedback reporting processes.
(2) Provision of augmented tobacco cessation services, including up to seven (7) telephone counseling
calls and 12 weeks of nicotine replacement therapy, annually, per individual.
(3) Reporting of patients' tobacco cessation progress.
HCA Contract No. K3285-01 Page 7 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
v. Assisting in the preparation of reports (e.g., SAMHSA Annual Report, SAMHSA Bi -annual Report)
and other data requested by SAMHSA, their designee, or the HCA Contract Manager.
w. Ensuring the utilization of third party and other revenue realized from provision of services to the
extent possible and use SAMHSA grant funds only for services to individuals who are not covered by
public or commercial health insurance programs, or for services that are not sufficiently covered by an
individual's health insurance plan. Facilitate the health insurance application and enrollment process
for eligible uninsured clients.
HCA Contract No. K3285-01 Page 8 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
2. Deliverables Table:
Deliverable
Due Date
Up to
1
Tobacco Treatment Specialist (TTS) 4 Day
October 31, 2019
$15 000 per staff up to a
Training — two (2) staff with achievement of
total of $30,000
certification. Show proof of achievement
certificate to HCA Contract Manager.
2
Tobacco Treatment Specialist (TTS) 1 Day
October 31, 2019
$11,382 per staff up to a
Training — two (2) staff with achievement of
total of $22,764
certification. Show proof of achievement
certificate to HCA Contract Manager.
3
Monthly Reports to HCA Contract Manager
Due by the second
$12,500 per month up to
including the items listed in l.s.(2) and (3) of this
Wednesday of the month
a total of $150,000
Schedule B Statement of Work as well as updates
following the month in
on progress, number of unique individuals served,
which services were
and Monthly Reports to RDA, compiled data of
provided
Local MAT Treatment Site referrals and services
including the breakdown of agonists and
antagonists ($12,500 per month x 12 months =
$150,000)
4
Tobacco Treatment Specialist (TTS) certification —
Payable in the month in
$13,000
This will partially reimburse OTN contractors for
which certification was
provider time spent counseling clients, after
received, not later than
completing the 240 post -training service hours
September 29, 2020.
required for the certification.
5
Provision of services to a minimum of 15 unique
Due by the second
Up to $15,000 per month
individuals per month, starting October 2019
Wednesday of the month
up to a total of up to
(I5,individuals per month x 12 months x $1,000=
following the month in
$180,000
$180,000)
which services were
(Payment will be prorated if minimum numbers
provided
are not met)
6
Benchmark payment for serving 180 unique
September 29, 2020
$20,000
individuals (an average of 15 unique individuals
per month) and meet an overall individual
retention of 50% over the period covered by this
Contract. Note: Ifthisbenchmark payment is
earned, Contractor shall also be entitled to bill, up
to the maximum amount that remains available
for payment under Deliverable 6, a pro rata
payment of $1,000 for each unique individual
whom Contractor has served but for whom
payment could not be received under the payment
terms applicable to Deliverable 5. In no event shall
more than a total of $200,000 be payable under
this Deliverable 6 combined with payment under
Deliverable 5.
7
Development of a written sustainability plan to
September 29, 2020
$15,000
ensure continued program services at the end of
SAMHSA funding presented at a site visit prior to
the end of the grant cycle.
TOTAL
$430,764
HCA Contract No. K3285-01 Page 9 of 10
DocuSign Envelope ID: 92DC3842-2524-40E9-B65C-941ABAA2F76B
3. Federal Award Identification (reference 2 CFR 200.331) — SOR Grant CFDA#93.788
(i)
Subrecipient name (which must match the name
Jefferson County DBA Sheriff's Office
associated with its unique entity identifier);
(ii)
Subrecipient's unique entity identifier; (DUNS)
619143741
(iii)
Federal Award Identification Number (FAIN);
H79TI081705
(iv)
Federal Award Date (see §200.39 Federal award
9/19/18
date);
(v)
Subaward Period of Performance Start and End Date;
12/31/2018 to 09/29/2019
(vi)
Amount of Federal Funds Obligated by this action;
$417,764
(vii)
Total Amount of Federal Funds Obligated to the
$880,764
subrecipient;
(viii) Total Amount of the Federal Award;
$21,573,093
(ix)
Federal award project description, as required to be
Washington State Opioid Response (SOR) Grant
responsive to the Federal Funding Accountability and
Transparency Act (FFATA);
(x)
Name of Federal awarding agency, pass-through
Department of Health and Human Services, Substance
entity, and contact information for awarding official,
Abuse and Mental Health Services Administration,
Center for Substance Abuse Treatment
Washington State Health Care Authority
Division of Behavioral Health and Recovery
Michael Langer, Director
Post Office Box 45330
Olympia, WA 98504-5330
(xi)
CFDA Number and Name; the pass-through entity
93.788
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
(xiii) Indirect cost rate for the Federal award (including if
de minimis (10%)
the de minimis rate is charged per §200.414 Indirect
(F&A) costs).
HCA Contract No. K3285-01 Page 10 of 10
Consent Agenda
Commissioners Office
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Leslie Locke, Executive Assistant
DATE: September 23, 2019
SUBJECT: Amendment No. 01 Professional Services Contract for Opiate Treatment
Networks; In the Amount of $417,764; Jefferson County; Washington
State Health Care Authority
STATEMENT OF ISSUE: The Jefferson County Sheriff requests the Board of County Commissioners to
approve Amendment No. 01 to Washington State Health Care Authority Contract No. K3285, a professional
services contract for an opiate treatment network in Jefferson County. Amendment No. 01 extends the
existing Agreement by one year to September 29, 2020, and provides up to $417,764 funding.
ANALYSIS: On January 14, 2019 the County approved an original agreement No. K3285 with the
Washington State Health Care Authority (HCA) to initiate Medication Assisted Treatment (MAT) services in
the Jail and provide for related treatment services for inmates after release through an opiate treatment
network in the community. The original term was through September 29, 2019.
The original HCA grant contract provided funding for the County to enter into a separate agreement with
Olympic Peninsula Health Services (OPHS) to initiate MAT in the Jefferson County Jail and establish an
Opiate Treatment Network in the community.
Jefferson County has been awarded an amendment to the HCA grant, extending funding for MAT services
for a full year, through September 29, 2020, and providing up to $417,764 of additional funding for services
during the extension.
If the Board of Commissioners approves Amendment No. 0l to the HCA contract, the Sheriff s Office is also
proposing a separate Amendment No. 1 to an agreement with OPHS which would extend OPHS's services
through September 29, 2020, and use the HCA funding to compensate OPHS.
FISCAL IMPACT: Amendment No. 01 to Washington State Health Care Authority Contract no. K3285
provides up to $417,764 of funding through September 29, 2020. That is slightly more than enough to pay
for the $414,264 amendment the Sheriff has proposed to our OPHS agreement..
RECOMMENDATION: The Commissioners are being asked to approve amendment No. 01 to Contract
no. K3285 with the Washington State Health Care Authority.
Hallem":- 'e�7 C111 -F /u
• fir'- Piliy, TC"inistratorDate
CONTRACT REVIEW FORM
CONTRACT WITH: WA State Health Care Authority
(Contractor/Consultant)
CONTRACT FOR: Opiate Treatment Network
COUNTY DEPARTMENT: Sheriffs Office
For More Information Contact: David Fortino
Contact Phone #: 360-344-9743
RETURN TO: Amanda Hamilton
(Person in Department)
AMOUNT:
RETURN BY:
Revenue $45 , 00 1-//7 7611
Expenditure
Matching funds Required
Source(s) of Matching Funds
TRACKING NO.: 07M - Z
PROCESS:
TERM: extend to 9/29/20
(Date)
❑ Exempt from Bid Process
❑ Consultant Selection Process
❑ Cooperative Purchase
❑ Competitive Sealed Bid
❑ Small Works Roster
❑ Vendor List Bid
❑ RFP or RFQ
0 Other
Step 1: REVIEW B�y:
ANA MEN
Revie
Date Rei e
PROVED FORM ❑ R&a1raod for revision (See Comments)
Co ' ents
Step 2: REVIEW BY PROSE NG ATTORNEY
Review by: • C`.Q7 Philip C. Hunsucker
Date Reviewed: Chief Civil Deputy Prosecuting Attorney
APPROVED AS TO FORM ❑ Re rned for revision (See Comments)
Comments * XAr k evil ka Ck -&,..
Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK
MANAGEMENT AND PROSECUTING ATTORNEY
Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF
ORIGINALS
Step 5: SUBMIT TO BOCC FOR APPROVAL
Submit original Contract(s), Agenda Request, and Contract Review form. Also, please send 2 copies of
just the Contract(s) (with the originals) to the BOCC Office. Place "Sign Here" markers on all places the
BOCC needs to sign.
MUST be in BOCC Office by 4:30 p.m. TUESDAY for the following Monday's agenda.
(This form to stay with contract throughout the contract review process.)
AL STATE CONTRACT
�,�,„�
µ�, tm statPROFESSIONAL
Hea f Care,'riW
SERVICES
CONTRACT for
HCA Contract Number: K3285
ResubV from Solicitation Number
KM
.lofferwo county
Opiate Treatnwt Networks
Contrac lorNenda Contract Number:
THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Jetfemon
County, (Contractor).
CONTRACTOR NAME
HCA DIVISIONISECTION
DBHRfSUD Treatmerrt
CONTRACTOR DOING BUSINESS AS (DBA)
.lofferwo county
Stephanie Endler, Medi Program Speck" 3
Sheriff's Office
MCA TURE
CONTRACTOR ADDRESS IStreet
1 TE NED
City
Stab
Zip Code
79 Elkins Road
stept>arnie.erxk*hca wa.gov
Pat Hadlock
' WA
98939-9700
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR E-MWL ADDRESS
Art Franck, Under" ff
360-344-9734
ei*W*Qco.jefferson.wa.us
Is Contractor a Subnx* bnt under this C,antucd?
CFDA NN4BEW
FFATA Form Required
®YES ONO
93.788
EYES []NO
HCA PROGRAM
Stats Opw d Response
HCA DIVISIONISECTION
DBHRfSUD Treatmerrt
HCJI CONTACT NAME AND TITLE
FICA CONTACT ADDRESS
Stephanie Endler, Medi Program Speck" 3
Health Care Au4twrfty
MCA TURE
450010e Avenue SE
1 TE NED
Lacey, WA 98503
FICA CONTACT TELEPHONE
HCA CONTACT E L ADDRESS
(380j 728.1996
stept>arnie.erxk*hca wa.gov
DATE
12/31/18 9129/2019 $463,000
PURPOSE OF CONTRACT
Providing quality and culturally competent replications of evidence -based and research -based substanoe use prevention
programs that loan on reducing the issue and abuse of opioids that would be provided by community-based
organizations or public agencies throughout the state of WasW&n.
The parties signing below warrant that they have read and understand this Contract, and have authority to
w ecute this Contract. This Contrad will be binding on HCA only upon signature by HCA.
TURE
PRINTED NARE AND TITLE
DATE SIGNED
MCA TURE
PRINTED NAME AND TITLE
1 TE NED
4# -AS,
Gayton, FICA CorXrads Administrator
t t ('
Rev M2=17
Washington State
9
PROFESSIONAL SERVICES
HCA Contract Number: K3285
Resulting from Solicitation Number
Health Carekukhoriit�
CONTRACT for
Opiate Treatment Networks
K3300
ContractorNendor Contract Number:
THIS CONTRACT is made by and between Washington State Health Care Authority, (HCA) and Jefferson
County, (Contractor).
CONTRACTOR NAME
CONTRACTOR DOING BUSINESS AS (DBA)
Jefferson County
Sheriff's Office
CONTRACTOR ADDRESS I Street
City
State
Zip Code
79 Elkins Road
Port Hadlock
WA
98339-9700
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR E-MAIL ADDRESS
Art Frank, Undersheriff
360-3449734
afrank@co.jefferson.wa.us
Is Contractor a Subrecipient under this Contract?
CFDA NUMBER(S):FFATA
Form Required
®YES []NO
93.788
®YES []NO
HCA PROGRAM
State Opioid Response
HCA DIVISION/SECTION
DBHR/SUD Treatment
HCA CONTACT NAME AND TITLE
HCA CONTACT ADDRESS
Stephanie Endler, Medical Program Specialist 3
Health Care Authority
HCA SIGkIATURE
450010"' Avenue SE
DATE SIGNED
Lacey, WA 98503
HCA CONTACT TELEPHONE
HCA CONTACT E-MAIL ADDRESS
(360) 725-1998
stephanie.endler@hca.wa.gov
CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT
12/31/18 9/29/2019 $4463,000
PURPOSE OF CONTRACT:
Providing quality and culturally competent replications of evidence -based and research -based substance use prevention
programs that focus on reducing the issue and abuse of opioids that would be provided by community-based
organizations or public agencies throughout the state of Washington.
The parties signing below warrant that they have read and understand this Contract, and have authority to
execute this Contract. This Contract will be binding on HCA only upon signature by HCA.
CONTRACTOR SI TURE
PRINTED NAME AND TITLE
DATE SIGNED
r� � -k',_
�L_L be4',,J1 C 6 t, ��
1/ 1 y
HCA SIGkIATURE
PRINTED NAME AND TITLE
DATE SIGNED
Jim Gayton, HCA Contracts Administrator
Rev 4!20/2017
TABLE OF CONTENTS
Recitals.............................................................................................................................................. 5
1. STATEMENT OF WORK (SOW).................................................................................................. 6
2. DEFINITIONS............................................................................................................................... 5
3. SPECIAL TERMS AND CONDITIONS.......................................................................................11
3.1
PERFORMANCE EXPECTATIONS..................................................................................
11
3.2
TERM.................................................................................................................................
12
3.3
COMPENSATION..............................................................................................................
12
3.4
INVOICE AND PAYMENT..................................................................................................
13
3.5
CONTRACTOR and HCA CONTRACT MANAGERS.........................................................
14
3.6
LEGAL NOTICES...............................................................................................................
15
3.7
SAMHSA Award Terms......................................................................................................
15
3.8
INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE ..........................
17
3.9
Business Associates Agreement........................................................................................
17
4. GENERAL TERMS AND CONDITIONS.....................................................................................18
4.15 FORCE MAJEURE.............................................................................................................
4.1 ACCESS TO DATA............................................................................................................
18
4.2 ADVANCE PAYMENT PROHIBITED.................................................................................
18
4.3 AMENDMENTS..................................................................................................................
18
4.4 ASSIGNMENT....................................................................................................................18
4.5 ATTORNEYS' FEES..........................................................................................................
18
4.6 CONFIDENTIAL INFORMATION PROTECTION...............................................................
19
4.7 CONFIDENTIAL INFORMATION SECURITY.....................................................................
19
4.8 CONFIDENTIAL INFORMATION BREACH - REQUIRED NOTIFICATION .......................
19
4.9 CONTRACTOR'S PROPRIETARY INFORMATION...........................................................
20
4.10 COVENANT AGAINST CONTINGENT FEES....................................................................
21
4.11 DEBARMENT.....................................................................................................................21
4.12 DISPUTES.........................................................................................................................
21
4.13 ENTIRE AGREEMENT.......................................................................................................
22
4.14 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA) ..................
22
4.15 FORCE MAJEURE.............................................................................................................
22
4.16 FUNDING WITHDRAWN, REDUCED OR LIMITED...........................................................
23
4.17 GOVERNING LAW.............................................................................................................
23
4.18 INDEMNIFICATION............................................................................................................
24
4.19 INDEPENDENT CAPACITY OF THE CONTRACTOR.......................................................
24
4.20 INDUSTRIAL INSURANCE COVERAGE...........................................................................
24
Washington State 2 Description of Services
Health Care Authority HCA Contract #K
4.21 LEGAL AND REGULATORY COMPLIANCE ...................................
4.22 LIMITATION OF AUTHORITY.........................................................
4.23 NO THIRD -PARTY BENEFICIARIES ..............................................
4.24 NONDISCRIMINATION...................................................................
4.25 OVERPAYMENTS TO CONTRACTOR ...........................................
4.26 PAY Equity ......................................................................................
4.27 PUBLICITY......................................................................................
4.28 RECORDS AND DOCUMENTS REVIEW .......................................
4.29 REMEDIES NON-EXCLUSIVE........................................................
4.30 RIGHT OF INSPECTION.................................................................
4.31 RIGHTS IN DATA/OWNERSHIP.....................................................
4.32 RIGHTS OF STATE AND FEDERAL GOVERNMENTS ..................
4.33 SEVERABILITY...............................................................................
4.34 SITE SECURITY.............................................................................
4.35 SUBCONTRACTING.......................................................................
4.36 SUBRECIPIENT..............................................................................
4.37 SURVIVAL.......................................................................................
4.38 TAXES............................................................................................
4.39 TERMINATION................................................................................
4.40 TERMINATION PROCEDURES......................................................
4.41 WAIVER..........................................................................................
4.42 WARRANTIES.................................................................................
Attachments
............................... 24
............................... 24
............................... 25
............................... 25
............................... 25
............................... 25
............................... 26
............................... 26
............................... 27
............................... 27
............................... 27
............................... 28
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............................... 28
............................... 29
............................... 29
............................... 31
............................... 31
............................... 31
............................... 33
............................... 34
............................... 34
Attachment 1: Confidential Information Security Requirements
Attachment 2: Federal Compliance, Certifications and Assurances
Attachment 3: Federal Funding Accountability and Transparency Act Data Collection
Form
Attachment 4: SAMHSA Center for Substance Abuse Treatment, 1 H79TI081705,
Washington State Opioid Response (SOR) Grant, Notice of Award (NOA).
Attachment 5: Business Associate Agreement
Washington State 3 Description of Services
Health Care Authority HCA Contract #K
Schedules
Schedule A: Statement of Work (SOW) SOR Opiate Treatment Networks
Exhibits
Exhibit A: HCA RFA #K3300 for SOR Opiate Treatment Networks
Exhibit B: Jefferson County Response to HCA RFA #K3300 for SOR Opiate
Treatment Networks
Note: Exhibits A and B are not attached but are available upon request from the HCA
Contracts Administrator.
Washington State 4 Description of Services
Health Care Authority HCA Contract #K
Contract #K3300 for Opiate Treatment Networks
Recitals
The state of Washington, acting by and through the Health Care Authority (HCA), issued a
Request for Applications (RFA) dated October 26, 2018 (Exhibit A) for the purpose to develop
Medication Assisted Treatment (MAT) OTNs, with the goal of reducing the morbidity and
mortality associated with Opioid Use Disorder (OUD) through an interagency, collaborative
statewide effort. The services are in accordance with its authority under chapters 39.26 and
41.05 Revised Code of Washington (RCW).
The Contractor submitted a timely Response to HCA's RFA #3300 (Exhibit B).
HCA evaluated all properly submitted Responses to the above -referenced RFA and has
identified Jefferson County as the Apparently Successful Bidder.
HCA has determined that entering into a Contract with Jefferson County will meet HCA's needs
and will be in the State's best interest.
NOW THEREFORE, HCA awards to Jefferson County this Contract, the terms and conditions of
which will govern Contractor's providing to HCA those services aimed at reducing the morbidity
and mortality associated with Opioid Use Disorder (OUD) through an interagency, collaborative
statewide effort in accordance with the State Opioid Response (SOR) federal grant.
IN CONSIDERATION of the mutual promises as set forth in this Contract, the parties agree as
follows:
1. STATEMENT OF WORK (SOW)
The Contractor will provide the services and staff as described in Schedule A: Statement of
Work.
2. DEFINITIONS
"Action Plan" means a document that the Contractor completed during the application
process and is included Exhibit B.
"Agonist" means an FDA -approved opioid agonist medication (e.g., methadone,
buprenorphine products including buprenorphine/naloxone combination formulations and
buprenorphine mono -product formulations) for the maintenance treatment of opioid use
disorder.
"Antagonist" means the FDA -approved opioid antagonist medication (e.g., naltrexone
products including extended-release and oral formulations) to prevent relapse to opioid use.
Washington State 5 Description of Services
Health Care Authority HCA Contract #K
"ADAI" means the University of Washington's Alcohol and Drug Abuse Institute, and its
employees and authorized agents.
"ASAM" means the American Society of Addiction Medicine.
"Application" means Contractor's Application to HCAs RFA #K3300 for Opiate Treatment
Network and is Exhibit B.
"Authorized Representative" means a person to whom signature authority has been
delegated in writing acting within the limits of his/her authority.
"Breach" means the unauthorized acquisition, access, use, or disclosure of Confidential
Information that compromises the security, confidentiality, or integrity of the Confidential
Information.
"Business Associate" means a Business Associate as defined in 45 Code of Federal
Regulations (CFR) 160.103, who performs or assists in the performance of an activity for or on
behalf of HCA, a Covered Entity, that involves the use or disclosure of protected health
information (PHI). Any reference to Business Associate in this DSA includes Business
Associate's employees, agents, officers, Subcontractors, third party contractors, volunteers, or
directors.
"Care Manager" means the nurse or other employee at the Initiation Site who is responsible
for providing medical support to the prescribing physician or other waivered prescribers. Duties
of the Care Manager include, but are not limited to patient screening, MAT education, assisting
with MAT inductions, taking vital signs, drug testing, lab work, medical assessments, charting,
care planning, stabilization, maintenance, ongoing coordination of follow-up care, relapse
prevention, support for patient self-management, and observation of the patient.
"Care Navigator" means the position responsible to provide support and work collaboratively
with the Care Manager. In addition, the Care Navigator will work closely and collaboratively
with staff at each Local MAT Treatment Site to coordinate patient care, keep the patient
engaged with services, address issues related to relapse, and communicate together on
patient needs. Duties will also include conducting screenings, scheduling appointments,
following up on missed appointments, medication diversion control, grant data recordkeeping
and reporting, and making referrals to the appropriate Local MAT Treatment Site. The Care
Navigator can be a licensed chemical dependency professional (CDP), behavioral healthcare
worker, social worker, primary healthcare worker, or other staff depending on the personnel
needs of the Initiation Site.
"Chemical Dependency Professional" or "CDP" means an individual certified in chemical
dependency counseling by the Washington State Department of Health professional licensing.
"CFR" means the Code of Federal Regulations. All references in this Contract to CFR
chapters or sections include any successor, amended, or replacement regulation. The CFR
may be accessed at http://www.ecfr.gov/cgi-bin/ECFR?r)age=browse.
Washington State 6 Description of Services
Health Cane Authority HCA Contract #K
"Confidential Information" means information that may be exempt from disclosure to the
public or other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other
state or federal statutes or regulations. Confidential Information includes, but is not limited to,
any information identifiable to an individual that relates to a natural person's health, (see also
Protected Health Information); finances, education, business, use or receipt of governmental
services, names, addresses, telephone numbers, social security numbers, driver license
numbers, financial profiles, credit card numbers, financial identifiers and any other identifying
numbers, law enforcement records, HCA source code or object code, or HCA or State security
information.
"Contract" means this Contract document and all schedules, exhibits, attachments,
incorporated documents and amendments.
"Contractor" means Jefferson County, its employees and agents. Contractor includes any
firm, provider, organization, individual or other entity performing services under this Contract. It
also includes any Subcontractor retained by Contractor as permitted under the terms of this
Contract.
"Covered entity" means a health plan, a health care clearinghouse or a health care provider
who transmits any health information in electronic form to carry out financial or administrative
activities related to health care, as defined in 45 CFR 160.103.
"CLAS" or national "Culturally and Linguistically Appropriate Services" means the
standards in health and health care intended to advance health equity, improve quality, and
help eliminate health disparities by establishing a blueprint for health and health care
organizations.
"Data" means information produced, furnished, acquired, or used by Contractor in meeting
requirements under this Contract.
"Data Coordinator" means the person responsible for managing all data collection activities
and also serves as the liaison between the OTN and the Project Evaluators (RDA). The
Coordinator must become competent in all aspects of GPRA data collection (intake, three-
month and six-month follow ups and discharge) required for this project (including completion
of SAMHSA GRPA training and project data collection systems) and be available and
responsive to Project Evaluators (RDA).
"DBHR" means the Division of Behavioral Health and Recovery or its successor.
"DUNS" or "Data Universal Numbering System" means a unique identifier for businesses.
DUNS numbers are assigned and maintained by Dun and Bradstreet (D&B) and are used for a
variety of purposes, including applying for government contracting opportunities.
"Effective Date" means the first date this Contract is in full force and effect. It may be a
specific date agreed to by the parties; or, if not so specified, the date of the last signature of a
party to this Contract.
Washington State 7 Description of Services
Health Care Authority HCA Contract #K
"Electronic Health Records or "EHR" means a certified electronic health record system that
has been tested and certified by an approved Office of National Coordinator for Health
Information Technology's (ONC) certifying body.
"Evidence -based Practice" or "EBP" means a prevention or treatment service or practice
that has been validated by some form of documented research evidence and is appropriate for
use with individuals with an opioid use disorder.
"FDA" means the U.S. Food and Drug Administration.
"GPRA" means Government Performance Results and Modernization Act. Grantees must
comply with the GPRA Modernization Act of 2010.
"HCA Contract Manager" means the individual identified on the cover page of this Contract
who will provide oversight of the Contractor's activities conducted under this Contract.
"Health Care Authority" or "HCA" means the Washington State Health Care Authority, any
division, section, office, unit or other entity of HCA, or any of the officers or other officials
lawfully representing HCA.
"Health Disparities" means `a particular type of health difference that is closely linked with
social, economic, and/or environmental disadvantage. Health disparities adversely affect
groups of people who have systematically experienced greater obstacles to health based on
their racial or ethnic group; religion; socioeconomic status; gender; age; mental health;
cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic
location; or other characteristics historically linked to discrimination or exclusion." (Healthy
People 2020).
"Health Equity" means the "attainment of the highest level of health for all people. Achieving
health equity requires valuing everyone equally with focused and ongoing societal efforts to
address avoidable inequalities, historical and contemporary injustices, and the elimination of
health and health care disparities." (Healthy People 2020).
"Induct" means the medically monitored initiation of treatment medication when a person with
an opioid use disorder has abstained from using opioids for the appropriate amount of time in
order to tolerate the utilization of MAT.
"Initiation Site Prescriber" or "Waivered Prescriber" means a physician, physician's
assistant (PA), or nurse practitioner (NP) that has obtained and maintained a current DATA
2000 Waiver to prescribe buprenorphine and other medications. A prescriber will also inform
individuals regarding the risks and benefits of MAT, allow for shared -decision making and
address other presenting medical needs either directly or by referral.
"Integrated Care" means the organized delivery and/or coordination of medical, behavioral or
social and recovery support services provided for individuals.
Washington State 8 Description of Services
Health Care Authority HCA Contract #K
"Local MAT Treatment Site" means a facility that will provide Opioid Use Disorder (OUD)
treatment medications, behavioral health treatment and/or primary healthcare services, and/or
wrap around services, and referrals. Local MAT Treatment Site may be a federally qualified
health center (FQHC), opioid treatment program, outpatient substance use disorder treatment
facility, mental health clinic, or integrated behavioral health clinic.
"Medication Assisted Treatment" or "MAT" means the use of FDA -approved opioid agonist
medications (e.g., methadone, buprenorphine products including buprenorphinetnaloxone
combination formulations and buprenorphine mono -product formulations) for the treatment of
opioid use disorder and the use of opioid antagonist medication (e.g. naltrexone products
including extended-release and oral formulations) to prevent relapse to opioid use.
"OTN" means an Opioid Treatment Network that includes an Initiation Site and Local MAT
Treatment Site(s).
"OUD" means Opioid Use Disorder as defined by a pattern of problematic use of opioids,
whether prescription painkillers, or heroin, or other illicit synthetic opioids. Practitioners use
criteria from the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM 5) to diagnose
opioid use disorder
"Overpayment" means any payment or benefit to the Contractor in excess of that to which the
Contractor is entitled by law, rule, or this Contract, including amounts in dispute.
"Prescriber/Administrator" means the position responsible for developing, administering, and
overseeing the program and ongoing performance of the OTN. Initiation Sites may use funding
to provide oversight and management to an administrator if more appropriate, depending on
the business needs of the OTN.
"Proprietary Information" means information owned by Contractor to which Contractor claims
a protectable interest under law. Proprietary Information includes, but is not limited to,
information protected by copyright, patent, trademark, or trade secret laws.
"Protected Health Information" or "PHI" means individually identifiable information that
relates to the provision of health care to an individual; the past, present, or future physical or
mental health or condition of an individual; or past, present, or future payment for provision of
health care to an individual, as defined in 45 CFR 160.103. Individually identifiable information
is information that identifies the individual or about which there is a reasonable basis to believe
it can be used to identify the individual, and includes demographic information. PHI is
information transmitted, maintained, or stored in any form or medium. 45 CFR 164.501. PHI
does not include education records covered by the Family Educational Rights and Privacy Act,
as amended, 20 United States Code (USC) 1232g(a)(4)(b)(iv).
"Report" or "Monthly Report" means and refers to a report that the Contractor will complete
and submit to DBHR on a monthly basis prior to monthly reimbursement.
Washington State 9 Description of Services
Health Care Authority HCA Contract #K
"RDA" means the Department of Social and Health Services, Research and Data Analysis
Division, to whom the Contractor will send required patient and program data through a secure
data file transfer.
"Response" means Contractor's Response to RCA's RFA #K3300 for SOR Opiate Treatment
Networks and is Exhibit B hereto.
"RCW" means the Revised Code of Washington. All references in this Contract to RCW
chapters or sections include any successor, amended, or replacement statute. Pertinent RCW
chapters can be accessed at: http://apps.leg.wa.-gov/rcw/.
"RFA" means the Request for Applications used as the solicitation document to establish this
Contract, including all its amendments and modifications and is attached as Exhibit A.
"SAMHSA" means the U.S. Department of Health and Human Services, Substance Abuse
and Mental Health Services Administration, and its employees and authorized agents.
"SPARS" means SAMHSA's Performance Accountability and Reporting System—SPARS is
an online data entry, reporting, technical assistance request, and training system to support
grantees in reporting timely and accurate data to SAMHSA. This system or an alternative
system, which will be defined later, will be required for GRPA reporting.
"Standard Reporting Tool" or "RDA -SRT" means a reporting tool provided by RDA to
routinely report on items required by SAMHSA that includes, but is not limited to: treatment
requirements, training requirements, and other services and outcomes to be determined.
"Statement of Work" or "SOW" means a detailed description of the work activities the
Contractor is required to perform under the terms and conditions of this Contract, including the
deliverables and timeline, and is Schedule A hereto.
"State Opioid Response" or "SOR" means the Federal Substance Abuse and Mental Health
Services Administration (SAMHSA) Grants Funding Opportunity TI -18-015 supporting
implementation of this state grant project. Anticipated start date 9/30/2018; length of project
period is up to two years. More information can be found at:
https://www.samhsa.gov/sites/defautVfiles/g ra nts/v&/sorfoafiinal.6.14.18. pdf.
"Subcontractor" means a person or entity that is not in the employment of the Contractor,
who is performing all or part of the business activities under this Contract under a separate
contract with Contractor. The term "Subcontractor' means subcontractor(s) of any tier.
"Subrecipient' means a contractor operating a federal or state assistance program receiving
federal funds and having the authority to determine both the services rendered and disposition
of program. See Office of Management and Budget (OMB) Super Circular 2 CFR 200.501 and
45 CFR 75.501, "Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for Federal Awards for additional detail.
Washington State 10 Description of Services
Health Care Authority NCA Contract #K
"SUD" means substance use disorder. Practitioners use criteria from the Diagnostic and
Statistical Manual of Mental Disorders 5 (DSM 5).
"Unique" means an individual who is counted once, regardless of the number of times he/she
enters treatment within the same Opioid Treatment Network.
"USC" means the United States Code. All references in this Contract to USC chapters or
sections shall include any successor, amended, or replacement statute. The USC may be
accessed at http://uscode.house.cov/
3. SPECIAL TERMS AND CONDITIONS
3.1 PERFORMANCE EXPECTATIONS EXPECTED PERFORMANCE UNDER THIS
CONTRACT INCLUDES, BUT IS NOT LIMITED TO, THE FOLLOWING:
3.1 .1 Knowledge of applicable state and federal laws and regulations pertaining to subject
of contract;
3.1.1.1 21 CFR Food and Drugs
Chapter 1, Subchapter C, Drugs: General
https://www.law.comell.edu/cfrttext/21 /chapter-1/subchapter-C
3.1.1.2 42 CFR Subchapter A -General Provisions Part 2 Confidentiality of
Alcohol and Drug Abuse Patient Records
https://www.law. comell.edu/cfrttext/45/part-96/subpart-L
3.1.1.3 Uniform Administrative Requirements, Cost Principles, and Audit
Requirements for HHS Awards 2 CFR Part 200 in 45 CFR Part 75
hftps:l/www.law.cornell.edu/cftttext/2/part-20
hftps://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;
Washington State 11 Description of Services
Health Care Authority HCA Contract #K
3.1.8 Regular, punctual attendance at all meetings; and
3.1.9 Provision of high quality services.
3.1.10 Prior to payment of invoices, HCA will review and evaluate the performance of
Contractor in accordance with Contract and these performance expectations and
may withhold payment if expectations are not met or Contractor's performance is
unsatisfactory.
3.2 TERM
3.2.1 The initial term of the Contract will commence on December 31, 2018, and continue
through September 29, 2019, unless terminated sooner as provided herein.
3.2.2 This Contract may be extended in whatever time increments HCA deems
appropriate. In addition, HCA reserves the sole right to extend the contract beyond
this date in accordance with the terms of RFA #K3300 (Exhibit A). No change in
terms and conditions will be permitted during these extensions unless specifically
agreed to in writing.
3.2.3 Work performed without a contract or amendment signed by the authorized
representatives of both parties will be at the sole risk of the Contractor. HCA will not
pay any costs incurred before a contract or any subsequent amendment(s) is fully
executed.
3.3 COMPENSATION
3.3.1 Compensation for the work provided in accordance with this Agreement has been
established under the terms of RCW 39.34.130. The Maximum Compensation
payable to Contractor for the performance of all things necessary for or incidental to
the performance of work as set forth in Schedule A: Statement of Work is
$463,000, and includes any allowable expenses.
3.3.2 Contractor's compensation for services rendered will be based on the amounts
listed in the Deliverables Table Schedule A: Statement of Work.
3.3.3 Federal funds disbursed through this Contract were received by HCA through OMB
Catalogue of Federal Domestic Assistance (CFDA) Number:
Washington State 12 Description of Services
Health Care Authority HCA Contract #K
3.3.3.1 93.788, SAMHSA Center for Substance Abuse Treatment,
1 H79TI081705, Washington State Opioid Response (SOR) Grant.
3.3.3.2 Contractor agrees to comply with applicable rules and regulations
associated with these federal funds and has signed Attachment 2: Federal
Compliance, Certification and Assurances, attached.
3.4 INVOICE AND PAYMENT
3.4.1 Contractor must submit accurate State Form A-19 invoices, or other such forms as
designated by HCA to the following address for all amounts to be paid by HCA via
e-mail to: AcctspayCD_hca.wa.gov. Include the HCA Contract number in the subject
line of the email and cc the Contract Manager when submitting the invoice.
3.4.2 Invoices must describe and document to HCA's satisfaction a description of the
work performed, the progress of the project, and fees. If expenses are invoiced,
invoices must provide a detailed breakdown of each type.
3.4.3 Contractor must submit property itemized invoices to include the following
information, as applicable:
3.4.3.1
HCA Contract number K3285;
3.4.3.2
Contractor name, address, phone number;
3.4.3.3
Description of Services;
3.4.3.4
Date(s) of delivery;
3.4.3.5
Net invoice price for each item;
3.4.3.6 Applicable taxes;
3.4.3.7 Total invoice price; and
3.4.3.8 Payment terms and any available prompt payment discount.
3.4.4 HCA will return incorrect or incomplete invoices to the Contractor for correction and
reissue. The Contract Number must appear on all invoices, bills of lading,
packages, and correspondence relating to this Contract.
3.4.5 1 n order to receive payment for services or products provided to a state agency,
Contractor must register with the Statewide Payee Desk at
http://des. wa.g ov/services/Contracbng Purchasi ng/Bus i nessNendo rPay/Pages/defa
ult.aspx.
3.4.6 Payment will be considered timely if made by HCA within thirty (30) calendar days
of receipt of property completed invoices. Payment will be directly deposited in the
bank account or sent to the address Contractor designated in its registration.
Washington State 13 Description of Services
Health Care Authority HCA Contract #K
3.4.7 Upon expiration of the Contract, any claims for payment for costs due and payable
under this Contract that are incurred prior to the expiration date must be submitted
by the Contractor to HCA within sixty (60) calendar days after the Contract
expiration date. HCA is under no obligation to pay any claims that are submitted
sixty-one (61) or more calendar days after the Contract expiration date ("Belated
Claims"). HCA will pay Belated Claims at its sole discretion, and any such potential
payment is contingent upon the availability of funds.
3.4.7.1 Submit final billing for services provided within forty-five (45) days after
the end of the State Fiscal Year.
3.4.7.2 Submit final billing for services for SOR within forty-five (45) days after the
end of each Federal Fiscal Year.
3.4.8 SOR funds may not be carried forward from year to year.
3.5 CONTRACTOR AND HCA CONTRACT MANAGERS
3.5.1 Contractor's Contract Manager will have prime responsibility and final authority for
the services provided under this Contract and be the principal point of contact for
the HCA Contract Manager for all business matters, performance matters, and
administrative activities.
3.5.2 HCA's Contract Manager, or designee is responsible for monitoring the Contractor's
performance and will be the contact person for all communications regarding
contract performance and deliverables. The HCA Contract Manager, or designee
has the authority to accept or reject the services provided and must approve
Contractor's invoices prior to payment.
3.5.3 The contact information provided below may be changed by written notice of the
change (email acceptable) to the other party.
CONTRACTOR
Contract Manager Information
Health Care Authority
Contract Manager Information
Name:
Art Frank
Name:
Stephanie Endler
Title:
Undersheriff
Title:
Medical Program Specialist 3
Address:
79 Elkins Road; Port Hadlock,
WA 98339-9700
Address:
Post Office Box 45330;
Olympia, WA 98504-5330
Phone:
360-344-9734
Phone:
360-725-1998
Email:
afrank@co.jefferson.wa.us
Email:
stephanie.endler@hca.wa.gov
Washington State 14 Description of Services
Health Care Authority HCA Contract #K
3.6 LEGAL NOTICES
Any notice or demand or other communication required or permitted to be given under this
Contract or applicable law is effective only if it is in writing and signed by the applicable
party, properly addressed, and delivered in person, via email, or by a recognized courier
service, or deposited with the United States Postal Service as first-class mail, postage
prepaid certified mail, return receipt requested, to the parties at the addresses provided in
this section.
3.6.1 In the case of notice to the Contractor:
Art Frank, Undersheriff
Jefferson County
79 Elkins Road
Port Hadlock, WA 98339-9700
3.6.2 In the case of notice to HCA:
Attention: Contracts Administrator
Health Care Authority
Division of Legal Services
Post Office Box 42702
Olympia, WA 985042702
3.6.3 Notices are effective upon receipt or four (4) Business Days after mailing, whichever
is earlier.
3.6.4 The notice address and information provided above may be changed by written
notice of the change given as provided above.
3.7 SAMHSA AWARD TERMS.
3.7.1 General. If the Contractor is a Subrecipient of federal awards under any Program
Agreement as defined by 2 CFR Part 200, the Contractor shall:
3.7.1.1 Comply with the all applicable provisions of the Notice of Awards for SOR
grants, Attachment 4. This includes any linked documents for Fiscal Year 2018 —
Award Standard Terms, if applicable.
3.7.1.2 Maintain records that identify, in its accounts, all federal awards received
and expended and the federal programs under which they were received, by
Catalog of Federal Domestic Assistance (CFDA) title and number, award number
and year, name of the federal agency, and name of the pass-through entity;
3.7.1.3 Maintain internal controls that provide reasonable assurance that the
Contractor is managing federal awards in compliance with laws, regulations, and
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provisions of contracts or grant agreements that could have a material effect on
each of its federal programs;
3.7.1.4 Comply with requirements of Charitable Choice (42 USC 300x-65 and 42
CFR Section 54);
3.7.1.4.1 The Contractor shall ensure that Charitable Choice Requirements of
42 CFR Part 54 are followed and that Faith -Based Organizations
(FBO) are provided opportunities to compete with traditional
alcohol/drug abuse prevention providers for funding.
3.7.1.4.2 If the Contractor subcontracts with FBOs, the Contractor shall require
the FBO to meet the requirements of 42 CFR Part 54 as follows:
3.7.1.4.3 . Applicants/recipients for/of services shall be provided with a choice of
prevention providers.
3.7.1.4.4 The FBO shall facilitate a referral to an alternative provider within a
reasonable time frame when requested by the recipient of services.
3.7.1.4.5 The FBO shall report to the Contractor all referrals made to alternative
providers.
3.7.1.4.6 The FBO shall provide recipients with a notice of their rights.
3.7.1.4.7 The FBO provides recipients with a summary of services that includes
any inherently religious activities. Prepare appropriate financial
statements, including a schedule of expenditures of federal awards;
3.7.1.5 Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
3.7.1.6 Incorporate 2 CFR Part 200, Subpart F audit requirements into all
agreements between the Contractor and its Subcontractors who are
Subrecipients;
3.7.1.7 Comply with the applicable requirements of 2 CFR Part 200, including
any future amendments to 2 CFR Part 200, and any successor or replacement
Office of Management and Budget (OMB) Circular or regulation; and
3.7.1.8 Comply with the Omnibus Crime Control and Safe Streets Act of 1968;
Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation Act of
1973; Title II of the Americans with Disabilities Act of 1990; Title IX of the
Education Amendments of 1972; The Age Discrimination Act of 1975; and The
Department of Justice Non -Discrimination Regulations at 28 CFR Part 42,
Subparts C, D, E, and G, and 28 CFR Parts 35 and 39. (Go to
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Health Care Authority HCA Contract #K
www.00p.usdoi.gov/ocr/ for additional information and access to the
aforementioned Federal laws and regulations.)
3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE
Each of the documents listed below is by this reference incorporated into this Contract. In
the event of an inconsistency, the inconsistency will be resolved in the following order of
precedence:
3.8.1 Applicable Federal and State of Washington statutes and regulations;
3.8.2 Business Associate Agreement, Attachment 5;
3.8.3 Recitals
3.8.4 Special Terms and Conditions;
3.8.5 General Terms and Conditions;
3.8.6 Attachment 1: Confidential Information Security Requirements;
3.8.7 Attachment 2: Federal Compliance, Certifications and Assurances;
3.8.8 Attachment 3: Federal Funding Accountability and Transparency Act Data
Collection Form;
3.8.9 Schedule A(s): Statement(s) of Work;
3.8. 10 Exhibit A: HCA RFA #K3300 for SOR Opiate Treatment Networks, dated 10/26/18;
3.8.11 Exhibit B: Contractor's Response dated November 20, 2018; and
3.8.12 Any other provision, term or material incorporated herein by reference or otherwise
incorporated.
3.9 BUSINESS ASSOCIATES AGREEMENT
Contractor agrees that it is a "Business Associate" of HCA as that term is defined in the
rules promulgated under the Health Insurance Portability and Accountability (HIPAA).
Contractor further agrees to comply with such rules and as further set forth in Attachment
5, Business Associate Agreement, of this Contract. If there is a conflict between the
provisions of Attachment 5 and provisions of this Agreement, then Attachment 5 controls.
If the other Contract is terminated, Attachment 5 nonetheless continues in effect.
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4. GENERAL TERMS AND CONDITIONS
4.1 ACCESS TO DATA
In compliance with RCW 39.26.180 (2) and federal rules, the Contractor must provide
access to any data generated under this Contract to HCA, the Joint Legislative Audit and
Review Committee, the State Auditor, and any other state or federal officials so authorized
by law, rule, regulation, or agreement at no additional cost. This includes access to all
information that supports the findings, conclusions, and recommendations of the
Contractor's reports, including computer models and methodology for those models.
4.2 ADVANCE PAYMENT PROHIBITED
No advance payment will be made for services furnished by the Contractor pursuant to
this Contract.
4.3 AMENDMENTS
This Contract may be amended by mutual agreement of the parties. Such amendments
will not be binding unless they are in writing and signed by personnel authorized to bind
each of the parties.
4.4 ASSIGNMENT
4.4.1 Contractor may not assign or transfer all or any portion of this Contract or any of its
rights hereunder, or delegate any of its duties hereunder, except delegations as set
forth in Section 4.35, Subcontracting, without the prior written consent of HCA. Any
permitted assignment will not operate to relieve Contractor of any of its duties and
obligations hereunder, nor will such assignment affect any remedies available to
HCA that may arise from any breach of the provisions of this Contract or warranties
made herein, including but not limited to, rights of setoff. Any attempted assignment,
transfer or delegation in contravention of this Subsection 4.4.1 of the Contract will
be null and void.
4.4.2 HCA may assign this Contract to any public agency, commission, board, or the like,
within the political boundaries of the State of Washington, with written notice of thirty
(30) calendar days to Contractor.
4.4.3 This Contract will inure to the benefit of and be binding on the parties hereto and
their permitted successors and assigns.
4.5 ATTORNEYS' FEES
In the event of litigation or other action brought to enforce the terms of this Contract,
each party agrees to bear its own attorneys' fees and costs.
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4.6 CONFIDENTIAL INFORMATION PROTECTION
4.6.1 Contractor acknowledges that some of the material and information that may come
into its possession or knowledge in connection with this Contract or its performance
may consist of Confidential Information. Contractor agrees to hold Confidential
Information in strictest confidence and not to make use of Confidential Information
for any purpose other than the performance of this Contract, to release it only to
authorized employees or Subcontractors requiring such information for the
purposes of carrying out this Contract, and not to release, divulge, publish, transfer,
sell, disclose, or otherwise make the information known to any other party without
HCA's express written consent or as provided by law. Contractor agrees to
implement physical, electronic, and managerial safeguards to prevent unauthorized
access to Confidential Information (See Attachment 1: Confidential Information
Security Requirements).
4.6.2 Contractors that come into contact with Protected Health Information may be
required to enter into a Business Associate Agreement with HCA in compliance with
the requirements of the Health Insurance Portability and Accountability Act of 1996,
Pub. L. 104-191, as modified by the American Recovery and Reinvestment Act of
2009 ("ARRA"), Sec. 13400 —13424, H. R. 1 (2009) (HITECH Act) (HIPAA).
4.6.3 HCA reserves the right to monitor, audit, or investigate the use of Confidential
Information collected, used, or acquired by Contractor through this Contract.
Violation of this section by Contractor or its Subcontractors may result in termination
of this Contract and demand for return of all Confidential Information, monetary
damages, or penalties.
4.6.4 The obligations set forth in this Section will survive completion, cancellation,
expiration, or termination of this Contract.
4.7 CONFIDENTIAL INFORMATION SECURITY
The federal government, including the Substance Abuse and Mental Health Services
Administration (SAMHSA), and the State of Washington all maintain security
requirements regarding privacy, data access, and other areas. Contractor is required
to comply with the Confidential Information Security Requirements set out in
Attachment 1 to this Contract and appropriate portions of the Washington OCIO
Security Standard, 141.10 (https://ocio.wa.gov/policies/141-securing-information-
technology-assets/14110-securing-information-technology-assets).
4.8 CONFIDENTIAL INFORMATION BREACH — REQUIRED NOTIFICATION
4.8.1 Contractor must notify the HCA Privacy Officer(HCAPrivacvOfficeri'c-hca.wa.gov)
within five Business Days of discovery of any Breach or suspected Breach of
Confidential Information.
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4.8.2 Contractor will take steps necessary to mitigate any known harmful effects of such
unauthorized access including, but not limited to, sanctioning employees and taking
steps necessary to stop further unauthorized access. Contractor agrees to
indemnify and hold HCA harmless for any damages related to unauthorized use or
disclosure of Confidential Information by Contractor, its officers, directors,
employees, Subcontractors or agents.
4.8.3 If notification of the Breach or possible Breach must (in the judgment of HCA) be
made under the HIPAA Breach Notification Rule, or RCW 42.56.590 or RCW
19.255.010, or other law or rule, then:
4.8.3.1 HCA may choose to make any required notifications to the individuals, to
the U.S. Department of Health and Human Services Secretary (DHHS)
Secretary, and to the media, or direct Contractor to make them or any of them.
4.8.3.2 In any case, Contractor will pay the reasonable costs of notification to
individuals, media, and governmental agencies and of other actions HCA
reasonably considers appropriate to protect HCA clients (such as paying for
regular credit watches in some cases).
4.8.3.3 Contractor will compensate HCA clients for harms caused to them by any
Breach or possible Breach.
4.8.4 Any breach of this clause may result in termination of the Contract and the demand
for return or disposition (Attachment 1, Section 6) of all Confidential Information.
4.8.5 Contractor's obligations regarding Breach notification survive the termination of this
Contract and continue for as long as Contractor maintains the Confidential
Information and for any breach or possible breach at any time.
4.9 CONTRACTOR'S PROPRIETARY INFORMATION
Contractor acknowledges that HCA is subject to chapter 42.56 RCW, the Public
Records Act, and that this Contract will be a public record as defined in chapter
42.56 RCW. Any speck 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.
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4.10 COVENANT AGAINST CONTINGENT FEES
Contractor warrants that no person or selling agent has been employed or retained
to solicit or secure this Contract upon an agreement or understanding for a
commission, percentage, brokerage or contingent fee, excepting bona fide
employees or bona fide established agents maintained by the Contractor for the
purpose of securing business. HCA will have the right, in the event of breach of this
clause by the Contractor, to annul this Contract without liability or, in its discretion, to
deduct from the contract price or consideration or recover by other means the full
amount of such commission, percentage, brokerage or contingent fee.
4.11 DEBARMENT
By signing this Contract, Contractor certifies that it is not presently debarred,
suspended, proposed for debarment, declared ineligible, or voluntarily excluded in
any Washington State or Federal department or agency from participating in
transactions (debarred). Contractor agrees to include the above requirement in any
and all subcontracts into which it enters, and also agrees that it will not employ
debarred individuals. Contractor must immediately notify HCA if, during the term of
this Contract, Contractor becomes debarred. HCA may immediately terminate this
Contract by providing Contractor written notice, if Contractor becomes debarred
during the term hereof.
4.12 DISPUTES
The parties will use their best, good faith efforts to cooperatively resolve disputes
and problems that arise in connection with this Contract. Both parties will continue
without delay to carry out their respective responsibilities under this Contract while
attempting to resolve any dispute. When a genuine dispute arises between HCA and
the Contractor regarding the terms of this Contract or the responsibilities imposed
herein and it cannot be resolved between the parties' Contract Managers, either
party may initiate the following dispute resolution process.
4.12.1 The initiating party will reduce its description of the dispute to writing and deliver it to
the responding party (email acceptable). The responding party will respond in
writing within five (5) Business Days (email acceptable). If the initiating party is not
satisfied with the response of the responding party, then the initiating party may
request that the HCA Director review the dispute. Any such request from the
initiating party must be submitted in writing to the HCA Director within five (5)
Business Days after receiving the response of the responding party. The HCA
Director will have sole discretion in determining the procedural manner in which he
or she will review the dispute. The HCA Director will inform the parties in writing
within five (5) Business Days of the procedural manner in which he or she will
review the dispute, including a timeframe in which he or she will issue a written
decision.
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4.12.2 A party's request for a dispute resolution must:
4.12.2.1 Be in writing;
4.12.2.2 Include a written description of the dispute;
4.12.2.3 State the relative positions of the parties and the remedy sought;
4.12.2.4 State the Contract Number and the names and contact information for the
parties;
4.12.3 This dispute resolution process constitutes the sole administrative remedy available
under this Contract. The parties agree that this resolution process will precede any
action in a judicial or quasi-judicial tribunal.
4.13 ENTIRE AGREEMENT
HCA and Contractor agree that the Contract is the complete and exclusive
statement of the agreement between the parties relating to the subject matter of the
Contract and supersedes all letters of intent or prior contracts, oral or written,
between the parties relating to the subject matter of the Contract, except as
provided in Section 4.42 Warranties.
4.14 FEDERAL FUNDING ACCOUNTABILITY & TRANSPARENCY ACT (FFATA)
4.14.1 This Contract is supported by federal funds that require compliance with the Federal
Funding Accountability and Transparency Act (FFATA or the Transparency Act).
The purpose of the Transparency Act is to make information available online so the
public can see how federal funds are spent.
4.14.2 To comply with the act and be eligible to enter into this Contract, Contractor must
have a Data Universal Numbering System (DUNS®) number. A DUNS® number
provides a method to verify data about your organization. if Contractor does not
already have one, a DUNS® number is available free of charge by contacting Dun
and Bradstreet at www.dnb.com.
4.14.3 Information about Contractor and this Contract will be made available on
www.uscontractorreQistration.com by HCA as required by P.L. 109-282. HCA's
Attachment 3: Federal Funding Accountability and Transparency Act Data .
Collection Form, is considered part of this Contract and must be completed and
returned along with the Contract.
4.15 FORCE MAJEURE
A party will not be liable for any failure of or delay in the performance of this Contract
for the period that such failure or delay is due to causes beyond its reasonable
control, including but not limited to acts of God, war, strikes or labor disputes,
embargoes, government orders or any other force majeure event.
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4.16 FUNDING WITHDRAWN, REDUCED OR LIMITED
If HCA determines in its sole discretion that the funds it relied upon to establish this
Contract have been withdrawn, reduced or limited, or if additional or modified
conditions are placed on such funding after the effective date of this contract but
prior to the normal completion of this Contract, then HCA, at its sole discretion, may:
4.16.1 Terminate this Contract pursuant to Section 4.39.3, Termination for Non Allocation
of Funds;
4.16.2 Renegotiate the Contract under the revised funding conditions; or
4.16.3 Suspend Contractor's performance under the Contract upon five (5) Business Days'
advance written notice to Contractor. HCA will use this option only when HCA
determines that there is reasonable likelihood that the funding insufficiency may be
resolved in a timeframe that would allow Contractor's performance to be resumed
prior to the normal completion date of this Contract.
4.16.3.1 During the period of suspension of performance, each party will inform
the other of any conditions that may reasonably affect the potential for
resumption of performance.
4.16.3.2 When HCA determines in its sole discretion that the funding insufficiency
is resolved, it will give Contractor written notice to resume performance. Upon the
receipt of this notice, Contractor will provide written notice to HCA informing HCA
whether it can resume performance and, if so, the date of resumption. For
purposes of this subsection, "written notice" may include email.
4.16.3.3 If the Contractor's proposed resumption date is not acceptable to HCA
and an acceptable date cannot be negotiated, HCA may terminate the contract
by giving written notice to Contractor. The parties agree that the Contract will be
terminated retroactive to the date of the notice of suspension. HCA will be liable
only for payment in accordance with the terms of this Contract for services
rendered prior to the retroactive date of termination.
4.17 GOVERNING LAW
This Contract is governed in all respects by the laws of the state of Washington,
without reference to conflict of law principles. The jurisdiction for any action
hereunder is exclusively in the Superior Court for the state of Washington, and the
venue of any action hereunder is in the Superior Court for Thurston County,
Washington. Nothing in this Contract will be construed as a waiver by HCA of the
State's immunity under the 11 m Amendment to the United States Constitution.
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4.18 INDEMNIFICATION
To the extent permitted by law, Contractor must defend, indemnify, and save HCA
harmless from and against all claims, including reasonable attorneys' fees resulting
from such claims, for any or all injuries to persons or damage to property, or Breach
of its confidentiality and notification obligations under Section 4.6 Confidential
Information Protection and Section 4.7 Confidentiality Breach -Required Notification,
arising from intentional or negligent acts or omissions of Contractor, its officers,
employees, or agents, or Subcontractors, their officers, employees, or agents, in the
performance of this Contract.
4.19 INDEPENDENT CAPACITY OF THE CONTRACTOR
The parties intend that an independent contractor relationship will be created by this
Contract. Contractor and its employees or agents performing under this Contract are
not employees or agents of HCA. Contractor will not hold itself out as or claim to be
an officer or employee of HCA or of the State of Washington by reason hereof, nor
will Contractor make any claim of right, privilege or benefit that would accrue to such
employee under law. Conduct and control of the work will be solely with Contractor.
4.20 INDUSTRIAL INSURANCE COVERAGE
Prior to performing work under this Contract, Contractor must provide or purchase
industrial insurance coverage for the Contractor's employees, as may be required of
an "employer" as defined in Title 51 RCW, and must maintain full compliance with
Title 51 RCW during the course of this Contract.
4.21 LEGAL AND REGULATORY COMPLIANCE
4.21.1 During the term of this Contract, Contractor must comply with all local, state, and
federal licensing, accreditation and registration requirements/standards, necessary
for the performance of this Contract and all other applicable federal, state and local
laws, rules, and regulations.
4.21.2 While on the HCA premises, Contractor must comply with HCA operations and
process standards and policies (e.g., ethics, Internet / email usage, data, network
and building security, -harassment, as applicable). HCA will make an electronic copy
of all such policies available to Contractor.
4.21.3 Failure to comply with any provisions of this section may result in Contract
termination.
4.22 LIMITATION OF AUTHORITY
Only the HCA Authorized Representative has the express, implied, or apparent
authority to alter, amend, modify, or waive any clause or condition of this Contract.
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Furthermore, any alteration, amendment, modification, or waiver or any clause or
condition of this Contract is not effective or binding unless made in writing and
signed by the HCA Authorized Representative.
4.23 NO THIRD -PARTY BENEFICIARIES
HCA and Contractor are the only parties to this contract. Nothing in this Contract
gives or is intended to give any benefit of this Contract to any third parties.
4.24 NONDISCRIMINATION
During the performance of this Contract, the Contractor must comply with all federal
and state nondiscrimination laws, regulations and policies, including but not limited
to: Title VII of the Civil Rights Act, 42 U.S.C. §12101 et seq.; the Americans with
Disabilities Act of 1990 (ADA), 42 U.S.C. §12101 et seq., 28 CFR Part 35; and Title
49.60 RCW, Washington Law Against Discrimination. In the event of Contractor's
noncompliance or refusal to comply with any nondiscrimination law, regulation or
policy, this Contract may be rescinded, canceled, or terminated in whole or in part
under the Termination for Default sections, and Contractor may be declared ineligible
for further contracts with HCA.
4.25 OVERPAYMENTS TO CONTRACTOR
In the event that overpayments or erroneous payments have been made to the
Contractor under this Contract, HCA will provide written notice to Contractor and
Contractor shall refund the full amount to HCA within thirty (30) calendar days of the
notice. If Contractor fails to make timely refund, HCA may charge Contractor one
percent (1 %) per month on the amount due, until paid in full. If the Contractor
disagrees with HCA's actions under this section, then it may invoke the dispute
resolution provisions of Section 4.12 Disputes.
4.26 PAY EQUITY
4.26.1 Contractor represents and warrants that, as required by Washington state law
(Laws of 2017, Chap. 1, § 147), during the term of this Contract, it agrees to
equality among its workers by ensuring similarly employed individuals are
compensated as equals. For purposes of this provision, employees are similarly
employed if (i) the individuals work for Contractor, (ii) the performance of the job
requires comparable skill, effort, and responsibility, and (iii) the jobs are performed
under similar working conditions. Job titles alone are not determinative of whether
employees are similarly employed.
4.26.2 Contractor may allow differentials in compensation for its workers based in good
faith on any of the following: (i) a seniority system; (ii) a merit system; (iii) a system
that measures earnings by quantity or quality of production; (iv) bona fide job-
related factor(s); or (v) a bona fide regional difference in compensation levels.
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4.26.3 Bona fide job-related factor(s)" may include, but not be limited to,
education, training, or experience, that is: (i) consistent with business necessity; (ii)
not based on or derived from a gender-based differential; and (iii) accounts for the
entire differential.
4.26.4 A "bona fide regional difference in compensation level" must be (i) consistent with
business necessity; (ii) not based on or derived from a gender-based differential;
and (iii) account for the entire differential.
4.26.5 Notwithstanding any provision to the contrary, upon breach of warranty and
Contractor's failure to provide satisfactory evidence of compliance within thirty (30)
Days of RCA's request for such evidence, HCA may suspend or terminate this
Contract.
4.27 PUBLICITY
4.27.1 The award of this Contract to Contractor is not in any way an endorsement of
Contractor or Contractor's Services by HCA and must not be so construed by
Contractor in any advertising or other publicity materials.
4.27.2 Contractor agrees to submit to HCA, all advertising, sales promotion, and other
publicity materials relating to this Contract or any Service furnished by Contractor in
which HCA's name is mentioned, language is used, or Internet links are provided
from which the connection of RCA's name with Contractor's Services may, in HCA's
judgment, be inferred or implied. Contractor further agrees not to publish or use
such advertising, marketing, sales promotion materials, publicity or the like through
print, voice, the Web, and other communication media in existence or hereinafter
developed without the express written consent of HCA prior to such use.
4.28 RECORDS AND DOCUMENTS REVIEW
4.28.1 The Contractor must maintain books, records, documents, magnetic media,
receipts, invoices or other evidence relating to this Contract and the performance of
the services rendered, along with accounting procedures and practices, all of which
sufficiently and properly reflect all direct and indirect costs of any nature expended
in the performance of this Contract. At no additional cost, these records, including
materials generated under this Contract, are subject at all reasonable times to
inspection, review, or audit by HCA, the Office of the State Auditor, and state and
federal officials so authorized by law, rule, regulation, or agreement [See 42 USC
1396a(a)(27)(B); 42 USC 1396a(a)(37)(B); 42 USC 1396a(a)(42(A); 42 CFR 431,
Subpart Q; and 42 CFR 447.202].
4.28.2 The Contractor must retain such records for a period of six (6) years after the date
of final payment under this Contract.
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4.28.3 If any litigation, claim or audit is started before the expiration of the six (6) year
period, the records must be retained until all litigation, claims, or audit findings
involving the records have been resolved.
4.29 REMEDIES NON-EXCLUSIVE
The remedies provided in this Contract are not exclusive, but are in addition to all
other remedies available under law.
4.30 RIGHT OF INSPECTION
The Contractor must provide right of access to its facilities to HCA, or any of its
officers, or to any other authorized agent or official of the state of Washington or the
federal government, at all reasonable times, in order to monitor and evaluate
performance, compliance, and/or quality assurance under this Contract.
4.31 RIGHTS IN DATA/OWNERSHIP
4.31.1 HCA and Contractor agree that all data and work products (collectively "Work
Product") produced pursuant to this Contract will be considered a work forhirie
under the U.S. Copyright Act, 17 U.S.C. §101 et seq, and will be owned by HCA.
Contractor is hereby commissioned to create the Work Product. Work Product
includes, but is not limited to, discoveries, formulae, ideas, improvements,
inventions, methods, models, processes, techniques, findings, conclusions,
recommendations, reports, designs, plans, diagrams, drawings, Software,
databases, documents, pamphlets, advertisements, books, magazines, surveys,
studies, computer programs, films, tapes, and/or sound reproductions, to the extent
provided by law. Ownership includes the right to copyright, patent, register and the
ability to transfer these rights and all information used to formulate such Work
Product.
4.31.2 If for any reason the Work Product would not be considered a work for hire under
applicable law, Contractor assigns and transfers to HCA, the entire right, title and
interest in and to all rights in the Work Product and any registrations and copyright
applications relating thereto and any renewals and extensions thereof.
4.31.3 Contractor will execute all documents and perform such other proper acts as HCA .
may deem necessary to secure for HCA the rights pursuant to this section.
4.31.4 Contractor will not use or in any manner disseminate any Work Product to any third
party, or represent in any way Contractor ownership of any Work Product, without
the prior written permission of HCA. Contractor shall take all reasonable steps
necessary to ensure that its agents, employees, or Subcontractors will not copy or
disclose, transmit or perform any Work Product or any portion thereof, in any form,
to any third party.
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4.31.5 Material that is delivered under this Contract, but that does not originate therefrom
("Preexisting Material"), must be transferred to HCA with a nonexclusive, royalty -
free, irrevocable license to publish, translate, reproduce, deliver, perform, display,
and dispose of such Preexisting Material, and to authorize others to do so.
Contractor agrees to obtain, at its own expense, express written consent of the
copyright holder for the inclusion of Preexisting Material. HCA will have the right to
modify or remove any restrictive markings placed upon the Preexisting Material by
Contractor.
4.31.6 Contractor must identify all Preexisting Material when it is delivered under this
Contract and must advise HCA of any and all known or potential infringements of
publicity, privacy or of intellectual property affecting any Preexisting Material at the
time of delivery of such Preexisting Material. Contractor must provide HCA with
prompt written notice of each notice or claim of copyright infringement or
infringement of other intellectual property right worldwide received by Contractor
with respect to any Preexisting Material delivered under this Contract.
4.32 RIGHTS OF STATE AND FEDERAL GOVERNMENTS
In accordance with 45 C.F.R. 95.617, all appropriate state and federal agencies,
including but not limited to the Centers for Medicare and Medicaid Services
(CMS), will have a royalty -free, nonexclusive, and irrevocable license to
reproduce, publish, translate, or otherwise use, and to authorize others to use for
Federal Government purposes: (i) software, modifications, and documentation
designed, developed or installed with Federal Financial Participation (FFP) under
45 CFR Part 95, subpart F; (ii) the Custom Software and modifications of the
Custom Software, and associated Documentation designed, developed, or
installed with FFP under this Contract; (iii) the copyright in any work developed
under this Contract; and (iv) any rights of copyright to which Contractor
purchases ownership under this Contract.
4.33 SEVERABILITY
If any provision of this Contract or the application thereof to any person(s) or
circumstances is held invalid, such invalidity will not affect the other provisions or
applications of this Contract that can be given effect without the invalid provision, and
to this end the provisions or application of this Contract are declared severable.
4.34 SITE SECURITY
While on HCA premises, Contractor, its agents, employees, or Subcontractors must
conform in all respects with physical, fire or other security policies or regulations.
Failure to comply with these regulations may be grounds for revoking or suspending
security access to these facilities. HCA reserves the right and authority to
immediately revoke security access to Contractor staff for any real or threatened
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Health Care Authority HCA Contract #K
breach of this provision. Upon reassignment or termination of any Contractor staff,
Contractor agrees to promptly notify HCA.
4.35 SUBCONTRACTING
4.35.1 Neither Contractor, nor any Subcontractors, may enter into subcontracts for any of
the work contemplated under this Contract without prior written approval of HCA.
HCA has sole discretion to determine whether or not to approve any such
subcontract. In no event will the existence of the subcontract operate to release or
reduce the liability of Contractor to HCA for any breach in the performance of
Contractor's duties.
4.35.2 Any agreement between Contractor and.a Subcontractor shall include the terms
and conditions that meet or exceed all requirements and conditions in this Contract
that the Contractor is required to meet when providing services to patients, clients,
or persons seeking assistance, including but not limited to: (a) identification of
funding sources; (b) DUNS number and zip code +4 of subcontractor; (c)
determination of eligible clients; (d) payment or reimbursement arrangement; (e)
termination of a subcontract shall be grounds for a fair hearing for the service
applicant or a grievance for the recipient if similar services are immediately
available in the County; (f) informing service applications and recipients of their right
to a grievance in the case of a denial or termination of service and/or failure to act
upon a request for services with reasonable promptness; (g) audit requirements in
compliance with OMB 2, Part 200, Subpart F (A-133); (h) authorizing Contractor to
conduct an inspection of any and all subcontractor facilities where services are
provided; (i) requiring Subcontractor to perform background checks on its
employees and independent contractors used to perform the services; Q)
representation and warranty that Subcontractor is not has not been debarred or
suspended by any state or the federal government; (k) Business Associate
Agreement in compliance with the requirements of HIPAA; (1) protection of the
Confidential Information and restrictions on the providing and sharing of data; and
(m) identifying unallowable uses of federal funds.
4.35.3 If at any time during the progress of the work HCA determines in its sole judgment
that any Subcontractor is incompetent or undesirable, HCA will notify Contractor,
and Contractor must take immediate steps to terminate the Subcontractor's
involvement in the work.
4.35.4 The rejection or approval by the HCA of any Subcontractor or the termination of a
Subcontractor will not relieve Contractor of any of its responsibilities under the
Contract, nor be the basis for additional charges to HCA.
4.36 SUBRECIPIENT
4.36.1 General
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Health Care Authority HCA Contract #K
If the Contractor is a Subrecipient (as defined in 45 CFR 75.2 and 2 CFR 200.93)
of federal awards, then the Contractor, in accordance with 2 CFR 200.501 and 45
CFR 75.501, shall:
4.36.1.1 Maintain records that identify, in its accounts, all federal awards received
and expended and the federal programs under which they were received, by
Catalog of Federal Domestic Assistance (CFDA) title and number, award number
and year, name of the federal agency, and name of the pass-through entity;
4.36.1.2 Maintain internal controls that provide reasonable assurance that the
Contractor is managing federal awards in compliance with laws, regulations, and
provisions of contracts or grant agreements that could have a material effect on
each of its federal programs;
4.36.1.3 Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
4.36.1.4 Incorporate OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501
audit requirements into all agreements between the Contractor and its
Subcontractors who are Subrecipients;
4.36.1.5 Comply with any future amendments to OMB Super Circular 2 CFR
200.501 and 45 CFR 75.501 and any successor or replacement Circular or
regulation;
4.36.1.6 Comply with the applicable requirements of OMB Super Circular 2 CFR
200.501 and 45 CFR 75.501and any future amendments to OMB Super Circular
2 CFR 200.501 and 45 CFR 75.501, and any successor or replacement Circular
or regulation; and
4.36.1.7 Comply with the Omnibus Crime Control and Safe streets Act of 1968,
Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of
1973, Title 11 of the Americans with Disabilities Act of 1990, Title IX of the
Education Amendments of 1972, The Age Discrimination Act of 1975, and The
Department of Justice Non -Discrimination Regulations, 28 C.F.R. Part 42,
Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to
http://oip.gov/abouttoffiaWocr.htm for additional information and access to the
aforementioned Federal laws and regulations.)
4.36.2 Single Audit Act Compliance
If the Contractor is a Subrecipient and expends $750,000 or more in federal
awards from any and/or all sources in any fiscal year, the Contractor shall procure
and pay for a single audit or a program -specific audit for that fiscal year. Upon
completion of each audit, the Contractor shall:
4.36.2.1 Submit to the Authority contact person the data collection form and
reporting package specified in OMB Super Circular 2 CFR 200.501 and 45 CFR
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Health Care Authority HCA Contract #K
75.501, reports required by the program -specific audit guide (if applicable), and a
copy of any management letters issued by the auditor;
4.36.2.2 Follow-up and develop corrective action for all audit findings; in
accordance with OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501,
prepare a "Summary Schedule of Prior Audit Findings."
4.36.3 Overpayments
4.36.3.1 If it is determined by HCA, or during the course of a required audit, that
Contractor has been paid unallowable costs under this or any Program
Agreement, Contractor shall refund the full amount to HCA as provided in
Section 4.25 Overpayments to Contractors.
4.37 SURVIVAL
4.38 TAXES
The terms and conditions contained in this Contract that, by their sense and
context, are intended to survive the completion, cancellation, termination, or
expiration of the Contract will survive. In addition, the terms of the sections titled
Confidential Information Protection, Confidential Information Breach — Required
Notification, Contractor's Proprietary Information, Disputes, Overpayments to
Contractor, Publicity, Records and Documents Review, Rights in Data/Ownership,
and Rights of State and Federal Governments, and Business Associate
Agreement (BAA) will survive the termination of this Contract. The right of HCA to
recover any overpayments will also survive the termination of this Contract.
HCA will pay sales or use taxes, if any, imposed on the services acquired
hereunder. Contractor must pay all other taxes including, but not limited to,
Washington Business and Occupation Tax, other taxes based on Contractor's
income or gross receipts, or personal property taxes levied or assessed on
Contractor's personal property. HCA, as an agency of Washington State
government, is exempt from property tax.
Contractor must complete registration with the Washington State Department of
Revenue and be responsible for payment of all taxes due on payments made
under this Contract.
4.39 TERMINATION
4.39.1 TERMINATION FOR DEFAULT
In the event HCA determines that Contractor has failed to comply with the terms
and conditions of this Contract, HCA has the right to suspend or terminate this
Contract. HCA will notify Contractor in writing of the need to take corrective action.
If corrective action is not taken within five (5) Business Days, or other time period
Washington State 31 Description of Services
Health Care Authority HCA Contract #K
agreed to in writing by both parties, the Contract may be terminated. HCA reserves
the right to suspend all or part of the Contract, withhold further payments, or
prohibit Contractor from incurring additional obligations of funds during
investigation of the alleged compliance breach and pending corrective action by
Contractor or a decision by HCA to terminate the Contract.
In the event of termination for default, Contractor will be liable for damages as
authorized by law including, but not limited to, any cost difference between the
original Contract and the replacement or cover Contract and all administrative
costs directly related to the replacement Contract, e.g., cost of the competitive
bidding, mailing, advertising, and staff time.
If it is determined that Contractor. (i) was not in default, or (ii) its failure to perform
was outside of its control, fault or negligence, the termination will be deemed a
"Termination for Convenience."
4.39.2 TERMINATION FOR CONVENIENCE
When, at RCA's sole discretion, it is in the best interest of the State, HCA may
terminate this Contract in whole or in part by providing ten (10) calendar days'
written notice. If this Contract is so terminated, HCA will be liable only for payment
in accordance with the terms of this Contract for services rendered prior to the
effective date of termination. No penalty will accrue to HCA in the event the
termination option in this section is exercised.
4.39.3 TERMINATION FOR NONALLOCATION OF FUNDS
If funds are not allocated to continue this Contract in any future period, HCA may
immediately terminate this Contract by providing written notice to the Contractor.
The termination will be effective on the date specified in the termination notice.
HCA will be liable only for payment in accordance with the terms of this Contract
for services rendered prior to the effective date of termination. HCA agrees to
notify Contractor of such nonallocation at the earliest possible time. No penalty will
accrue to HCA in the event the termination option in this section is exercised.
4.39.4 TERMINATION FOR WITHDRAWAL OF AUTHORITY
In the event that the authority of HCA to perform any of its duties is withdrawn,
reduced, or limited in any way after the commencement of this Contract and prior
to normal completion, HCA may immediately terminate this Contract by providing
written notice to the Contractor. The termination will be effective on the date
specked in the termination notice. HCA will be liable only for payment in
accordance with the terms of this Contract for services rendered prior to the
effective date of termination. HCA agrees to notify Contractor of such withdrawal of
authority at the earliest possible time. No penalty will accrue to HCA in the event
the termination option in this section is exercised.
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Health Care Authority HCA Contract #K
4.39.5 TERMINATION FOR CONFLICT OF INTEREST
HCA may terminate this Contract by written notice to the Contractor if HCA
determines, after due notice and examination, that there is a violation of the Ethics
in Public Service Act, Chapter 42.52 RCW, or any other laws regarding ethics in
public acquisitions and procurement and performance of contracts. In the event
this Contract is so terminated, HCA will be entitled to pursue the same remedies
against the Contractor as it could pursue in the event Contractor breaches the
contract.
4.40 TERMINATION PROCEDURES
4.40.1 Upon termination of this Contract, HCA, in addition to any other rights provided in
this Contract, may require Contractor to deliver to HCA any property specifically
produced or acquired for the performance of such part of this Contract as has been
terminated.
4.40.2 HCA will pay Contractor the agreed-upon price, if separately stated, for completed
work and services accepted by HCA and the amount agreed upon by the Contractor
and HCA for (i) completed work and services for which no separate price is stated;
(ii) partially completed work and services; (iii) other property or services that are
accepted by HCA; and (iv) the protection and preservation of property, unless the
termination is for default, in which case HCA will determine the extent of the liability.
Failure to agree with such determination will be a dispute within the meaning of
Section 4.12 Disputes. HCA may withhold from any amounts due the Contractor
such sum as HCA determines to be necessary to protect HCA against potential loss
or liability.
4.40.3 After receipt of notice of termination, and except as otherwise directed by HCA,
Contractor must:
4.40.3.1 Stop work under the Contract on the date of, and to the extent specified
in, the notice;
4.40.3.2 Place no further orders or subcontracts for materials, services, or facilities
except as may be necessary for completion of such portion of the work under the
Contract that is not terminated;
4.40.3.3 Assign to HCA, in the manner, at the times, and to the extent directed by
HCA, all the rights, title, and interest of the Contractor under the orders and
subcontracts so terminated; in which case HCA has the right, at its discretion, to
settle or pay any or all claims arising out of the termination of such orders and
subcontracts;
4.40.3.4 Settle all outstanding liabilities and all claims arising out of such
termination of orders and subcontracts, with the approval or ratification of HCA to
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Health Care Authority HCA Contract #K
the extent HCA may require, which approval or ratification will be final for all the
purposes of this clause;
4.40.3.5 Transfer title to and deliver as directed by HCA any property required to
be furnished to HCA;
4.40.3.6 Complete performance of any part of the work that was not terminated by
HCA; and
4.40.3.7 Take such action as may be necessary, or as HCA may direct, for the
protection and preservation of the records related to this Contract that are in the
possession of the Contractor and in which HCA has or may acquire an interest.
4.41 WAIVER
Waiver of any breach of any term or condition of this Contract will not be deemed
a waiver of any prior or subsequent breach or default. No term or condition of this
Contract will be held to be waived, modified, or deleted except by a written
instrument signed by the parties. Only the HCA Authorized Representative has
the authority to waive any term or condition of this Contract on behalf of HCA.
4.42 WARRANTIES
4.42,1 Contractor represents and warrants that it will perform all services pursuant to this
Contract in a professional manner and with high quality and will immediately re-
perform any services that are not in compliance with this representation and
warranty at no cost to HCA.
4.42.2 Contractor represents and warrants that it shall comply with all applicable local,
State, and federal licensing, accreditation and registration requirements and
standards necessary in the performance of the Services.
4.42.3 Any written commitment by Contractor within the scope of this Contract will be
binding upon Contractor. Failure of Contractor to fulfill such a commitment may
constitute breach and will render Contractor liable for damages under the terms of
this Contract. For purposes of this section, a commitment by Contractor includes:
(i) Prices, discounts, and options committed to remain in force over a specked
period of time; and (ii) any warranty or representation made by Contractor to HCA
or contained in any Contractor publications, or descriptions of services in written or
other communication medium, used to influence HCA to enter into this Contract.
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Attachment 1
Confidential Information Security Requirements
Definitions
In addition to the definitions set out in Section 4.7 of this Contract for SOR Opiate
Treatment Networks, the definitions below apply to this Attachment.
a. "Hardened Password" means a string of characters containing at least three of the
following character classes: upper case letters; lower case letters; numerals; and
special characters, such as an asterisk, ampersand or exclamation point.
Passwords for external authentication must be a minimum of 10 characters
long.
ii. Passwords for internal authentication must be a minimum of 8 characters
long.
iii. Passwords used for system service or service accounts must be a minimum
of 20 characters long.
b. "Portable/Removable Media" means any Data storage device that can be detached or
removed from a computer and transported, including but not limited to: optical media
(e.g. CDs, DVDs); USB drives; or flash media (e.g. CompactFlash, SD, MMC).
c. "Portable/Removable Devices" means any small computing device that can be
transported, including but not limited to: handhelds/PDAs/Smartphones; Ultramobile
PC's, flash memory devices (e.g. USB flash drives, personal media players); and
laptops/notebook/tablet computers. If used to store Confidential Information, devices
should be Federal Information Processing Standards (FIPS) Level 2 compliant.
d. "Secured Area" means an area to which only Authorized Users have access. Secured
Areas may include buildings, rooms, or locked storage containers (such as a filing
cabinet) within a room, as long as access to the Confidential Information is not
available to unauthorized personnel.
e. "Transmitting" means the transferring of data electronically, such as via email, SFTP,
webservices, AWS Snowball, etc.
"Trusted System(s)" means the following methods of physical delivery: (1) hand -
delivery by a person authorized to have access to the Confidential Information with
written acknowledgement of receipt; (2) United States Postal Service ("USPS") first
class mail, or USPS delivery services that include Tracking, such as Certified Mail,
Express Mail or Registered Mail; (3) commercial delivery services (e.g. FedEx, UPS,
DHL) which offer tracking and receipt confirmation; and (4) the Washington State
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Campus mail system. For electronic transmission, the Washington State
Governmental Network (SGN) is a Trusted System for communications within that
Network.
g. "Unique User ID' means a string of characters that identifies a specific user and which,
in conjunction with a password, passphrase, or other mechanism, authenticates a user
to an information system.
Confidential Information Transmitting
a. When transmitting HCA's Confidential Information electronically, including via email,
the Data must be encrypted using NIST 800 -series approved algorithms
(hitt):/hcsrc.nist.aov/publications[PubsSPs.html . 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.
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, cans key, combination lock, or comparable
mechanism.
ii. Data stored on PortabletRemovable Media or Devices:
• Confidential Information provided by HCA on Removable Media will be
encrypted with NIST 800 -series approved algorithms. Encryption keys will
be stored and protected independently of the Data.
HCA's data must not be stored by the Receiving Party on Portable Devices
or Media unless specifically authorized within the Data Share Agreement. If
so authorized, the Receiving Party must protect the Data by:
Encrypting with NIST 800 -series approved algorithms. Encryption
keys will be stored and protected independently of the data;
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2. Control access to the devices with a Unique User ID and Hardened
Password or stronger authentication method such as a physical token
or biometrics;
3. Keeping devices in locked storage when not in use;
4. Using check-in/check-out procedures when devices are shared;
5. Maintain an inventory of devices; and
6. Ensure that when being transported outside of a Secured Area, all
devices with Data are under the physical control of an Authorized
User.
b. Paper documents. Any paper records containing Confidential Information must be
protected by storing the records in a Secured Area that is accessible only to authorized
personnel. When not in use, such records must be stored in a locked container, such
as a file cabinet, locking drawer, or safe, to which only authorized persons have
access.
Confidential Information Segregation
HCA Confidential Information received under this Contract must be segregated or
otherwise distinguishable from non -HCA data. This is to ensure that when no longer
needed by the Contractor, all HCA Confidential Information can be identified for return or
destruction. It also aids in determining whether HCA Confidential Information has or may
have been compromised in the event of a security Breach.
A. THE HCA CONFIDENTIAL INFORMATION MUST BE KEPT IN ONE OF THE
FOLLOWING WAYS:
on media (e.g. hard disk, optical disc, tape, etc.) which will contain only HCA
Data; or
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.
4.43 WHEN 1T IS NOT FEASIBLE OR PRACTICAL TO SEGREGATE HCA CONFIDENTIAL
INFORMATION FROM NON -HCA DATA, THEN BOTH THE HCA CONFIDENTIAL
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INFORMATION AND THE NON -HCA DATA WITH WHICH IT IS COMMINGLED MUST
BE PROTECTED AS DESCRIBED IN THIS ATTACHMENT.
Confidential Information Shared with Subcontractors
If HCA Confidential Information provided under this Contract is to be shared with a
Subcontractor, the contract with the Subcontractor must include all of the Confidential
Information Security Requirements.
Confidential Information Disposition
When the Confidential Information is no longer needed, except as noted below, the
Confidential Information must be returned to HCA or destroyed. Media are to be destroyed
using a method documented within NIST 800-88
(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 0, above. Destruction of the
Confidential Information as outlined in this section of this Attachment may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secured
Area.
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ATTACHMENT
FEDERAL COMPLIANCE, CERTIFICATIONS, AND ASSURANCES
In the event federal funds are included in this agreement, the following sections apply: 1. Federal Compliance
and II. Standard Federal Assurances and Certifications. In the instance of inclusion of federal funds, the
Contractor may be designated as a sub -recipient and the effective date of the amendment shall also be the
date at which these requirements go into effect.
I. FEDERAL COMPLIANCE - The use of federal funds requires additional compliance and control
mechanisms to be in place. The following represents the majority of compliance elements that
may apply to any federal funds provided under this contract. For clarification regarding any of
these elements or details specific to the federal funds in this contract, contact: Stephanie
Endler
a. Source of Funds: This agreement is being funded partially or in full through Cooperative Agreement
number 1 H79TI081705-01, the full and complete terms and provisions of which are hereby
incorporated into this agreement can be found by reference in Attachment 4. Federal funds to
support this agreement are identified by the Catalog of Federal Domestic Assistance (CFDA) number
93.788 and amount to $463,000. The sub-awardee is responsible for tracking and reporting the
cumulative amount expended under HCA Contract No. K3285.
b. Period of AvailabAty 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 H79TIO81705-01, unless
carryover of unobligated balances is permitted, in which case the carryover balances may be charged
for costs resulting from obligations of the subsequent funding period. All obligations incurred under
the award must be liquidated no later than 90 days after the end of the funding period.
c. Single Audit Act: A sub-awardee (including private, for-profit hospitals and non-profit institutions)
shall adhere to the federal Office of Management and Budget (OMB) Super Circular 2 CFR 200.501
and 45 CFR 75.501. A sub-awardee who expends $750,000 or more in federal awards during a
given fiscal year shall have a single or program -specific audit for that year in accordance with the
provisions of OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501.
d. Modifications: This agreement may not be modified or amended, nor may any term or provision be
waived or discharged, including this particular Paragraph, except in writing, signed upon by both
parties.
1. Examples of items requiring Health Care Authority prior written approval include, but are not
limited to, the following:
i. Deviations from the budget and Project plan.
ii. Change in scope or objective of the agreement.
iii. Change in a key person specified in the agreement.
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iv. The absence for more than three months or a 25% reduction in time by the Project
Manager/Director.
v. Need for additional funding.
vi. Inclusion of costs that require prior approvals as outlined in the appropriate cost principles.
vii. Any changes in budget line item(s) of greater than twenty percent (20%) of the total budget
in this agreement.
2. No changes are to be implemented by the Sub-awardee until a written notice of approval is
received from the Health Care Authority.
e. Sub -Contracting. The sub-awardee shall not enter into a sub -contract for any of the work performed
under this agreement without obtaining the prior written approval of the Health Care Authority. If sub-
contractors are approved by the Health Care Authority, the subcontract, shall contain, at a minimum,
sections of the agreement pertaining to Debarred and Suspended Vendors, Lobbying certification,
Audit requirements, and/or any other project Federal, state, and local requirements.
f. Condition for Receipt of Health Can; Authority Funds: Funds provided by Health Care Authority to the
sub-awardee under this agreement may not be used by the sub-awardee as a match or cost-sharing
provision to secure other federal monies without prior written approval by the Health Care Authority.
g. Unallowable Costs: The sub-awardees' expenditures shall be subject to reduction for amounts
included in any invoice or prior payment made which determined by HCA not to constitute allowable
costs on the basis of audits, reviews, or monitoring of this agreement.
h. Citizenship/Alien Verffication/Determination: The Personal Responsibility and Work Opportunity
Reconciliation Act (PRWORA) of 1996 (PL 104-193) states that federal public benefits should be
made available only to U.S. citizens and qualified aliens. Entities that offer a service defined as a
"federal public benefit' must make a citizenship/qualified alien determination/ verification of applicants
at the time of application as part of the eligibility criteria. Non -US citizens and unqualified aliens are
not eligible to receive the services. PL 104-193 also includes specific reporting requirements.
i. Federal Compliance: The sub-awardee shall comply with all applicable State and Federal statutes,
laws, rules, and regulations in the performance of this agreement, whether included specifically in this
agreement or not.
Civil Rights and Non -Discrimination Obligations During the performance of this agreement, the
Contractor shall comply with all current and future federal statutes relating to nondiscrimination.
These include but are not limited to: Title VI of the Civil Rights Act of 1964 (PL 88-352), Title IX of the
Education Amendments of 1972 (20 U.S.C. §§ 1681-1683 and 1685-1686), section 504 of the
Rehabilitation Act of 1973 (29 U.S.C. § 794), the Age Discrimination Act of 1975 (42 U.S.C. §§ 6101-
6107), the Drug Abuse Office and Treatment Act of 1972 (PL 92-255), the Comprehensive Alcohol
Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and
527 of the Public Health Service Act of 1912 (42 U.S.C. §§290dd-3 and 290ee-3), Title Vill of the Civil
Rights Act of 1968 (42 U.S.C. §§3601 et seq.), and the Americans with Disability Act (42 U.S.C.,
Section 12101 et seq.) http://www.hhs.gov/ocr/civilb_ghts
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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
11. CIRCULARS `COMPLIANCE MATRIX' - The following compliance matrix identifies the OMB
Circulars that contain the requirements which govern expenditure of federal funds. These
requirements apply to the Washington State Health Care Authority (HCA), as the primary
recipient of federal funds and then follow the funds to the sub-awardee Community Counseling
Institute. The federal Circulars which provide the applicable administrative requirements, cost
principles and audit requirements are identified by sub-awardee organization type.
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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-Profd Organizations
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"Sub-recipiwr; means the legal entity to which a sub -award is made and which is accountable to the State for the
use of the funds provided in carrying out a portion of the State's programmatic effort under a sponsored project. The
term may include institutions of higher education, for-profit corporations or non -U.S. Based entities.
"Sub -award and Sub -grant' are used interchangeably and mean a lower tier award of financial support from a
prime awardee (e.g., Washington State Health Care Authority) to a Sub -recipient for the performance of a substantive
portion of the program. These requirements do not apply to the procurement of goods and services for the benefit of
the Washington State Health Care Authority.
IV. STANDARD FEDERAL CERTIFICATIONS AND ASSURANCES - Following are the Assurances,
Certifications, and Special Conditions that apply to all federally funded (in whole or in part) agreements
administered by the Washington State Health Care Authority.
CERTIFICATIONS
1. CERTIFICATION REGARDING
DEBARMENT AND SUSPENSION
The undersigned (authorized official signing
for the contracting organization) certifies to
the best of his or her knowledge and belief,
that the contractor, defined as the primary
participant in accordance with 45 CFR Part
76, and its principals:
b) have not within a 3 -year period preceding
this contract been convicted of or had a
civil judgment rendered against them for
commission of fraud or a criminal offense
in connection with obtaining, attempting
to obtain, or performing a public (Federal,
State, or local) transaction or contract
under a public transaction; violation of
Federal or State antitrust statutes or
commission of embezzlement, theft,
forgery, bribery, falsification or
destruction of records, making false
statements, or receiving stolen property;
a) are not presently debarred, suspended,
proposed for debarment, declared c) are not presently indicted or otherwise
ineligible, or voluntarily excluded from criminally or civilly charged by a
covered transactions by any Federal governmental entity (Federal, State, or
Department or agency; local) with commission of any of the
offenses enumerated in paragraph (b) of
this certification; and
Washington State Page 42 of 72 #K
Health Care Authority Attachment
d) have not within a 3 -year period preceding
this contract had one or more public
transactions (Federal, State, or local)
terminated for cause or default.
Should the contractor not be able to provide
this certification, an explanation as to why
should be placed after the assurances page
in the contract.
The contractor agrees by signing this
contract that it will include, without
modification, the clause titled "Certification
Regarding Debarment, Suspension, In
eligibility, and Voluntary Exclusion --Lower
Tier Covered Transactions" in all lower tier
covered transactions (i.e., transactions with
sub -grantees and/or contractors) and in all
solicitations for lower tier covered
transactions in accordance with 45 CFR Part
76.
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
2. CERTIFICATION REGARDING DRUG- required by paragraph (a), above, that,
FREE WORKPLACE REQUIREMENTS as a condition of employment under the
contract, the employee will—
(1) Abide by the terms of the statement;
The undersigned (authorized official signing and
for the contracting organization) certifies that
the contractor will, or will continue to, provide (2) Notify the employer in writing of his or
a drug-free workplace in accordance with 45 her conviction for a violation of a criminal
CFR Part 76 by: drug statute occurring in the workplace
no later than five calendar days after
such conviction;
a) Publishing a statement notifying
employees that the unlawful
manufacture, distribution, dispensing,
Washington State Page 43 of 72 #(
Health Care Authority Attachment
e) Notifying the agency in writing within ten
calendar days after receiving notice
under paragraph (d)(2) from an
employee or otherwise receiving actual
notice of such conviction. Employers of
convicted employees must provide
notice, including position title, to every
contract officer or other designee on
whose contract activity the convicted
employee was working, unless the
Federal agency has designated a central
point for the receipt of such notices.
Notice shall include the identification
numbers) of each affected grant;
f) Taking one of the following actions,
within 30 calendar days of receiving
notice under paragraph (d) (2), with
respect to any employee who is so
convicted—
(1) Taking appropriate personnel action
against such an employee, up to
and including termination,
consistent with the requirements of
the Rehabilitation Act of 1973, as
amended; or
(2) Requiring such employee to
participate satisfactorily in a drug
abuse assistance or rehabilitation
program approved for such
purposes by a Federal, State, or
local health, law enforcement, or
other appropriate agency;
g) Making a good faith effort to continue to
maintain a drug-free workplace through
implementation of paragraphs (a), (b),
(c), (d), (e), and (f).
For purposes of paragraph (e) regarding
agency notification of criminal drug
convictions, Authority has designated the
following central point for receipt of such
notices:
Legal Services Manager
Washington State
Health Care Authority
WA State Health Care Authority
PO Box 42700
Olympia, WA 98504-2700
3. CERTIFICATION REGARDING
LOBBYING
Title 31, United States Code, Section 1352,
entitled "Limitation on use of appropriated
funds to influence certain Federal contracting
and financial transactions," generally
prohibits recipients of Federal grants and
cooperative agreements from using Federal
(appropriated) funds for lobbying the
Executive or Legislative Branches of the
Federal Government in connection with a
SPECIFIC grant or cooperative agreement.
Section 1352 also requires that each person
who requests or receives a Federal grant or
cooperative agreement must disclose
lobbying undertaken with non -Federal
(nonappropriated) funds. These
requirements apply to grants and
cooperative agreements EXCEEDING
$100,000 in total costs (45 CFR Part 93).
The undersigned (authorized official signing
for the contracting organization) certifies, to
the best of his or her knowledge and belief,
that:
(1) No Federal appropriated funds have
been paid or will be paid, by or on behalf
of the undersigned, to any person for
influencing or attempting to influence an
Page 44 of 72
#(
officer or employee of any agency, a
Member of Congress, an officer or
employee of Congress, or an employee
of a Member of Congress in connection
with the awarding of any Federal
contract, the making of any Federal
grant, the making of any Federal loan,
the entering into of any cooperative
agreement, and the extension,
continuation, renewal, amendment, or
modification of any Federal contract,
grant, loan, or cooperative agreement.
(2) If any funds other than Federally
appropriated funds have been paid or
will be paid to any person for influencing
or attempting to influence an officer or
employee of any agency, a Member of
Congress, an officer or employee of
Congress, or an employee of a Member
of Congress in connection with this
Federal contract, grant, loan, or
cooperative agreement, the undersigned
shall complete and submit Standard
Form -LLL, "Disclosure of Lobbying
Activities," in accordance with its
instructions. (If needed, Standard Form -
LLL, "Disclosure of Lobbying Activities,"
its instructions, and continuation sheet
are included at the end of this
application form.)
1352, U.S. Code. Any person who fails to file the
required certification shall be subject to a civil
penalty of not less than $10,000 and not more than
$100,000 for each such failure.
4. CERTIFICATION REGARDING
PROGRAM FRAUD CIVIL REMEDIES
ACT (PFCRA)
The undersigned (authorized official signing
for the contracting organization) certifies that
the statements herein are true, complete,
and accurate to the best of his or her
knowledge, and that he or she is aware that
any false, fictitious, or fraudulent statements
or claims may subject him or her to criminal,
civil, or administrative penalties. The
undersigned agrees that the contracting
organization will comply with the Public
Health Service terms and conditions of
award if a contract is awarded.
5. CERTIFICATION REGARDING
ENVIRONMENTAL TOBACCO SMOKE
Public Law 103-227, also known as the Pro -
Children Act of 1994 (Act), requires that
smoking not be permitted in any portion of
any indoor facility owned or leased or
(3) The undersigned shall require that the contracted for by an entity and used routinely
language of this certification be included or regularly for the provision of health, day
in the award documents for all care, early childhood development services,
subcontracts at all tiers (including education or library services to children
subcontracts, subcontracts, and
contracts under grants, loans and under the age of 18, if the services are
cooperative agreements) and that all funded by Federal programs either directly or
sub -recipients shall certify and disclose through State or local governments, by
accordingly. Federal grant, contract, loan, or loan
guarantee. The law also applies to children's
services that are provided in indoor facilities
This certification is a material representation of fad
upon which reliance was placed when this that are constructed, operated, or maintained
transaction was made or entered into. Submission with such Federal funds. The law does not
of this certification is a prerequisite for making or apply to children's services provided in
entering into this transaction imposed by Section private residence, portions of facilities used
Washington State Page 45 of 72 p(
Health Care Authority Attachment
for inpatient drug or alcohol treatment,
1)
By signing and submitting this proposal, the
service providers whose sole source of
prospective contractor is providing the
applicable Federal funds is Medicare or
2)
certification set out below.
The inability of a person to provide the
Medicaid, or facilities where WIC coupons
certification required below will not
are redeemed.
necessarily result in denial of participation in
this covered transaction. The prospective
contractor shall submit an explanation of why
it cannot provide the certification set out
below. The certification or explanation will be
Failure to comply with the provisions of the law
considered in connection with the department
may result in the imposition of a civil monetary
or agency's determination whether to enter
penalty of up to $1,000 for each violation and/or
into this transaction. However, failure of the
the imposition of an administrative compliance
prospective contractor to furnish a
order on the responsible entity.
certification or an explanation shall disqualify
such person from participation in this
transaction.
By signing the certification, the undersigned
3)
The certification in this clause is a material
certifies that the contracting organization will
representation of fact upon which reliance
comply with the requirements of the Act and
was placed when the department or agency
determined to enter into this transaction. If it
will not allow smoking within any portion of
is later determined that the prospective
any indoor facility used for the provision of
contractor knowingly rendered an erroneous
services for children as defined by the Act.
certification, in addition to other remedies
available to the Federal Government, the
department or agency may terminate this
transaction for cause of default_
4)
The prospective contractor shall provide
The contracting organization agrees that it
immediate written notice to the department or
will require that the language of this
agency to whom this contract is submitted if
certification be included in any subcontracts
at any time the prospective contractor learns
that its certification was erroneous when
which contain provisions for children's
submitted or has become erroneous by
services and that all sub -recipients shall
reason of changed circumstances.
certify accordingly.
5)
The terms covered transaction, debarred,
suspended, ineligible, lower tier covered
transaction, participant, person, primary
covered transaction, principal, proposal, and
voluntarily excluded, as used in this clause,
The Public Health Services strongly
have the meanings set out in the Definitions
encourages all recipients to provide a
and Coverage sections of the rules
smoke-free workplace and promote the non-
implementing Executive Order 12549. You
use of tobacco products. This is consistent
may contact the person to whom this contract
with the PHS mission to protect and advance
is submitted for assistance in obtaining a
the physical and mental health of the
copy of those regulations.
American people.
6)
The prospective contractor agrees by
submitting this contract that, should the
proposed covered transaction be entered
6. CERTIFICATION REGARDING
into, it shall not knowingly enter into any lower
DEBARMENT, SUSPENSION, AND
tier covered transaction with a person who is
OTHER RESPONSIBILITY MATTERS
debarred, suspended, declared ineligible, or
INSTRUCTIONS FOR CERTIFICATION
voluntarily excluded from participation in this
covered transaction, unless authorized by
Authority.
Washington State Page 46 of 72 OK
Health Care Authority Attachment
7) The prospective contractor further agrees by
submitting this contract that it will include the
clause titled "Certification Regarding
Debarment, Suspension, Ineligibility and
Voluntary Exclusion — Lower Tier Covered
Transaction," provided by HHS, without
modification, in all lower tier covered
transactions and in all solicitations for lower
tier covered transactions.
8) A participant in a covered transaction may
rely upon a certification of a prospective
participant in a lower tier covered transaction
that it is not debarred, suspended, ineligible,
or voluntarily excluded from the covered
transaction, unless it knows that the
certification is erroneous. A participant may
decide the method and frequency by which it
determines the eligibility of its principals.
Each participant may, but is not required to,
check the Non -procurement List (of excluded
parties).
9) Nothing contained in the foregoing shall be
construed to require establishment of a
system of records in order to render in good
faith the certification required by this clause.
The knowiedge and information of a
participant is not required to exceed that
which is normally possessed by a prudent
person in the ordinary course of business
dealings.
10) Except for transactions authorized under
paragraph 6 of these instructions, if a
participant in a covered transaction
knowingly enters into a lower tier covered
transaction with a person who is suspended,
debarred, ineligible, or voluntarily excluded
from participation in this transaction, in
addition to other remedies available to the
Federal Government, Authority may
terminate this transaction for cause or
default.
7. CERTIFICATION REGARDING
DEBARMENT, SUSPENSION, AND
OTHER RESPONSIBILITY MATTERS -
- PRIMARY COVERED
TRANSACTIONS
1) The prospective contractor certifies to the
best of its knowledge and belief, that it and its
principals:
a) Are not presently debarred, suspended,
proposed for debarment, declared
ineligible, or voluntarily excluded from
Washington State
covered transactions by any Federal
department or agency;
b) Have not within a three-year period
preceding this contract been convicted of or
had a civil judgment rendered against them
for commission of fraud or a criminal offense
in connection with obtaining, attempting to
obtain, or performing a public (Federal, State
or local) transaction or contract under a
public transaction; violation of Federal or
State antitrust statutes or commission of
embezzlement, theft, forgery, bribery,
falsification or destruction of records, making
false statements, or receiving stolen
property;
c) Are not presently indicted for or
otherwise criminally or civilly charged by
a governmental entity (Federal, State or
local) with commission of any of the
offenses enumerated in paragraph (1)(b)
of this certification; and
d) Have not within a three-year period
preceding this contract had one or more
public transactions (Federal, State or
local) terminated for cause or default.
2) Where the prospective contractor is unable to
certify to any of the statements in this
certification, such prospective contractor
shall attach an explanation to this proposal.
Page 47 of 72
#K
Heafth Care Authority Attachment
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING
TITLE
OFFICIAL
C
Please also print or type name:
6,�— b e0,Av-,—
ORGANIZATION NAME: (if applicable)
DATE
Washington State Page 48 of 72 W
Health Care Authority
Attachment 3
Federal Funding Accountability and Transparency Act (FFATA) Data Collection Form
This Contract is supported by federal funds that require compliance with the Federal Funding Accountability and
Transparency Act (FFATA or the Transparency Act). The purpose of the Transparency Act is to make
information available online so the public can see how federal funds are spent.
To comply with the act and be eligible to enter into this contract, your organization must have a Data Universal
Numbering System (DUNS®) number. A DUNS® number provides a method to verify data about your
organization. If you do not already have one, you may receive a DUNS® number free of charge by contacting
Dun and Bradstreet at www.dnb.com.
Required Information about your organization and this contract will be made available on USASpending.gov by
the Washington State Health Care Authority (HCA) as required by P.L. 109-282. As a tool to provide the
information, HCA encourages registration with the Central Contractor Registry (CCR) because less data entry
and re-entry is required by both HCA and your organization. You may register with CCR on-line at
hftps://www.uscontractorregistrabon.com/.
Contractor must complete this form and return it to the Health Cane Authority (HCA).
CONTRACTOR
1. Legal Name
2. DUNS Number
Jefferson County
619143741
3. Principle Place of Performance
3a. Congressional District
79 Elkins Road
6th
3b. City
3c. State
Port Hadlock
WA
3d. Zip+4
3e. Country
98339-9700
USA
4. Are you registered in CCR (https://www.uscontractorregistration.com? S (skip to page 2. Sign, date
and return) FINO
5. In the preceding fiscal year did your organization:
a. Receive 80% or more of annual gross revenue from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements; and
b. $25,000,000 or more in annual gross revenues from federal contracts, subcontracts, grants, loans,
subgrants, and/or cooperative agreements;nod
c. The public does not have access to information about the compensation of the executives through
periodic reports filled with the IRS or the Security and Exchange Commission per 2 CFR Part 170.330
® NO (skip the remainder of this section - Sign, date and return)
❑ YES (You must report the names and total compensation of the top 5 highly compensated officials of your
organization).
Name Of Official Total Compensation
1.
2.
3.
4.
5.
Washington State Page 49 of 72 SK
Health Care Authority Attachment
Note: "Total compensation' means the cash and noncash dollar value earned by the executive during the sub -
recipient's past fiscal year of the following (for more information see 17 CFR 229.402 (c)(2)).
By signing this document, the Contractor Authorized Representative attests to the information.
Signature Contractor Authorized Representative Dat
e
HCA will not endorse the Contractor's subaward until this form is completed and returned.
FOR HEALTH CARE AUTHORITY USE ONLY
HCA Contract Number: K3285
Project Description (see instructions and examples below)
Instructions for Sub -award Project Description:
In the first line of the description provide a title for the sub -award that captures the main purpose of the
subrecipients work_ Then, indicate the name of the subrecipient and provide a brief description that captures
the overall purpose of the sub -award, how the funds will be used, and what will be accomplished.
Example of a Sub -award Project Description:
Washington State Page 50 of 72 #K
Health Care Authority Attachment
Increase Healthy Behaviors: Educational Services District XYZ will provide training and technical assistance to
chemical dependency centers to assist the centers to integrate tobacco use into their existing addiction
treatment programs. Funds will also be used to assist centers in creating tobacco free treatment environments.
Washington State Page 51 of 72 #K
Health Care Authority Attachment
Attachment 4
SOR Grant Notice of Award 1 H79TI081795 is included as separate document.
Washington State Page 52 of 72
iK
Health Care Authority Attachment
Notice of Award
SOR Issue Date: 09/19/2018
Department of Health and Human Services
Substance Abuse and Mental Health Services Administration
Center for Substance Abuse Treatment
Grant Number: 1 H79TIO81705-01
FAIN: H79TIO81705
Program Director: Alicia C Hughes
Project Title: Washington State Opioid Response (SOR) Grant
Grantee Address
HEALTH CARE AUTHORITY
Mr. Thomas Fuchs
Washington State Health Care Authority
626 8th Ave SE
PO Box 45330
Olympia, WA 985045330
Budget Period: 09/30/2018 — 09/29/2019
Project Period: 09/302018 — 09/29/2020
Dear Grantee:
Business Address
Mr. Michael Langer
Washington State Health Care Authority
PO Box 45330
Olympia, WA 985045330
The Substance Abuse and Mental Health Services Administration hereby awards a grant in the amount of
$21,573,093 (see "Award Calculation' in Section I and "Terms and Conditions" in Section III) to HEALTH
CARE AUTHORITY in support of the above referenced project. This award is pursuant to the authority of
Title II Division H of the Consolidated Appropriations Act and is subject to the requirements of this statute
and regulation and of other referenced, incorporated or attached terms and conditions.
Award recipients may access the SAMHSA website at www.samhsa.gov (click on "Grants" then SAMHSA
Grants Management), which provides information relating to the Division of Payment Management
System, HHS Division of Cost Allocation and Postaward Administration Requirements. Please use your
grant number for reference.
Acceptance of this award including the "Terms and Conditions" is acknowledged by the grantee when
funds are drawn down or otherwise obtained from the grant payment system.
If you have any questions about this award, please contact your Grants Management Specialist and your
Government Project Officer listed in your terms and conditions.
Sincerely yours,
Odessa Crocker
Grants Management Officer
Division of Grants Management
See additional information below
Page -1
SECTION I — AWARD DATA —1 H79TIO81705-01
Award Calculation 1U.S. Dollars)
Other
Direct Cost
Approved Budget
Federal Share
Cumulative Prior Awards for this Budget Period
AMOUNT OF THIS ACTION (FEDERAL SHARE)
SUMMARY TOTALS FOR ALL YEARS
YR AMOUNT
1 $21,573,093
2
$21,573,093
$21,573,093
$21,573,093
$21,573,093
$21,573,093
$0
$21,573,093
*Recommended future year total cost support, subject to the availability of funds and satisfactory
progress of the project.
Fiscal Information:
CFDA Number:
EIN:
Document Number:
Fiscal Year:
IC CAN
TI C96N600
93.788
191141278OAl
18TI81705A
2018
Amount
$21,573,093
IC
I CAN
2018
2019
Tl
I C96N600
$21,573,093
$21,573,093
TI Administrative Data:
PCC: SOR / OC: 4145
SECTION II — PAYMENT/HOTLINE INFORMATION —1 H79TIO81705-01
Payments under this award will be made available through the HHS Payment Management
System (PMS). PMS is a centralized grants payment and cash management system, operated by
the HHS Program Support Center (PSC), Division of Payment Management (DPM). Inquiries
regarding payment should be directed to: The Division of Payment Management System, PO Box
6021, Rockville, MD 20852, Help Desk Support —Telephone Number: 1-877-614-5533.
The HHS Inspector General maintains a toll-free hotline for receiving information concerning
fraud, waste, or abuse under grants and cooperative agreements. The telephone number is: 1-
800 -HHS -TIPS (1-800-447-8477). The mailing address is: Office of Inspector General,
Department of Health and Human Services, Attn: HOTLINE, 330 Independence Ave., SW,
Washington, DC 20201.
SECTION III — TERMS AND CONDITIONS —1 H79TIO81706-01
This award is based on the application submitted to, and as approved by, SAMHSA on the
above -title project and is subject to the terms and conditions incorporated either directly or by
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reference in the following:
a. The grant program legislation and program regulation cited in this Notice of Award.
b. The restrictions on the expenditure of federal funds in appropriations acts to the extent
those restrictions are pertinent to the award.
c. 45 CFR Part 75 as applicable.
d. The HHS Grants Policy Statement.
e. This award notice, INCLUDING THE TERMS AND CONDITIONS CITED BELOW.
Treatment of Program Income:
Additional Costs
In accordance with the regulatory requirements provided at 45 CFR 75.113 and Appendix XII to
45 CFR Part 75, recipients that have currently active Federal grants, cooperative agreements,
and procurement contracts with cumulative total value greater than $10,000,000 must report and
maintain information in the System for Award Management (SAM) about civil, criminal, and
administrative proceedings in connection with the award or performance of a Federal award that
reached final disposition within the most recent five-year period. The recipient must also make
semiannual disclosures regarding such proceedings. Proceedings information will be made
publicly available in the designated integrity and performance system (currently the Federal
Awardee Performance and Integrity Information System (FAPIIS)). Full reporting requirements
and procedures are found in Appendix XII to 45 CFR Part 75.
SECTION IV – TI Special Terms and Conditions –1 H79TIO81705-01
REMARKS:
This Notice of Award (NoA) is issued to inform your organization that the application submitted
through Funding Opportunity Announcement (FOA) TI -18-015 has been selected for funding.
Based on the availability of additional available funding for the State Opioid Response
(SOR) program, the annual approval funding amount for your state has increased. As a
result, all funds have been placed in the Other Budget Category and a revised budget is
required to be submitted per the special conditions of award reflected below.
Key Personnel (or key staff positions, if staff has not been selected) are listed below:
TBD (Acting PD: Alicia C Hughes), Program Director 0-) 100% level of effort
TBD. State Opioid Coordinator — l- 100% level of effort
Any changes in key staff including level of effort involving separation from the project for more
than three months or a 25 percent reduction in time dedicated to the project, requires prior
approval. Reference the Prior Approval Standard Term for additional information and instructions.
Recipients are expected to plan their work to ensure that funds are expended within the 12 -month
budget period reflected on this Notice of Award. if activities proposed in the approved budget
cannot be completed within the current budget period, SAMSHA cannot guarantee the approval of
any request for carryover of remaining unobligated funding.
Register your Program Director/Project Director (PD) in eRA Commons: You must complete
registrations in order to submit an FY19 Continuation Application in eRA Commons. You must
register both the Organization and the PD. Additional information for eRA registration can be
found at: https://era.nih.nov/req accounts/register commons.cfm.
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The response to term and conditions of award must be submitted as .pdf documents in the "View
Terms Tracking Details" page in eRA Commons.
For more information on how to upload a document in response to a tracked term, please
reference under heading "4 Additional Materials — grantee" in the User Guide located at:
httos://era.nih.gov/files/TCM User Guide Grantee pdf.
SPECIAL TERMS OF AWARD:
SOR funds shall be used to fund services and practices that have a demonstrated evidence -base,
and that are appropriate for the population(s) of focus.
SOR funds shall not be utilized for services that can be supported through other accessible
sources of funding such as other federal discretionary and formula grant funds, e.g. HHS (CDC,
CMS, HRSA, and SAMHSA), DOJ (OJP/BJA) and non-federal funds, 3rd party insurance, and
sliding scale self -pay among others.
SOR funds for treatment and recovery support services shall only be utilized to provide services to
individuals with a diagnosis of an opioid use disorder or to individuals with a demonstrated history
of opioid overdose problems.
Grantees are expected to report data as required in the FOA and to fully participate in any
SAMHSA-sponsored evaluation of this program. All required data must be reported to the SPARS
system within SAMHSA specified timelines. The submission of these data in the form required by
SAMHSA is a requirement of funding.
Medication Assisted Treatment (MAT) using one of the FDA -approved medications for the
maintenance treatment of opioid use disorder (methadone, buprenorphine/naloxone
prod ucts/buprenorphine products including sublingual tablets/film, buccal film, and extended
release, long-acting injectable buprenorphine formulations and injectable naltrexone) is a required
activity of your grant per the terms of your grant award.
Recipients are required to work with the SAMHSA Opioid-STR TA grant awarded to AAAP as the
primary means of TA provision. Recipients are expected to report data as required in the Funding
Opportunity Announcement (FOA) and to fully participate in the cross -site evaluation of the
program.
Grantees are required to track funding of activities by providers and be prepared to submit these
data to SAMHSA upon request.
STANDARD TERMS OF AWARD:
Refer to the following SAMHSA website to access the Standard Terms applicable to your grant
award for FY 2018: httos://www samhsa gov/grants/-_rants-management/notice-award-
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noa/standard-terms-conditions and reference the FY 2018 Standard and New Grant Terms
REPORTING REQUIREMENTS:
Annual Federal Financial Report (SF -425)
The Federal Financial Report (FFR) (SF -425) is required on an annual basis and must be
submitted no later than 90 days after the end of the budget period (by December 31, 2019).
The annual FFR should reflect only cumulative actual Federal funds authorized and disbursed,
any non -Federal matching funds (if identified in the Funding Opportunity Announcement (FOA)),
unliquidated obligations incurred, the unobligated balance of the Federal funds for the award, as
well as program income generated during the timeframe covered by the report.
Additional guidance to complete the FFR can be found at
http://www. sam hsa. gov/grants/g rantsmanagement/reporting-requirements.
FFR reporting must be entered directly into the eRA Commons system. Instructions on how to
submit a Federal Financial Report (FFR) via the eRA Commons is available at
https://www.samhsa. gov/sites/defautt/files/samhsa-grantee-submit-ffr-10-22-17. pptx.
Annual Performance Progress Report (PPR)
The Performance Progress Report (PPR) is required on an annual basis and must be submitted
no later than 90 days after the end of the budget period (by December 31, 2019)
Note: Recipients must also comply with the GPRA requirements that include the collection and
periodic reporting of performance data as specified in the FOA or by the Grant Program Official
(GPO). This information is needed in order to comply with PL 102-62, which requires that
Substance Abuse and Mental Health Services Administration (SAMHSA) report evaluation data to
ensure the effectiveness and efficiency of its programs.
This information will be gathered using SAMHSA's Performance Accountability and Reporting
System (SPARS); access will be provided upon award.
Additional information on reporting requirements is available at
https://www.samhsa.gov/g rants/grants-management/reporting-requirements
Compliance with Terms and Conditions
Failure to comply with the Terms and Conditions of the grant award may result in actions in
accordance with 45 CFR 75.371, Remedies for Non -Compliance and 45 CFR 75.372
Termination. This may include withholding payment, disallowance of costs, suspension and
debarment, termination of grant award or denial of future funding.
Unless otherwise identified in the special terms and conditions of award and post award requests,
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all responses to special terms and conditions of award and post award requests must be
submitted through the eRA Commons system.
It is essential that the Grant Number be included in the SUBJECT line of the email.
SPECIAL CONDITIONS
SOR Revised Budget
SAMHSA recently revised its budget threshold for State Opioid Response Grants. The
funding recommendation has increased resulting in an overall increase in your
authorized budget amount. The administrative/infrastructure costs limits to administer
this award of up to 5 percent, and up to 2 percent of the grant award for data collection
and reporting, including client -level data collection and reporting are still requirements
of this award.
By October 31, 2018, you are required to submit a detailed budget into the Terms Tracker in
eRA to release this restricted award. For more information on how to upload a document in
response to a tracked term, please reference Terms and Conditions Module (TCM) in the User
Guide located at: https:Hera.nih.gov/modules_user-guides_documentation.cfm
The components required to resolve this restriction are:
• A revised budget breakdown
• A budget narrative
• SF -424A
• Contract, Subcontract, and Consortium detailed budgets and budget justifications must
accompany each full budget.
• Other Support page for Key Personnel (please provide a statement confirming that total
level of effort between SOR and STR does not exceed 100% level of effort)
• Clearly identified PD, A confirmation of the PD is required and will require submission of a
revised HHS Checklist or revised Budget Justification, depending on the correct PD. The
HHS Checklist and Budget Justification identify different individuals as the PD, and these
documents must be consistent. Please revise accordingly and submit either a revised
Checklist or a revised budget for consistency.
The following document(s) were missing from your application and must be submitted by
October 31, 2018:
• SMA 170
• SF -LLL
We recommend that recipients use the SAMHSA provided template for the revised budget.
Marginal/Unacceptable
"For the marginal section as noted in the summary statement, you must submit the requested
information to the GMS and GPO by October 31, 2018 via the term tracker and an emailed
copy to the GMO.
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The application submitted received a marginal rating for Section C: Proposed Evidence -Based
Service/Practice. Reviewers noted that the grantee:
• Does not link the identified EBPs back to the specific needs of the population of focus.
• Does provide a detailed description of its implementation of the evidence based
strategies.
• Does not identify specific psychosocial interventions.
• Does not detail how or why the identified modifications are appropriate for the project.
To ensure the grantee meets acceptable standards for this section, you must submit the
following information to the GMS and GPO:
• Describe how the identified EBPs link to the specific needs of the population of focus.
• Describe your implementation of the evidence -based strategies.
• Identify specific psychosocial interventions.
• Describe how and why the identified modifications are appropriate for the project.
Staff Contacts:
Kim Thierry, Program Official
Phone: (240) 276-2907 Email: kim.thierry@samhsa.hhs.gov Fax: (240) 276-2970
LeSchell D Browne, Grants Specialist
Phone: 240-276-1144 Email: leschell.browne@samhsa.hhs.gov
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Attachment 5
Business Associates Agreement
This BUSINESS ASSOCIATE AGREEMENT is made between the Contractor listed on page one of
this aggreement (Business Associate) and the Washington State Health Care Authority (HCA). This
agreement does not expire or automatically terminate except as stated in Section 5.
Business Associate is or may be a "Business Associate" of HCA as defined in the HIPAA Rules. If
there is a conflict between the provisions of this Agreement and provisions of other contracts, this
Agreement controls; otherwise, the provisions in this Agreement do not replace any provisions of any
other contracts. If the other Contract is terminated, this Agreement nonetheless continues in effect.
This Business Associate Agreement supersedes any existing Business Associate Agreement the
Business Associate may have with HCA. It also supersedes any "business associate" section in an
underlying Contract.
Definitions
1.1 ACCESS ATTEMPTS
Information systems are the frequent target of probes, scans, "pings," and other activities that
may or may not indicate threats, whose sources may be difficult or impossible to identify, and
whose motives are unknown, and which do not result in access or risk to any information
system or PHI. Those activities are "access attempts."
1.2 DAY
"Day" means business days observed by Washington State government.
1.3 CATCH-ALL DEFINITIONS
The following terms used in this Agreement have the same meaning as those terms in the
HIPAA Rules: Breach, Business Associate, Data Aggregation, Designated Record Set,
Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy
Practices, Secretary, Security Incident, Unsecured Protected Health Information (PHI), and Use.
1.4 CLIENTS OR INDIVIDUALS
"Clients" or "individuals" are people who have health or other coverage or benefits from or
through HCA. They include Medicaid clients, Public Employees Benefits Board subscribers and
enrollees, and others.
1.5 CONTRACT OR UNDERLYING CONTRACT
"Contract" or "underlying contract" means all agreements between Business Associate and HCA
under which Business Associate is a "business associate" as defined in the Security or Privacy
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Rules. The terms apply whether there is one such agreement or more than one, and if there is
more than one the terms include them all even though a singular form is used except as
otherwise specified. The terms include agreements now in effect and agreements that become
effective after the effective date of this Agreement.
1.6 EFFECTIVE DATE
"Effective Date" means the date of the signature with the latest date affixed to the Agreement.
1.7 HIPAA RULES; SECURITY, BREACH NOTIFICATION, AND PRIVACY RULES
"HIPAA Rules" means the Privacy, Security, Breach Notification, and Enforcement Rules at 45
CFR Part 160 and Part 164, as now in effect and as modified from time to time. In part 164 of
title 45 CFR, the "Security Rule" is subpart C (beginning with §164.302), the "Breach Notification
Rule" is subpart D (beginning with § 164.400), and the "Privacy Rule" is subpart E (beginning
with § 164.500).
1.8 PROTECTED HEALTH INFORMATION OR PHI
"Protected Health Information" has the same meaning as in the HIPAA Rules except that in this
Agreement the term includes only information created by Business Associate or any of its
contractors, or received from or on behalf of HCA, and relating to Clients. "PHI" means
Protected Health Information.
2 Obligations and Activities of Business Associate
2.1 LIMITS
Business Associate will not use or disclose PHI other than as permitted or required by the
Contract or this Agreement or as required by law. Except as otherwise limited in this Agreement,
Business Associate may use or disclose PHI on behalf of, or as necessary for purposes of the
underlying contract, if such use or disclosure of PHI would not violate the Privacy Rule if done
by a Covered Entity and is the minimum necessary.
2.2 SAFEGUARDS
Business Associate will use appropriate safeguards, and will comply with the Security Rule with
respect to electronic PHI, to prevent use or disclosure of PHI other than as provided for by the
Contract or this Agreement. Business Associate will store and transfer PHI in encrypted form.
2.3 REPORTING SECURITY INCIDENTS
2.3.1 Business Associate will report security incidents that materially interfere with an
information system used in connection with PHI. Business Associate will report those
security incidents to HCA within five days of their discovery by Business Associate. If
such an incident is also a Breach or may be a Breach, subsection 2.4 applies instead
of this provision.
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2.3.2 Access Attempts shall be recorded in Business Associate's system logs. Access
Attempts are not categorically considered unauthorized Use or Disclosure, but Access
Attempts do fall under the definition of Security Incident and Business Associate is
required to report them to HCA.
Since Business Associate's reporting and HCA's review of all records of Access
Attempts would be materially burdensome to both parties without necessarily reducing
risks to information systems or PHI, the parties agree that Business Associate will
review logs and other records of Access Attempts, will investigate events where it is
not clear whether or not an apparent Access Attempt was successful, and determine
whether an Access Attempt:
a. Was in fact a "successful" unauthorized Access to, or unauthorized Use,
Disclosure, modification, or destruction of PHI subject to this Agreement, or
b. Resulted in material interference with Business Associate's information system
used with respect to PHI subject to this Agreement, or
c. Caused an unauthorized Use or Disclosure.
2.3.3 Subject to Business Associate's performance as described in 2.3.2., this provision shall
serve as Business Associate's notice to HCA that Access Attempts will occur and are
anticipated to continue occurring with respect to Business Associate's information
systems. HCA acknowledges this notification, and Business Associate is not required
to provide further notification of Access Attempts unless they are successful as
described in Section 2.3.2. above, in which case Business Associate will report them in
accordance with Section 2.3.1 or Section 2.4.
2.4 BREACH NOTIFICATION
2.4.1 "Breach" is defined in the Breach Notification Rule. The time when a Breach is
considered to have been discovered is explained in that Rule. HCA, or its designee, is
responsible for determining whether an unauthorized Use or Disclosure constitutes a
Breach under the Breach Notification Rule, RCW 42.56.590 or RCW 19.255.010, or
other law or rule, and for any notification under the Breach Notification Rule, RCW
42.56.590 or RCW 19.255.010, or other law or rule.
2.4.2 Business Associate will notify HCA of any unauthorized use or disclosure and any
other possible Breach within five days of discovery. If Business Associate does not
have full details at that time, it will report what information it has, and provide full details
within 15 days after discovery. The initial report may be oral. Business Associate will
give a written report to HCA, however, as soon as possible. To the extent possible,
these reports must include the following:
a. The identification of each individual whose PHI has been or may have been
accessed, acquired, or disclosed;
b. The nature of the unauthorized Use or Disclosure, including a brief description of
what happened, the date of the event(s), and the date of discovery;
c. A description of the types of PHI involved;
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d. The investigative and remedial actions the Business Associate or its subcontractor
took or will take to prevent and mitigate harmful effects, and protect against
recurrence;
e. Any details necessary for a determination of the potential harm to Individuals
whose PHI is believed to have been Used or Disclosed and the steps such
Individuals should take to protect themselves; and
f. Such other information as HCA may reasonably request.
2.4.3 If Business Associate determines that it has or may have an independent notification
obligation under any state breach notification laws, Business Associate will promptly
notify HCA. In any event, Business Associate will notify HCA of its intent to give any
notification under a state breach notification law no fewer than ten business days
before giving such notification.
2.4.4 If Business Associate or any subcontractor or agent of Business Associate actually
makes or causes, or fails to prevent, a use or disclosure constituting a Breach within
the meaning of the Breach Notification Rule, and if notification of that use or disclosure
must (in the judgment of HCA) be made under the Breach Notification Rule, or RCW
42.56.590 or RCW 19.255.010, or other law or rule, then:
a. HCA may choose to make any notifications to the individuals, to the Secretary, and
to the media, or direct Business Associate to make them or any of them.
b. In any case, Business Associate will pay the reasonable costs of notification to
individuals, media, and governmental agencies and of other actions HCA
reasonably considers appropriate to protect clients (such as paying for regular
credit watches in some cases), and
c. Business Associate will compensate HCA clients for harms caused to them by the
Breach or possible Breach described above.
2.4.5 Business Associate's obligations regarding breach notification survive the termination
of this Agreement and continue for as long as Business Associate maintains the PHI
and for any breach or possible breach at any time.
2.5 SUBCONTRACTORS
Business Associate will ensure that any subcontractors or agents that create, receive, maintain,
or transmit PHI on behalf of the Business Associate agree to protective restrictions, conditions,
and requirements at least as strict as those that apply to the Business Associate with respect to'
that information. Upon request by HCA, Business Associate will identify to HCA all its
subcontractors and provide copies of its agreements (including business associate agreements
or contracts) with them. The fact that Business Associate subcontracted or otherwise delegated
any responsibility to a subcontractor or anyone else does not relieve Business Associate of its
responsibilities.
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2.6 ACCESS
Business Associate will make available PHI in a designated record set to the HCA as necessary
to satisfy HCA's obligations under 45 CFR § 164.524. Business Associate will give the
information to HCA within five days of the request from the individual or HCA, whichever is
earlier. If HCA requests, Business Associate will make that information available directly to the
individual. If Business Associate receives a request for access directly from the individual,
Business Associate will inform HCA of the request within three days, and if requested by HCA it
will provide the access in accordance with the HIPAA Rules.
2.7 AMENDING PHI
Business Associate will make any amendments to PHI in a designated record set as directed or
agreed to by the HCA pursuant to 45 CFR § 164.526, or take other measures requested by
HCA to satisfy HCA's obligations under that provision. If Business Associate receives a request
for amendment directly from an individual, Business Associate will both acknowledge it and
inform HCA within three days, and if HCA so requests act on it within ten days and inform HCA
of its actions.
2.8 ACCOUNTING
Business Associate will maintain and make available to HCA the information required to provide
an accounting of disclosures as necessary to satisfy HCA's obligations under 45 CFR §
164.528. If Business Associate receives an individual's request for an accounting, it will either
provide the accounting as required by the Privacy Rule or, at its option, pass the request on to
HCA within ten days after receiving ft.
2.9 OBLIGATIONS
To the extent the Business Associate is to cant' out one or more of RCA's obligations under the
Privacy Rule, it will comply with the requirements of that rule that apply to HCA in the
performance of such obligations.
2.10 BOOKS, ETC.
Business Associate will make its internal practices, books, and records available to the
Secretary for purposes of determining compliance with the HIPAA Rules.
2.11 MITIGATION
Business Associate will mitigate, to the extent practicable, any harmful effect of a use or
disclosure of PHI by Business Associate or any of its agents or subcontractors in violation of the
requirements of any of the HIPAA Rules, this Agreement, or the Contract.
2.12 INDEMNIFICATION
To the fullest extent permitted by law, Business Associate will indemnify, defend, and hold
harmless the State of Washington, HCA, and all officials, agents and employees of the State
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from and against all claims of any kind arising out of or resulting from the performance of this
Agreement, including Breach or violation of HIPAA Rules.
3 Permitted Uses and Disclosures by Business Associate
3.1 LIMITED USE AND DISCLOSURE
Except as provided in this Section 3, Business Associate may use or disclose PHI only as
necessary to perform the services set forth in the Contract.
3.2 GENERAL LIMITATION
Business Associate will not use or disclose PHI in a manner that would violate the Privacy Rule
if done by HCA.
3.3 REQUIRED BY LAW
Business Associate may use or disclose PHI as required by law.
3.4 DE -IDENTIFYING
Business Associate may de -identified PHI in accordance with 45 CFR § 164.514(a) -(c).
3.6 MINIMUM NECESSARY
Business Associate will make uses and disclosures of only the minimum necessary PHI, and
will request only the minimum necessary PHI.
3.6 DISCLOSURE FOR MANAGEMENT AND ADMINISTRATION OF BUSINESS ASSOCIATE
3.6.1 Subject to subsection 3.6.2, Business Associate may disclose PHI for the proper
management and administration of Business Associate or to carry out the legal
responsibilities of the Business Associate.
3.6.2 The disclosures mentioned in subsection 3.6.1 above are permitted only if either:
a. The disclosures are required by law, or
b. Business Associate obtains reasonable assurances from the person to whom the
information is disclosed that the information will remairi confidential and used or
further disclosed only as required by law or for the purposes for which it was
disclosed to the person, and that the person will notify Business Associate of any
instances of which it is aware in which the confidentiality of the information has
been breached.
3.7 AGGREGATION
Business Associate may use PHI to provide data aggregation services relating to the health
care operations of the HCA, if those services are part of the Contract.
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4 Activities of HCA
4.1 NOTICE OF PRIVACY PRACTICES
HCA will provide a copy of its current notice of privacy practices under the Privacy Rule to
Business Associate on request. HCA will also provide any revised versions of that notice by
posting on its website, and will send it on request.
4.2 CHANGES IN PERMISSIONS
HCA will notify Business Associate of any changes in, or revocation of, the permission by an
individual to use or disclose his or her PHI, to the extent that such changes may affect Business
Associate's use or disclosure of PHI.
4.3 RESTRICTIONS
HCA will notify Business Associate of any restriction on the use or disclosure of PHI that HCA
has agreed to or is required to abide by under 45 CFR § 164.522, to the extent that such
restriction may affect Business Associate's use or disclosure of PHI. Business Associate will
comply with any such restriction.
5 Term and Termination
5.1 TERM
5.1.1 This Agreement is effective as of the earliest of:
a. The first date on which Business Associate receives or creates PHI subject to this
Agreement, or
b. The effective date of the Contract, or if there is more than one Contract then the
effective date of the first one to be signed by both parties.
5.1.2 This Agreement continues in effect until the earlier of.
a. Termination of the provision of Services under the Contract or, if there is more than
one Contract, under the last of the Contracts under which services are terminated,
b. The termination of this Agreement as provided below, or
c. The written agreement of the parties.
5.2 TERMINATION FOR CAUSE
HCA may terminate this Agreement and the Contract (or either of them), if HCA determines
Business Associate has violated a material term of the Agreement. The termination will be
effective as of the date stated in the notice of termination.
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6.3 OBLIGATIONS OF BUSINESS ASSOCIATE UPON TERMINATION
The obligations of the Business Associate under this subsection 5.3 survive the termination of
the Agreement. Upon termination of this Agreement for any reason, Business Associate will:
5.3.1 Retain only that PHI that is necessary for Business Associate to continue its proper
management and administration or to cavy out its legal responsibilities;
5.3.2 Return to HCA or, if agreed to by HCA, destroy the PHI that the Business Associate
and any subcontractor of Business Associate still has in any form (for purposes of this
subsection 5.3, to destroy PHI is to render it unusable, unreadable, or indecipherable
to the extent necessary to establish it is not Unsecured PHI, and Business Associate
will provide HCA with appropriate evidence of destruction within ten days of the
destruction);
5.3.3 Continue to use appropriate safeguards and comply with the Security Rule with respect
to electronic PHI to prevent use or disclosure of the PHI, other than as provided for in
this Agreement, for as long as Business Associate retains any of the PHI (for purposes
of this subsection 5.3, If the PHI is destroyed it shall be rendered unusable, unreadable
or indecipherable to the extent necessary to establish it is not Unsecured PHI.
Business Associate will provide HCA with appropriate evidence of destruction);
5.3.4 Not use or disclose any PHI retained by Business Associate other than for the
purposes for which the PHI was retained and subject to the same conditions that
applied before termination;
5.3.5 Return to HCA, or, if agreed to by HCA, destroy, the PHI retained by Business
Associate when it is no longer needed by Business Associate for its proper
management and administration or to cant' out its legal responsibilities; and
5.3.6 Business Associate's obligations relating to providing information to the Secretary and
other government survive the termination of this Agreement for any reason.
6.4 SUCCESSOR
Nothing in this Agreement limits the obligations of Business Associate under the Contract
regarding giving data to HCA or to a successor Business Associate after termination of the
Contract.
6 Miscellaneous
6.9 AMENDMENT
The Parties agree to take such action as is necessary to amend this Agreement from time to
time as is necessary for compliance with the requirements of the HIPAA Rules and any other
applicable law.
6.2 INTERPRETATION
Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA
Rules.
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6.3 HCA CONTACT FOR REPORTING AND NOTIFICATION REQUIREMENTS
Business Associate will address all reporting and notification communications required in this
Agreement to:
HCA Privacy Officer
Washington State Health Care Authority
626 8th Avenue SE
PO Box 42700
Olympia, WA 98504-2700
Telephone: 360-725-1116
E-mail: PrivacyOffrcerd@hca.wa.gov
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Schedule A
Statement of Work
1. Performance Work Statement. The Contractor shall serve as the Initiation Site and be
responsible for:
a. Bringing MAT initiation, referral, and retention to an individual prior to his or her transfer to
the Local MAT Treatment Site, ensuring MAT capacity is maintained at both the Initiation
and Local MAT Treatment Site(s).
b. Serving as the lead organization and recipient of funding for the development and
implementation of an Opioid Treatment Network model for adults with an Opioid Use
Disorder who are Medicaid eligible or low income. OTN will give priority to:
(1) Individuals at highest risk of overdose and death.
(2) Tribal members to address their OUD needs.
(3) MAT services for Pregnant and Parenting individuals with OUD.
(4) MAT services for IV drug users.
c. Ensuring services at the Initiation Site and Local MAT Treatment Site(s) begin no later than
February 1, 2019.
d. Monitoring and ensuring MAT is initiated to a minimum of 126 unique individuals no later
than September 29, 2019 at the Initiation Site.
e. Holding responsibility for oversight of the OTN, and ensuring the Local MAT Treatment
Site(s) are working in coordination (including participation in regularly scheduled leadership
meetings and educational and technical assistance opportunities) and meet the terms of
the project, contract, goals and project deliverables.
f. Ensuring travel per diem, computers, office supplies, and all other supplies and tools
necessary to perform defined duties are provided to staff at the Initiation Site and Local
MAT Treatment Site(s) (through contract).
g. Ensuring a low -barrier medication model.
h. Providing both agonist and antagonist MAT medications (on-site or in relationship with a
pharmacy) in order to facilitate initial inductions and ongoing treatment.
Providing intensive services by developing a central Initiation Site to provide MAT, and a
warm hand-off to a Local MAT Treatment Site(s) for continuity of care through the usage of
a coordinated network team and processes. Local MAT Treatment Site(s) will provide
referrals for other behavioral health and ancillary services necessary to address the
individual's holistic medical and recovery needs, including tobacco cessation services
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when appropriate. Build, strengthen, and maintain referral relationships between Initiation
Site and Local MAT Treatment Site(s).
j. Hiring and/or contracting up to 2.0 FTEs to cover the functions listed below at the Initiation
Site. Through subcontracting, provide for staffing at Local MAT Treatment Site(s). Specific
staffing arrangements will be determined by Initiation Site. The following functions are
required (individual staff may perform multiple functions):
(1) OTN Nurse Care Manager (NCM): The NCM's primary responsibilities are to provide
medical support to the prescribing physicians or other waivered practitioners. Duties of
the NCM will include, but are not limited to: individual screening, MAT education,
assisting with MAT inductions, taking vital signs, drug testing, lab work, medical
assessments, charting, care planning, stabilization, observation and maintenance,
ongoing coordination of follow-up care, relapse prevention, and support for an
individual's self-management.
(2) OTN Care Navigator: The Care Navigator expedites enrollment into Medicaid as
necessary, conducts screenings, assessments and evaluations, provides education,
and coordinates referrals for MAT (and tobacco cessation services if appropriate).
Care Navigators assist with data collection requirements and facilitate referrals for
infectious disease screenings, housing, employment services, withdrawal management
services, transportation, referral to OUD or behavioral health counseling, and provide a
warm hand-off to a MAT provider upon an individual's transfer from any current
treatments.
(3) OTN Data Collection Coordinator (Coordinator): The Coordinator is responsible for
managing all data collection activities and serves as the liaison between the OTN,
DBHR and RDA. The Coordinator must become competent in all aspects of GPRA
data collection required for this project (including completion of SAMHSA GRPA
training) and be available and responsive to project evaluators.
(4) OTN MAT Prescriber: Continue to employ and or contract at least one prescriber and
at least one back-up prescriber with a current DATA -2000 Waiver (in case of primary
prescriber absence) at the Initiation Site.
k. Ensuring specific tools, such as job descriptions and statements of work, are developed to
ensure consistent practice throughout the OTN.
I. Obtain Tobacco Treatment Specialist (TTS) certification by completing the 240 post -
training service hours required for the certification.
m. Identifying, collaborating, and subcontracting with Local MAT Treatment Site(s) that are
willing to support and embrace MAT and are responsible for providing integrated care that
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includes therapy, SLID counseling, outreach, MAT education, case management, tobacco
cessation services, and/or referral services.
n. Ensuring policies and procedures are in place throughout the OTN to mitigate medication
diversion.
o. Securing and maintaining release -of -information forms that meet federal confidentiality
regulations and allow the release of patient identifying information between Initiation Site
and Local MAT Treatment Site(s) and to DSHS RDA for the purpose of program
monitoring and performance evaluation.
p. Working collaboratively with the University of Washington Alcohol and Drug Abuse Institute
Technical Assistance staff to identify training needs and participate in peer-to-peer and
educational teaming opportunities including the utilization of EBPs.
q. Meeting at a minimum, monthly (phone or in-person) with the HCA Contract Manager or
SOR Project Director or Treatment Manager to discuss project contract requirements,
compliance, technical assistance needs, and problem -solving.
r. Ensuring the use of a certified electronic health record system, and review of the
Prescription Monitoring Drug Program data, when available and appropriate.
s. Ensuring patient assessments utilized for MAT treatment services are consistent and
transferable across the Opioid Treatment Network.
t. Data Collection Requirements shall include:
(1) Government Performance and Results Act (GPRA):
(a) OTNs are required to have staff collect data on all individuals receiving services at
the Initiation Site (and subsequent MAT services received). The data collection
consists of multiple individual interviews and a participant log. Inflation Sites are
responsible for ensuring data collection for individuals prior to and after warm hand -
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offs, including coordination of data collection with Local MAT Treatment Site(s)
staff.
(b) Participant interviews are based on the GPRA Client Outcome Measures Tool.'
OTN staff will conduct face-to-face interviews, compile answers, and enter the
results into the web -based, SAMHSA Performance Accountability and Reporting
System (SPARS) or aftemative data collection system.z OTN staff must collect
survey data at four points for each individual served:
(c) Intake: GPRA Baseline interview is to be completed as soon as possible with every
individual who begins MAT at a facility in your network.
(d) Three-month follow-up: completed from one month before to two months after the
scheduled follow-up date --regardless of an individual's discharge status. OTNs
failing to complete 80 percent of follow-up surveys must submit corrective action
plans and demonstrate improved performance.
(e) Six-month follow-up: completed one month before to two months after the
scheduled follow-up date --regardless of individual discharge status. OTNs failing
to complete 80 percent of follow-up surveys must submit corrective action plans
and demonstrate improved performance.
(f) Discharge: to be completed within 15 days for all individuals leaving treatment.
Administrative discharges (without interviews) are required for those lost to follow-
up.
(g) SAMHSA's Performance Accountability and Reporting System (SPARS) accounts,
online training, and survey templates will be provided to OTNs (unless an
1 httos://www.samhsa.gov/sites/default/files/GPRA/sais aura client outcome instrument final.pdf A shorter version of this
instrument will be used for this grant, however, it has not yet been finalized.
2 Your staff must enter surveys into SPARS within seven days. When the interview takes place, say, prior to or after
induction will depend on the setting individuals, and workflows.
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alternative system is identified); Project Evaluation (RDA) will provide OTN staff
with technical assistance as needed.
(h) GPRA Client Outcome Tool Implementation Delay: There will be a delay in
implementation of the GPRA tool. Sites will not be considered out of compliance
during this delay period by SAMHSA. RDA and SOR Treatment Manager will
inform Initiation Sites of the required start dates for GPRA data collection and
training.
(2) Research and Data Analysis (RDA): Maintain and submit monthly through a secure
DSHS portal to RDA, a participant data log template (to be provided) from the Initiation
Site only that includes, but is not limited to the following for every new MAT treatment
episode:
First name, last name and middle initial; date of birth; Social Security Number, gender;
race; ethnicity; treatment start date (induction date); MAT drug prescribed (methadone,
Bup-mono, Bup-combo, Naltrexone -Injectable; Naltrexone -Oral), transfers to Local
MAT Provider, discharge date and discharge status (completed, transferred or lost to
follow up).
(3) DBHR: Submit a Monthly Report as detailed in the Deliverables Table with the invoice
to the DBHR Contract Manager, including, but not limited to: the number of individuals
inducted and successfully transferred to local MAT treatment, barriers and successes,
technical assistance needs and staff changes.
u. Promoting abstinence from tobacco products (except with regard to accepted tribal
traditional practices) and integrating tobacco cessation strategies, medications and
services in coordination with the Department of Health's (DOH's) Tobacco and Vapor
Product Prevention and Control Program (TVPPCP).
(1) Training of two (2) staff as Tobacco Treatment Specialists (TTS) to incorporate tobacco
cessation as part of treatment (direct training costs will be covered by DOH, and the
240 service hours required for TTS certification are eligible for partial reimbursement
through this contract).
(2) General tobacco -free training of three (3) additional staff on the best practices of
tobacco use screening and cessation counseling with individuals in SUD treatment,
including training on cross -addiction, application of the Screening, Brief Intervention,
and Referral to Treatment (SKIRT) model of SUD treatment to the Ask, Advise, and
Refer model of nicotine dependence treatment.
(3) Ongoing technical assistance from TVPPCP for tobacco cessation practices and
implementation of tobacco -free facility policies.
Washington State Page 66 of 72 SK
Health Care Authority Attachment
v. Participating in a pilot program in which patients are referred for tailored, augmented
tobacco cessation services through the Washington State Tobacco Quitline (WAQL). This
pilot program will include the following:
(1) Training of staff on WAQL referral and feedback reporting processes.
(2) Provision of augmented tobacco cessation services, including up to seven (7)
telephone counseling calls and 12 weeks of nicotine replacement therapy, annually,
per individual.
(3) Reporting of patients' tobacco cessation progress.
w. Assisting in the preparation of reports (e.g., SAMHSA Annual Report, SAMHSA Bi -annual
Report) and other data requested by SAMHSA, their designee, or the HCA Contract
Manager.
x. Ensuring the utilization of third party and other revenue realized from provision of services
to the extent possible and use SAMHSA grant funds only for services to individuals who
are not covered by public or commercial health insurance programs, or for services that
are not sufficiently covered by an individual's health insurance plan. Facilitate the health
insurance application and enrollment process for eligible uninsured clients.
Washington State Page 67 of 72 /t(
Health Care Authority Attachment
2. Deliverables Table:
Deliverable
Due Date
Up to
1
Startup phase — copies of signed
January 14, 2019
$50,000
agreements with Local MAT Treatment
Site(s) (including Data Share Agreements
among Initiation Local MAT Treatment
Sites)
2
Required staff hired as listed in 3.j.
March 1, 2019
$35,000
3
Provision of services by February 1, 2019
February 1, 2019
$60,000
4
Monthly Reports to HCA Contract
Due by the second
$140,000
Manager including the items listed in
Wednesday of the
3.s.(2) and (3) of this contract as well as
month following the
updates on progress, number of unique
month in which
individuals served, and Monthly Reports
services were
to RDA, compiled data of Local MAT
provided
Treatment Site referrals and services
including the breakdown of agonists and
antagonists ($20,000 per month x 7
months = $140,000)
5
Tobacco Treatment Specialist (TTS)
Due by the last day of
$13,000
certification — This will partially reimburse
the month following
OTN contractors for provider time spent
the month in which
counseling clients, after completing the
certification was
240 post -training service hours required
received
for the certification.
6
Provision of services to a minimum of 18
Due by the second
$126,000
unique individuals per month, starting
Wednesday of the
March 2019 (18 individuals per month x 7
month following the
months x $1,000= $126,000)
month in which
(Payment will be prorated if minimum
services were
numbers are not met)
provided
7
Benchmark payment for serving 126
September 29, 2019
$39,000
unique individuals (an average of 18
unique individuals per month) and meet
an overall individual retention of 50% over
the period covered by this Contract. Note:
If this benchmark payment is earned,
Contractor shall also be entitled to bill, up
to the maximum amount that remains
available for payment under
Deliverable 6, a pro rata payment of
$1,000 for each unique individual whom
Contractor has served but for whom
payment could not be received under the
payment terms applicable to Deliverable
6. In no event shall more than a total of
Washington State Page 68 of 72 SK
Health Care Authority Attachment
$165,000 be payable under this
Deliverable 7 combined with payment
under Deliverable 6.
TOTAL $463,000
3. Federal Award Identification (reference 2 CFR 200.331) — SOR Grant CFDA#93.788
(i)
Subrecipient name (which must match the name
Jefferson County
associated with its unique entity identifier);
(ii)
Subrecipient's unique entity identifier; (DUNS)
619143741
(iii)
Federal Award Identification Number (FAIN);
H79TIO81705
(iv)
Federal Award Date (see §200.39 Federal award
9/19/18
date);
(v)
Subaward Period of Performance Start and End
12/31/2018 to 09/29/2019
Date;
(vi)
Amount of Federal Funds Obligated by this
$463,000
action;
(vii) Total Amount of Federal Funds Obligated to the
$463,000
subrecipient;
(viii)Total Amount of the Federal Award;
$21,573,093
(ix)
Federal award project description, as required to
Washington State Opioid Response (SOR) Grant
be responsive to the Federal Funding
Accountability and Transparency Act (FFATA);
(x)
Name of Federal awarding agency, pass-through
Department of Health and Human Services,
entity, and contact information for awarding
Substance Abuse and Mental Health Services
official,
Administration, Center for Substance Abuse
Treatment
Washington State Health Care Authority
Division of Behvavioral Health and Recovery
Michael Langer, Director
Post Office Box 45330
Olympia, WA 98504-5330
(xi)
CFDA Number and Name; the pass-through
93.788
entity must identify the dollar amount made
available under each Federal award and the
CFDA number at time of disbursement;
Washington State Page 69 of 72
4K
Health Care Authority Attachment
(xii) Identification of whether the award is R&D; and
❑ Yes ® No
(xiii)Indirect cost rate for the Federal award
de minimis (101/o)
(including if the de minimis rate is charged per
§200.414 Indirect (F&A) costs).
Washington State Page 70 of 72 #K
Health Care Authority Attachment
Exhibit A
Available upon request from the HCA Contracts Administrator.
Washington State Page 71 of 72 S(
Health Care Authority Attachment
Exhibit B
Available upon request from the HCA Contracts Administrator.
Washington State Page 72 of 72 #K
Health Care Authority Attachment
RFA EXHIBITS
EXHIBIT A
3.3. Application Face Page
This document can be downloaded at httos://fortress.wa.coy/ga/webs/.
Please complete this two page form and submit it as the first page of your application.
! Applicant information
Please type responses or mark selections
in this column only.
F
Community name (service area(s)
; Jefferson County Jail
where proposed services will be
Jefferson County, Clallam County, and Kitsap
provided)
County
Applicant Organization Contact Person
David Fortino
j Name
i
Applicant Organization Contact Person
i Jail Superintendent
Title
s
i
Applicant Organization Contact Person
dfortino@0jefferson.wa.us
Email
Applicant Organization Contact Phone
360-344-9743
Number
' Applicant Organization Name
; Jefferson County Sheriffs Office
I
Applicant Organization Mailing Address
I
1 79 Elkins Road, Port Hadlock, WA 98339
i
Applicant Organization Organization's
DUNS number
' 619143741
Applicant Organization Zip code + 4
! 98339-9700
(assigned by the US Postai Service)
Applicant Organization Applicant type
H Government agency/ Public agency
❑ Non-profit
j County
i
Jefferson
HCA RFA No. K 3300
EXHIBIT B
Project Narrative — 80 Points - 80% of total score
1. Overview (20 Total Points)
a. Provide a brief overview of how your organization proposes to implement OTNs in your
community. Identify potential Local MAT Treatment Sites, including the organization
name, location, and MAT prescriber(s). (4 points)
The Jefferson County Sheriff's Office proposes to establish an OTN in partnership with Olympic
Peninsula Health Services (OPHS) to provide MAT to incarcerated individuals in the County
Jail. The County Jail will be the `Initiation Site' for induction of incarcerated individuals who
would benefit from MAT. To ensure continuity of care, OPHS will be contracted to provide both
initiation site MAT in the County Jail as well as post -release MAT in the local community. This
will ensure that the MAT provider has developed a rapport and relationship with the patient and
will provide a seamless `warm hand-off from incarceration to community clinic setting.
OPHS will provide Prescriber, Nurse Care Manager, Care Navigator, and Data Collection
functions for the OTN that will be shared between the initiation site and the local MAT treatment
site as detailed in the budget template. In addition to MAT, OPHS will provide tobacco cessation
services and will address social service and other needs in collaboration with local organizations
including Safe Harbor Recovery Center (outpatient chemical dependency counseling), Believe in
Recovery (outpatient substance abuse treatment), Specialty Services (inpatient rehab and medical
detox), Dove House Advocacy Service (domestic abuse shelter and counseling), Pregnancy
Resource Center, and Olympic Community Action Programs (OlyCAP), as well as Jefferson
County Public Health and Jefferson County Drug Court.
OPHS is a new State Hub for opioid treatment as well as a Local MAT Treatment Site and
operates in multiple locations in Jefferson and Clallam counties with 5 MAT prescribers. Other
potential Local MAT Treatment Sites include: Jefferson Healthcare, operating out of Port
Townsend, with 20 -plus MAT prescribers serving Jefferson and surrounding counties; and
Sound Integrated Health, operating out of Bremerton and Tacoma, with 7 MAT prescribers
serving nearby Kitsap and Pierce counties.
b. Include how you will address the OUD needs of American Indians/Alaska Natives,
veterans, incarcerated individuals, pregnant and parenting individuals,
underinsured/uninsured individuals, and other marginalized populations. (4 points)
The County Jail, as the initiation site for MAT, will connect incarcerated individuals (which
includes American Indians/Alaska Natives, veterans, underinsured/ uninsured, and other
marginalized populations) to effective opioid treatment. Well over half those incarcerated in the
County Jail meet the criteria for drug dependence or abuse. All individuals entering the County
Jail will be screened for OUD. MAT will be started with appropriate inmates during
incarceration and then continued post -release in a community-based clinic setting. OPHS will
provide referrals to tribal health, PCAP, VA, and agencies focused on specific demographics
when appropriate. As the majority of incarcerated individuals qualify for Medicaid, OPHS Care
Navigators will work with the County Jail to assure that inmates have applied for healthcare
prior to release and will coordinate care during follow-up as needed. Data on veteran status and
underinsured/uninsured status will be collected as part of this program.
c. Briefly describe the demographics of the population and community you intend to serve. In
your narrative, include DOH overdose rates by county, population and current placement
of existing HAS and other available MAT services. (8 points)
The proposed OTN will serve incarcerated individuals in the 57 -bed County Jail. In 2017 there
were 1,258 bookings in the County Jail. The incarcerated population is predominately made up
of Jefferson County residents but also includes individuals from neighboring Clallam, Kitsap,
and other counties. The population of Jefferson County is 31,590 with 25% receiving Medicaid
assistance. The percentage of Jefferson County Medicaid enrollees with history of OUD is
similar to neighboring counties but their initiation to MAT has been found to be below average.
2.2% of the population identifies as American Indian/Alaska Native. DOH reported 15 opioid -
related overdose deaths in Jefferson County for 2012-2016, a rate of 10.3 per 100,000
population. In 2017 there were I 1 hospitalizations and 3 deaths related to opioid overdose in
Jefferson County.
OPHS, based in Port Hadlock, is a new State Hub to serve Jefferson and Clallam counties. OPHS
works closely with Sound Integrated Health which has clinics in Bremerton and Tacoma.
Peninsula Community Health Services based in Bremerton is the existing State Hub operating
from Kitsap County. SAMHSA currently lists 12 buprenorphine prescribers in Jefferson County.
d. Describe your plans for integrating tobacco cessation into your behavioral health service
milieu. (4 points)
OPHS will provide tobacco cessation services for the proposed OTN and will provide
intervention screening using the 5 -A's (Ask, Advise, Assess, Assist, Arrange). The Fagerstrbm
tool will be used to assess nicotine dependence and treatment recommendations, to include
nicotine replacement therapy and medications, as appropriate.
e. Describe the specific technical assistance and training you will need to implement this
scope of work. (O points)
County Jail and OPHS staff will access SAMHSA resources for technical assistance and training
to help understand and comply with GPRA data collection and SPARS reporting requirements.
We will also reach out to other OTNs regarding lessons learned with specific emphasis on the
challenges involving incarcerated individuals.
2. For Initiation Sites: Describe your ability to implement MAT coordination by
December 31, 2018 (15 Total Points)
a. Describe your relationships with medical providers and MAT champions in your
community and network (S points)
The County Jail currently contracts with Healthcare Delivery Systems (HDS) for medical
services. Shannon Slack coordinates HDS services in the County Jail. Slack is a MAT treatment
provider and recognizes the need to expand MAT access. She supports the role of the County Jail
as an Initiation Site for the proposed OTN and the partnership with OPHS to provide MAT.
The County Jail is closely partnering with Olympic Peninsula Health Services (OPHS), the new
State Hub, to provide both initiation site MAT in the County Jail as well as post -release MAT in
the local community. Communication protocols between the County Jail, HDS and OPHS are
being developed to ensure coordination of care. Both the County Jail and OPHS maintain a
strong working relationship with Jefferson Healthcare, another MAT provider in the community.
b. Describe potential barriers to overcome in order to implement service coordination by
December 31, 2018. (3 points)
The biggest challenge – identification of a MAT provider for both inside the County Jail and for
post -release follow-up – has been resolved through partnership with OPHS. The proposed OTN
has the capacity to begin MAT inductions immediately. Other potential barriers involve
modifying the workflow to incorporate OUD screening and data collection. OUD screening will
be added to the booking process. Hiring qualified staff in a rural county can also be a barrier.
c. Describe your ability to establish 42 CFR Part 2 -compliant Releases of Information (ROIs)
with community and network service providers. (S points)
During assessment in the County Jail, MAT patients will sign consent forms and 42 CFR Part 2 -
compliant ROI for follow-up with community providers. If post -release follow-up is conducted
through OPHS clinics, the ROI will be redundant since OPHS will be handling assessment,
induction and follow-up treatment for the patient.
d. What screening or assessment instruments do you plan on utilizing to identify individuals
appropriate for MAT? (2 points)
We will use validated tools for addiction diagnosis and assessment including NIDA Quick
Screen, Fagerstrom (for nicotine), AUDIT -C, CRAFFT, and DSM -V for opioid use disorder.
3. Describe your potential MAT prescribing capacity (15 Total Points)
a. List your data -waived prescribers at Initiation Site, including available capacity for each
prescriber. (S points)
Initiation Site MAT prescribing will be provided by OPHS with a capacity of approximately 700.
Other prescribers will be added soon. Current OPHS data -waived prescribers include:
Atif Mian, MD – 275
Ronald Bergman, MD – 275
Ana Vasquez, ARNP – 30
Tina Lenson, ARNP – 30
Annie Failoni, ARNP – 100
b. For potential Local MAT Treatment Site(s), describe available MAT participant capacity, a
current average monthly census, and potential for MAT capacity expansion. (5 points)
Local MAT Treatment Site prescribing will be provided by OPHS, located in Port Hadlock and
another clinic opening soon in Port Angeles. OPHS has multiple data -waived prescribers with an
available MAT participant capacity of approximately 700. Current monthly MAT prescriptions
are approximately 350. Other prescribers will be added soon to increase capacity over 700.
c. Describe your plan for when prescriber capacity is full—how will individuals be admitted
and/or referred to other prescribers? (5 points)
OPHS, our MAT partner has current prescriber capacity to meet the OTN needs. OPHS capacity
will increase in the next 2-3 months to accommodate future needs. Overflow patients can be
transferred to other local MAT providers. We will continue to maintain a strong relationship with
Jefferson Healthcare, another local provider, in case additional capacity is needed.
d. What MAT medications will your proposed Initiation Site and proposed Local MAT
Treatment Site(s) prescribe? (0 points)
Medications for opioid dependence, including Buprenorphine, an opioid agonist, and Naltrexone,
an opioid antagonist, will be available at both sites.
4. Describe collaboration approach with Local MAT Treatment Sites (15 Total Points)
a. Describe referral procedure from Initiation to Local MAT Treatment Sites)—specifically,
Me "warm hand -q " Process. (S points)
To ensure continuity of care, OPHS will be contracted to provide both Initiation Site MAT in the
County Jail as well as post -release MAT at their Local MAT Treatment Site in the community.
This will ensure that the MAT provider has developed a rapport and relationship with the patient
and will provide a seamless `warm hand-off from incarceration to community clinic setting
without the usual barriers. Before release, follow-up appointments will be coordinated with the
OPHS clinic and all pertinent information will be shared. Follow-up in the local clinic will be
scheduled to occur the same day and no later than the day following release. At time of release,
an inmate's family and friends will be enlisted to facilitate the transfer to the nearby OPHS
clinic. If necessary, other transportation options can be arranged by the Care Navigator.
b. Describe approach to ensure the individual's treatment continues without interruption
from Initiation Site to Local MAT Treatment Site. (S points)
The proposed OTN will utilize the same MAT provider (OPHS) for MAT treatment both inside
the County Jail and in the community. This will ensure that the MAT provider is familiar with
the patient, has developed a rapport and relationship with the patient and will provide a seamless
follow up from incarceration to community clinic setting. This will also reduce 42 CFR Part 2 -
compliant ROI issues. OPHS staff performing the Care Navigator function will ensure that
appropriate transportation is in place for the inmate to get to the clinic following release.
OPHS will induct appropriate inmates into MAT during incarceration using Vivitrol so that they
have adequate MAT prior to release and then to continue MAT for several weeks post -release.
Accurate and detailed contact information will be obtained by the Care Navigator so that strong
connections can be maintained with the MAT patient after their release from the County Jail. The
MAT patient will receive frequent prompts to follow up in the OPHS outpatient clinic. The Care
Navigator will work on identifying barriers to this follow-up and reduce or eliminate them as
able. The Care Navigator will work on any pre- and post -release issues identified as well.
c. Describe communication and follow-up plan between Initiation and Local MAT Treatment
Sites. (S points)
The proposed OTN will utilize the same MAT provider (OPHS) for MAT treatment both inside
the County Jail and in the community which will streamline communication between Initiation
and Local MAT Treatment Sites and provide for seamless, barrier -free follow-up. The Care
Navigator will liaison with the County Jail, HDS, and OPHS to foster and maintain open
channels of communication for integration of care.
5. SOR OTN Application Requirement: Data Collection (15 Total Points)
a. Describe the qualifications and work effort of staff arcigned to manage and oversee all
data collection activities and how the OTN will ensure continuity of this resource,
including your training plan for staff' conducting interviews and compiling or entering
data. (S points)
For continuity the Prescriber, Nurse Care Manager, Care Coordinator, and Data Collection
Coordinator functions will be performed for both the Initiation Site and the Local MAT
Treatment Site by OPHS staff in a shared capacity as detailed in the budget template.
Preliminary screening for OUD and preliminary data collection at the County Jail will be
conducted by Commissioned Corrections Officers during the booking process. Incarcerated
individuals who are positive on the OUD screen will be referred for initial assessment and
follow-up within 12 hours of booking to an experienced RN/LPN (or similar level) Nurse Care
Manager. Follow-up interviews as well as data collection and reporting will be conducted by an
RN/LPN (or similar level) Care Coordinator and Data Collection Coordinator. An MD or ARNP
Prescriber will conduct medical evaluations, add any additional data needed, and start
incarcerated individuals on MAT if appropriate. County Jail and OPHS staff will access
SAMHSA resources for technical assistance and training to help understand and comply with
GPRA data collection and SPARS reporting requirements. Staff will also work with UW AIMS
and UW AID center for education and training as needed.
b. Describe your workflow and staffing for maintaining participant log (or logs, if multiple
Local MAT Treatment Sites). Include your workflow for completing intake, 3 -month, 6 -
month, and discharge surveys and entering data into SPARS. (S points)
County Jail staff will conduct initial OUD screening at the time of booking. Incarcerated
individuals who are positive on the OUD screen will be referred to the Nurse Care Manager for
assessment and if warranted MAT induction with the Prescriber. OPHS staff performing the Care
Manager and Data Collection functions will keep a log of incarcerated individuals referred for
assessment as well as those started on MAT. Post -release, 3-, and 6 -month data will be collected,
compiled, and entered into SPARS by County Jail and OPHS staff performing the Data
Collection function.
c. Describe your strategies for meeting 80 -percent completion rate for 3 -month and 6 -month
follow-up surveys. Describe how you will complete follow-up surveys for individuals who
have left your care, including coordination with the Local MAT Treatment Site related to
data collection. (S points)
OPHS, the Local MAT Treatment Site for this OTN, will follow MAT patients after release from
custody and will maintain solid connections during and after treatment using the detailed contact
information collected pre-release by the Care Navigator. OPHS staff performing the Data
Collection function will continue to track MAT patients and collect necessary data throughout
and after MAT treatment, including MAT patients who have left care.
EXHIBIT C
Bu Narrafte and Sudgot Tem late 20 Points - 20% of total score
Budget Narrative: Your budget narrative should detail each element within your submitted Budget. A
Budget Template is provided below. Any variations to the Budget Template must be explained thoroughly
so evaluators will understand the variance and justification. Attach additional Budget Templates as
necessary to describe additional Local MAT Treatment Sites.
Budget Template:
WA State - SOR Opioid
Treatment Network Budget
Annual Budget
Annual
Monthly
Personnel
FTE %
Salary
Salary only
Benefits
TOTAL
Personnel -Initiation Site
1.75
Prescribers
0.5
$5,000
$60,000
$9,000
$69,000
Nurse Care Manager CM
0.25
$1,875
$22,500
$3,375
$25,875
Care Navigators
0.5
$2,083
$25,000
$3,750
$28,750
Data Collection Coordinators
0.5
$2,083
$25,000
$3,750
$28,750
Personnel -Local MAT
Treatment Site(s)
1.5
Prescribers
0.5
$5,000
$60,000
$9,000
$69,000
Nurse Care Manager C
0.5
$3,750
$45,000
$6,750
$51,750
Care Navigators (CN)
0.5
$2,083
$25,000
$3,750
$28,750
Personnel Subtotal
3.25
$21,874
$262
$39,375
$301,875
Other
Costs/Supplies/Travel
TOTAL
MAT Medications
$115,500
Computers/Software
$10,000
Phone
$2,500
Office Supplies
$2,500
Printing/duplicating
$1,000
Data en
$500
Travel
$11,125
OTN Development
$5,000
Other
Costs/Supplies/Travel/
OTN Development
Subtotal
$148,125
Total
S450,000
Indirect Cost
0
Grand Total
$450,000
EXHIBIT D
1.4. Letters) of Commitment from Local MAT Treatment Sties
Olympic Peninsula Health Services
661 Ness Corner Road
Port Hadlock, WA 98339
PH 360-912-5777
FX 206-472-6035
Olympic Peninsula Health Services PS is committing to work in collaboration with Jefferson County Jail
and the Sheriff Department in evaluating and treating patients with Opioid Use disorder.
We are a group of providers and ancillary staff that has been delivering MAT in Jefferson, Kitsap and
Pierce County for many years and soon to be providing services in Clallam County. We are well versed
with the challenges these patients face as we currently work with the legal system. We have adequate
prescriber capacity to treat a high volume of patients with OUD and other addictions.
We will provide MAT services in the jail to incarcerated individuals and follow them post release in our
local clinic. We will provide MAT prescribers to the jail along with a nurse manager and a care navigator
to assist in coordination of care for MAT patients both inside and outside the jail. Patients going to other
community MAT providers will also be followed. Data will be collected for all patients at initiation, 3, 6
months for GPRA requirements.
We also work with the local counseling agencies and will continue to coordinate care with them. Along
with MAT we will begin screening all patients for tobacco use and provide counseling and treatment for
such as needed.
Annie Failoni President OPHS
EXHIBIT E
3.7. Certifications and Assurances
IMre make the following certifications and assurances as a required element of the proposal to which
it is attached, understanding that the truthfulness of the facts affirmed here and the continuing
compliance with these requirements are conditions precedent to the award or continuation of the
related contract:
1. 1/we declare that all answers and statements made in the proposal are true and correct.
2. The prices andlor cost data have been determined independently, without consultation,
communication, or agreement with others for the purpose of restricting competition. However,
I/we may freely join with other persons or organizations for the purpose of presenting a single
proposal.
3. The attached proposal is a firm offer for a period of 120 days following receipt, and it may be
accepted by HCA without further negotiation (except where obviously required by lack of certainty
in key terms) at any time within the 120 -day period.
4. In preparing this proposal, I/we have not been assisted by any current or former employee of the
state of Washington whose duties relate (or did relate) to this proposal or prospective contract,
and who was assisting in other than his or her official, public capacity. If there are exceptions to
these assurances, Itwe have described them in full detail on a separate page attached to this
document.
5. ltwe understand that HCA will not reimburse me/us for any costs incurred in the preparation of
this proposal. All proposals become the property of HCA, and I/we claim no proprietary right to
the ideas, writings, items, or samples, unless so stated in this proposal.
6. Unless otherwise required by law, the prices and/or cost data which have been submitted have
not been knowingly disclosed by the Applicant and will not knowingly be disclosed by him/her
prior to opening, directly or indirectly, to any other Applicant or to any competitor.
7. I/we agree that submission of the attached proposal constitutes acceptance of the solicitation
contents and the attached sample contract and general terms and conditions. If there are any
exceptions to these terms, Uwe have described those exceptions in detail on a page attached to
this document.
8. No attempt has been made or will be made by the Applicant to induce any other person or firm to
submit or not to submit a proposal for the purpose of restricting competition.
9. I/we grant HCA the right to contact references and other, who may have pertinent information
regarding the ability of the Applicant and the lead staff person to perform the services
contemplated by this RFA.
10. If any staff member(s) who will perform work on this contract has retired from the State of
Washington under the provisions of the 2008 Early Retirement Factors legislation, his/her name(s)
is noted on a separately attached page.
We (circle one) are /submitting proposed Contract exceptions. If Contract exceptions are
being submitted, Itwe have attached them to this form.
On behalf of the Applicant submitting this proposal, my name below attests to the accuracy of
the above statement. K electronic, also include: We are submitting a scanned signature of
this form with our proposal.
r
w
Signature of A rcant
iz
Title Datd
HCA RFA No_ K 3300
EXHIBIT F
4.6 Contractor Intake Form
I - Ident"ng Information
A) Contractor Legal Name:
B) DBA or Facility Name:
JEFFERSON COUNY
SHERIFF'S OFFICE
C) WA Uniform Business Identifier (UBI) Number:
D) Taxpayer Identification Number
161-001-169
(TIN):
91-0001322
E) State Wide Vendor Number (SWV#):
E) Funding Amount (ALL
0002430-29
amendments included):
2 - Contractor Address
A) Number, Street, Apartment/Suite:
79 ELKINS RD
B) City, State, Zip Code:
PORT HADLOCK, WA 98339
C) Email Address: D) Phone Number:
(360) 385-3831
3 - ContractorNendor Primary Contact
A) Full Name:
B) Job Title:
DAVID FORTINO
JAIL SUPERINTENDENT
C) Email Address:
D) Phone Number:
DFORTI O.JEFFERSON.WA.US
360 344-9743
Authorized to Sign Contracts? ❑ Yes ® No
H `no' selected - Section Four 4 is REQUIRED
4 - ContractorNendor Primary Signatory
A) Full Name:
8) Job Tide:
ART FRANK
UNDERSHERIFF
C) Email Address:
D) Phone Number.
AFRANK O.JEFFERSON.WAUS
360 344-9734
6 - Additional ContractorNendor Staff to be Notified
A) Full Name: 8) Email Address:
C) Full Name: D) Email Address:
6 - Contract Information
A) Contract
B) Exact Start Date:
C) Exact End Date (this
Number.
December 2018
contractiwork order/amendment
RFA NO. 3300
ONLY):
September 28 2020
D) Funding Amount (this contract/work
E) Funding Amount (ALL
order/amendment ONLY):$450,000
amendments included):
$450,000
F) Additional Instructions:
P� lx4aj -M-ZAr$
Completed By: [ (Nan*] - ' Date: [Date]
HCA RFA No. K 3300
EXHIBIT G
4.7 FFATA Form
STATE OF WASHINGTON
HEALTHCARE AUTHORITY
Budget and Finance
PO Box 45330, Olympia, WA 985045330
Federal Funding Accountability and Transparency Act (FFATA)
YELL : CONTRACTOR TO COMPLETE YELLOW HIGHLIGHTED SECTIONS
BLUE: DSHS PROGRAM MANAGER TO COMPLETE BLUE HIGHLIGHTED SECTIONS
GRAY: DSHS CONTRACT TO COMPLETE GRAY HIGHLIGHTED SECTIONS
(i)
Contractor DUNS Number; (must be a 9 digit number)
619143741
YOUR DUNS # MUST MATCH BACK TO YOUR
ADDRESS BELOW
(ii)
Contractor Zip Code + 4
98339+9700
(iii)
Contractor Name;
JEFFERSON COUNTY
(iv)
Contractor doing business as;
JEFFERSON COUNTY SHERIFF'S OFFICE
(v)
Contractor Physical Address —
1.79 ELKINS RD
1. street address;
2.PORT HADLOCK
2. city;
3.WA
3. state;
4.JEFFERSON
4. country;
5.98339+9700
S. zip +4; and
6. congressional district.
6.WA-6
Congressional District Look Up:
httpsJ/www.itovtrack.us/congress/memhgELma2
(vi)
If applicable, the Contractor's Parent Company DUNS Number;
(vii)
Amount of Contract/Amendment Award —This includes any
prior amendment amounts;
1. This amount should only reflect the total amount of funds
for the specific ¢rant related to this FFATA form and may
or may not reflect the total amount of the contract if
other funds are included in the contract.
2. If more than one Federal fund source (that requires a
FFATA form) is included in the Contract, each fund source
must have its' own FFATA form completed.
(viii) Contract/Amendment Authorization (Date
Contract/Amendment) was signed;
(ix)
CFDA Program Number and Program Title;
Choose One
(x)
Description of the overall purpose and expected outcomes,
OR results of the Contract, including significant deliverables
and, if appropriate, associated units of measure;
HCA RFA No. K 3300
(A) Contractor Place of Performance —
1.79 ELKINS RD
1. street address;
2.PORT HADLOCK
2. city;
3.WA
3. state;
4.JEFFERSON
4. country;
5.98339+9700
S. zip +4; and
6. congressional district.
6.WA-6
Congressional District Look Up:
httt)s://www.itovtrack.us/conitress/members/map
(xii) DSHS Contract Number;
(xiii) As provided by the Contractor — in the contractor's business or
NO
organization's preceding completed fiscal year, did the
business or organization (the legal entity to which the DUNS
number is provided belongs) receive (1) 80 percent or more of
its annual gross revenues in U.S. federal contracts, sub-
contracts, loans, grants, subgrants, and/or cooperative
agreement; and (2) $25,000,000 or more in annual gross
revenues from U.S. federal contracts, sub -contracts, bans
grants, subgrants, and or cooperative agreements?;
If No, you do not need to complete xfv. And xv.
(xiv) As provided by the contractor — does the public have access to
information about the compensation of the executives in the
contractor's business or organization (the legal entity to which
the DUNS number it provided belongs) through periodic
reports filed under section 13(a) or 15(d) of the Securities
Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section
6104 of the Internal Revenue Code of 1986?;
If No, proceed to section xv.
(xv) If answer to xiv is no; provide the names and Total
1.
Compensation of the Top 5 Employees for the contractor.
2
3.
4.
5.
PRIME GRANT RECIPIENTS awarded a new Federal grant greater than or equal to $25,000 as
of October 1,2010 aro subject to FFATA sub -award reporting requirements as outlined in the
Office of Management and Budgets guidance issued August 27, 2010.
Subawardee (Prime Contractor) Information Template (Note — This is based on Information in
Section 5 of FFATA Grants Reporting Template)
HCA RFA No. K 3300
4.9 Application Checklist
is your application complete? Please check box indicating that your application includes
the following:
Application Face Page
Project Narrative
Budget and Budget Narrative
Letter(s) of commitment from Local MAT Treatment Sites
Certifications and Assurances
Contractor Intake Form
FFATA Form
® The individual with Contractor signature authority, as indicated on the Contractor Intake
Form, is has reviewed this application and has authorized submission of this application.
Please copy this individual in the email when submitting the application materials.
I, ART FRANK, certify that, on behalf of the applicant agency, I am authorized to submit this
application to provide the described services.
Signature: fit) .-y SI
Date: /—I 9 - z O 8
HCA RFA No. K 3300
Regular Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: David Fortino, Jail Superintendent
DATE: January 14, 2019
SUBJECT: Agenda Item — WA State Health Care Authority Opiate Treatment Network
Grant Contract and Service Agreement with Olympic Peninsula Health
Services
STATEMENT OF ISSUE:
Jefferson County Sheriff s Office is requesting Board approval of the professional services contract with the
WA State Health Care Authority for Opiate Treatment Networks #K3285; December 31, 2018 — September
29, 2019 and for Board approval of the Service Agreement with Olympic Peninsula Health Services to
cooperatively administer the OTN Contract.
ANALYSIS:
This contract and service agreement establishes the Jefferson County Jail as an initiation site for Medicated
Assisted Treatment as well as establishes an Opiate Treatment Network with Olympic Peninsula Health
Services (OPHS) to provide wrap around services for those individuals with Opiate Use Disorder (OUD),
including education and induction into MAT program, Care Navigation and establishment with social
services if qualified. The OTN will enhance services within the Jefferson County Jail for those individual
with OUDs.
FISCAL IMPACT:
Reimbursement for services provided are based on the Deliverables Table within the HCA contract to
include startup costs, provision of services, and performance based reimbursement established by
benchmark goals. The maximum reimbursement allowed is $463,000 to be disbursed according to the
Service Agreement with OPHS.
RECOMMENDATION:
The Jefferson County Sheriff s Office request approval of the professional services contract with HCA
#K3285, and the Service agreement with OPHS.
REVIEWED BY:
-�
��Philip ` e ministrator Date
CONTRACT REVIEW FORM
CONTRACT WITH: Olympic Peninsula Health Services
(Contractor/Consultant)
CONTRACT FOR: Cooperatively Administrating the HCA OTN TERM: 12/31/2018 — 9/29/2019
Contract
AMOUNT: $444700 PROCESS:
Revenue:
Expenditure:
Matching Funds Required:
Sources(s) of Matching Funds
N/A
N/A
N/A
N/A
Exempt from Bid Process
Consultant Selection Process
Cooperative Purchase
Competitive Sealed Bid
Small Works Roster
Vendor List Bid
RFP or RFQ
X Other Sole source
Step 1: RE`TIEW BY RIS N NT
Review by:
Date Reviewed:
APPROVED FORM HReturned for revision (See Comments)
Comments
Step 2: REVIEW BY PROSEC 7X7�ATTORNEY
Review by: ( ;
Date Reviewed: / /,
ITAPPROVED AS TO FORM Returned for revision (See Comments)
Comments
Step 3: (If required) DEPARTMENT MAKES REVISIONS & RESUBMITS TO
RISK MANAGEMENT AND PROSECUTING ATTORNEY
Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF
ORIGINALS
Step 5: SUBMIT TO BOCC FOR APPROVAL
Submit originals and 2 copies of Contract, Review Form, and Agenda Request to BOCC Office.
Place "Sign Here" markers on all places the BOCC needs to sign.
MUST be in BOCC Office by 4:30 p.m. TUESDAY for the following Monday's agenda.
(This form to stay with contract throughout the contract review process.)
JOE HOLE
JEFFERSON COUNTY SHERIFF
79 Elkins Road • Port Hadlock, Washington 98339 • (360) 385-3831
To: Philip Morley—Jefferson County Administrator
From: David Fortino
Re: Sole Source Provider— HCA OTN Local MAT provider
January 11, 2019
Mr. Morley,
In the processing of our application to the WA State Health Care Authorities Grant for Opiate
Treatment Networks, as the initiation site, the Jefferson County Jail was required to establish a
relationship with a local MAT provider(s). The Jefferson County Jail utilized SAMHSA's list of
buprenorphine prescribers In our area and made contact with Olympic Peninsula Health
Services, Discovery Behavioral Health, and Jefferson Health Care. Of those providers OPHS was
the only qualified provider that was interested In providing services by the timelines established
In the Grant.
Respectfully,
David Fortino
Jail Superintendent
dfortino@co.lefferson.wa.us
(360) 344-9743
81 Elkins Rd
Port Hadlock, WA 98339