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Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
Public Health Consent Agenda
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, DD & BH County Coordinator
DATE:
SUBJECT: Agenda Item — a Memorandum of Understanding Agreement to Jefferson
County Superior Court; January 1, 2021— December 31, 2022;
$100,000.00
STATEMENT OF ISSUE:
Jefferson County Public Health, (JCPH); as the fund manager of the 1/10th of 1% Behavioral Health Sales Tax
Treatment Funds, is requesting Board approval of a Memorandum of Understanding, (MOU); with the
Jefferson County Superior Court; for Drug Court Case Management Services and Family Therapeutic Case
Management Services; in the amounts of: January 1, 2021— December 31, 2022; $84,000.00 for Drug Court;
($42,000.00 in 2021 and $42,000.00 in 2022); January 1, 2021 — December 31, 2022; $16,000.00 for Family
Therapeutic Court; ($8,000.00 in 2021 and $8,000.00 in 2022) for a total of; $100,000.00.
ANALYSIS/STRATEGIC GOALS/PRO'S and CONS:
This Memorandum of Understanding, is with the Jefferson County Superior Court; for Drug Court Case
Management Services and Family Therapeutic Court Case Management Services; for Jefferson County citizens
with behavioral health issues, seeking substance abuse and chemical dependency treatment.
This Memorandum of Understanding, results from an RFP process and is recommended by the Behavioral
Health Advisory Committee.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This is sales tax revenue raised by the County in the 1/10 of 1% Behavioral Health Sales Tax Treatment Fund;
and is allocated by the BOCC, with advice from the Behavioral Health Advisory Committee. The Memorandum
of Understanding states, if the sales tax revenue decreases; the Court will be contacted and the agreement
may be renegotiated.
RECOMMENDATION:
JCPH management request approval of a Memorandum of Understanding, to the Jefferson County Superior
Court; in the amounts of: January 1, 2021— December 31, 2022; $84,000.00 for Drug Court; ($42,000.00 in
2021 and $42,000.00 in 2022); January 1, 2021— December 31, 2022; $16,000.00 for Family Therapeutic
Court; ($8,000.00 in 2021 and $8,000.00 in 2022) for a total of; $100,000.00.
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
REVIEWED BY:
i
h ' orley, Cto ty Administrator
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Date
Always working for a safer and healthier community
Environmental Public Health
360-385-9444
(f) 360-379-4487
MEMORANDUM OF UNDERSTANDING
Between
Jefferson County Superior Court
and
Jefferson County Board of County Commissioners as Administrator of
1/10th of 1% Behavioral Health Sales Tax Fund — 2021-2022
WHEREAS, this Memorandum of Understanding (MOU) is between Jefferson County Superior
Court (Court) and the Jefferson County Board of County Commissioners (County) which administers
the 1/101h of 1% Behavioral Health Sales Tax; (Fund 131); through Jefferson County Public Health;
and
WHEREAS, this Memorandum of Understanding describes the mutually -agreed conditions under
which 1/loth of 1% Behavioral Health Sales Tax; (Fund 131); is being allocated to Jefferson County
Superior Court for the Court's Case Management Services for individuals affected by substance
abuse, chemical dependency and mental health issues; and
WHEREAS, the Jefferson County Behavioral Health Advisory Committee voted to recommend the
1/1 oth of 1 % Behavioral Health Sales Tax; (Fund 131); be allocated for therapeutic court case
management services in 2021-2022 as follows; $100,000 for Drug Court & Family Therapeutic Court
case management and services in Jefferson County Superior Court;
WHEREAS, the Board of County Commissioners approved a 2021-2022 County Budget that
allocates funding from the 1 /1 oth of 1 % Behavioral Health Sales Tax; (Fund 131); the consistent with
the Jefferson County Behavioral Health Advisory Committee's recommendations; and
WHEREAS, the Superior Court will administer the contracts and expenditures to provide the
therapeutic court case management services pursuant to this MOU from January 1, 2021 to December
31, 2022; and
WHEREAS, Work performed between January 1, 2021 and the execution of this Agreement that is
consistent with the provisions of this Agreement is hereby ratified; and
WHEREAS, all funds from the 1/1oth of 1% Behavioral Health Sales Tax; (Fund 131); may only be
used for their intended purpose within that budget year, and any unexpended funds remaining at the
end of a budget year must be retained in the 1/loth of 1 % Behavioral Health Sales Tax; (Fund 131);
fund balance, to be available for allocation for eligible services in future years; and
WHEREAS, Superior Court agrees to regularly report deliverables and metrics to Jefferson County
through the Jefferson County Public Health as specified under this MOU as a condition of receiving,
1/IOth of 1% Behavioral Health Sales Tax; (Fund 131); and to facilitate overall management of the
Fund;
NOW, THEREFORE, it is mutually agreed that:
The County, as administrator of the 1 /1 oth of 1 % Behavioral Health Sales Tax; (Fund 131);
Jefferson County Superior Court mutually agrees for the Court to provide case management
services and other services to individuals enrolled in Drug Court & Family Therapeutic Court,
in Superior Court, as described in this MOU, including EXHIBIT A: Scope of Work: Drug.
Court & Family Therapeutic Court and EXHIBIT B: Therapeutic Courts Logic Model and
Performance Measures and EXHIBIT C: Jefferson County, 1/101" of 1% Behavioral Health
Sales Tax; (Fund 131) Spreadsheet attached hereto and incorporated herein.
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2. Funding from the 1/10th of 1% Behavioral Health Sales Tax; (Fund 131); to the Superior Court
Branch for the services pursuant to this MOU shall be up to $50,000 in 2021 and up to $50,000
in 2022; as described in the following Budget Tables; on page two and three; subject to
modification pursuant to Section 8 of this MOU.
3. Superior Court will use the 1/loth of 1% Behavioral Health Sales Tax; (Fund 131); for all
participants enrolled in in Drug Court and Family Therapeutic Court. Services include case
management, court time, administrative duties, drug court team staffing, treatment supervision
and client support, (e.g. housing, urine analyses, Court incentives, out of custody assessments, in
custody assessments, training, and alternative to jail) for participants; per the following Budget
Tables;
Description
Service Period
Amount from
Fund 131
FTC Case Management and Other 1/1/2021—
Services Budget: 12/31/2021
Case Management $5,000
Transportation $1,000
UA Test Standard $500
Incentives* $500
Housing Vouchers $1,000
Total FTC Budget $8,000
Drug Court Case Management and 1/1/2021—
Other Services Budget: 12/31/2021
Case Management $20,000
Housing Reimbursement OlyCAP $3,000
Housing Vouchers $5,000
Incentives* $4,000
Transportation $1,480
UA Test -Standard $2,500
UA Test -Random Weekend $2,500
In Custody drug/alcohol Eval $2,500
Supplies/Materials $1,020
Total Drug Court Budget $42,000
All Superior Court Branch Budgets $50,000
Description
Service Period
Amount from
Fund 131
FTC Case Management and Other 1/1/2022 —
Services Budget: 12/31/2022
Case Management $5,000
Transportation $1,000
UA Test Standard $500
Incentives* $500
Housing Vouchers $1,000
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Total FTC Budget
$8,000
Drug Court Case Management and 1/l/2022 —
Other Services Budget: 12/31/2022
Case Management
$20,000
Housing Reimbursement OlyCAP
$3,000
Housing Vouchers
$5,000
Incentives*
$4,000
Transportation
$1480
UA Test -Standard
$2,500
UA Test -Random Weekend
$2,500
In Custody drug/alcohol Eval
$2,500
Supplies/Materials
$1021
Total Drug Court Budget
$42,000
All Superior Court Branch Budgets
$50,000
*Incentives for Family Therapeutic Court and Drug Court include; clothing vouchers from Goodwill
and grocery store gift cards
4. Funding approved pursuant to this MOU will be included in the 2021 and 2022 expenditure
appropriation budgets of Superior Court. In addition, a quarterly transfer from the 1/loth of 1%
Behavioral Health Sales Tax; (Fund 131); for a total equal to the amount expended during the
YTD period minus previous expenditure reimbursements from this award not to exceed the
authorized annual amounts stated in the Tables on page two and three, will be made to the
Superior Court revenue budget upon timely submittal of required reports. Funds provided
pursuant to this MOU will be tracked separately by the Court and may only be used for its
intended purpose within that budget year. At the end of each budget year, if documented actual
authorized expenditures pursuant to this MOU services related to/for the Drug Court and Family
Therapeutic Court are less than the authorized budgeted amount, the difference will be
transferred back to the 1/101h of 1% Behavioral Health Sales Tax; (Fund 131); Superior Court
will not exceed the amount provided by the 1/101h of 1% Behavioral Health Sales Tax; (Fund
131); without obtaining an appropriation.
5. Funding provided by the 1/loth of 1% Behavioral Health Sales Tax; (Fund 131); will be used to
monitor participant compliance and as well as help participants improve psychiatric symptoms
and functioning, reduce substance use, reduce hospitalizations, increase housing stability, reduce
arrests, and improve quality of life. Funding will be used to assist participants with the above
areas. Funding listed in the Budget Table on page two and three are approximations for each
line item, and may be shared between the descriptions, with budget updates given to Public
Health.
6. Superior Court will use the 1/101h of 1% Behavioral Health Sales Tax; (Fund 131); Spreadsheet;
see EXHIBIT C - Jefferson County, 1/loth of 1% Behavioral Health Sales Tax; (Fund 131)
Spreadsheet for actual paid monthly expenses that have incurred.
7. Provide monthly financial reports per EXHIBIT C - Jefferson County, 1/10th of 1%
Behavioral Health Sales Tax; (Fund 131); Spreadsheet for actual paid monthly expenses that
have incurred and email them quarterly to the Auditor's Chief Accountant and to Public Health.
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8. Superior Court and any Contractors it may use to provide Case Management with the 1 / 1 Oth of 1%
Behavioral Health Sales Tax; (Fund 131); shall comply with the following:
ATTACHMENT A - Jefferson County 1/101h of 1% Behavioral Health Sales Tax Match
Policy.
a. The County reserves first right to use as match, the Chemical Dependency or Mental Health
Treatment Sales and Use Tax, (now known as the 1/loth of 1% Behavioral Health Sales Tax)
and the services funded by them for purposes of qualifying for additional funding and grants.
The County may allow the Contractor to use the 1/loth of 1% Behavioral Health Sales Tax
funds as match, at the County's sole discretion. Should the County decline to use the 1/101h
of 1 % Behavioral Health Sales Tax funds as match for additional funding and/or grants, then
the County may authorize the Contractor to use such funds for match consistent with this
MOU; as required by ATTACHMENT A - Jefferson County 1/101h of 1% Behavioral
Health Sales Tax Funding Match Policy.
b. Where the Court or its Contractor proposes to use 1/loth of 1% Behavioral Health Sales Tax
funds for match, the Court or its Contractor shall be solely responsible for compliance with all
state and federal laws and regulations, including but not limited to DSHS, CMS and DBHR
funding rules, applicable to the use of 1/loth of 1% Behavioral Health Sales Tax funds as
match.
c. The Court or its Contractor shall document it has met this responsibility by submitting in
writing to the Superior Court and County Administrator their match formula, allocation plan
and any other documentation required of them by ATTACHMENT A - Jefferson County
1/1011 of 1% Behavioral Health Sales Tax Funding Match Policy. The County may
withhold authorization to utilize the 1/101h of 1% Behavioral Health Sales Tax as match. The
Court's or its Contractor's failure to provide adequate documentation does not relieve the
Court or its Contractor of their responsibility to comply with all state and federal laws and
regulations related to match.
9. This MOU may be amended by mutual written agreement of both parties. The basis for
amending this agreement includes, but is not limited to, an increase or decrease in sales tax
funding, or addition of required tasks not addressed in this agreement.
10. This MOU shall remain in effect from January 1, 2021 until December 31, 2022, unless
terminated before then by either party with 30 days' prior written notice, except that the
requirements to provide financial and program reports and other documentation required
pursuant to EXHIBIT A, EXHIBIT B, EXHIBIT C and ATTACHMENT A shall remain in
effect until fulfilled. All work performed in 2021 and 2022 consistent with this MOU prior to its
adoption is hereby ratified.
DATED this day of 2021.
Jefferson County Board of Commissioners Jefferson County Superior Court
Kate Dean, Chair Keith Harper, Presiding Judge
Attest:
Carolyn Gallaway, Clerk of the Board
Approved as t Form Only:
//e,47/
Philip Hunsucker, Chief Civil Dell6ty
Prosecuting Attorney
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EXHIBIT A
Scope of Work: Drug Court, Family Therapeutic Court
Jefferson County Superior Court agrees to utilize the 1/101h of 1% Behavioral Health Sales Tax;
(Fund 131); provided through this MOU to provide the following services and provide tracking
reports as follows:
Provide for and supervise case management services for all citizens enrolled in Drug Court
and Family Therapeutic Court.
a) At a minimum, case management shall include:
• Prepare and maintain files or a data base on enrollees to track and document their
attendance and participation in the therapeutic court, the enrollee's treatment plan,
their progress in following the treatment plan, and their progress toward graduation
from the therapeutic court.
• Communicate with enrollees outside of court as necessary to answer questions, steer
enrollees to appropriate resources, and provide guidance to help them comply with
their treatment plans.
• Coordinate the scheduling and participation of, and communication between, all
representatives of agencies that are part of each therapeutic court, such as the
Judge/Commissioner, Prosecutor, County Clerk, Public Defenders, and treatment
Providers.
• Provide administrative support for the smooth functioning of the therapeutic court as
may be required by Superior Court.
• Collect and share statistics and data as may be required for the administration of the
therapeutic court and for reporting purposes.
• EXHIBIT B: The Drug Court and Family Therapeutic Court Logic Model and
Performance Measures are attached hereto and incorporated herein.
2. Adults charged in Jefferson County for criminal activity whose criminal behavior is
related to, or affected by, substance abuse may be eligible to participate in Drug Court and
Family Therapeutic Court, which is up to a two-year voluntary program that promotes
treatment and accountability. Participants are required to comply with law abiding
behavior, participate in recommended treatment, submit to random urinalyses, attend
regular court reviews and maintain frequent contact with the Case Manager and Staff.
3. The 1/10t' of 1% Behavioral Health Sales Tax; (Fund 131); provides support needed to
operate Drug Court and Family Therapeutic Court which protects public safety while reducing
offender risk for future justice involvement and placement in a higher, more restrictive level
of care or incarceration. Funds are provided to assist in housing, jail alternatives, in and out of
custody assessments, treatment not covered by insurance, as well as the substance use
monitoring services of urine analysis (UA) testing and biological alcohol monitoring devices
(Sober -Link) to determine compliance with court orders.
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4. If the Court utilizes funds under this MOU to hire a Contractor to provide case management
services or administration and billing services subject to this MOU, the Court agrees to
prepare for BoCC approval a professional services agreement with the Contractor, which
Agreement has been approved by the County's Risk Management and Legal review, and
which requires Contractor's compliance with the provisions of this MOU, including
compliance with the provisions of Section 5 of this MOU, and requires the Contractor to
timely provide all financial and program reports and other documentation necessary for the
Court to comply with this MOU.
5. Provide at least the following for the Therapeutic Courts; so the Behavioral Health Advisory
Committee is able to review usage of allocated funds in order to assure access to appropriate
treatments and services:
a) Provide monthly financial reports per EXHIBIT C -Jefferson County, 1/1011 of 1 %
Behavioral Health Sales Tax; (Fund 131); Spreadsheet for actual paid monthly
expenses that have incurred and email them quarterly to the Auditor's Chief Accountant
and to Public Health.
b) Juvenile Court will provide an estimate of projected expenditures under this MOU for the
remainder of the year at the end of October of 2021 and at the end of October 2022 to
Public Health.
c) Juvenile Court will provide all 2021 invoices to the Auditor's office for processing during
the Open Period, (a.k.a. 131h Month, in January); and the final reporting by Jan 20, 2022
and Jan 19, 2023.
d) Provide to Jefferson County through Jefferson County Public Health a copy of any service
contracts (and all amendments associated therewith) with the 1/1oth of 1% Behavioral
Health Sales Tax; (Fund 131); under this MOU.
e) Jefferson County Superior Court will provide quarterly statistics in an electronic form that
is developed and may be revised by Jefferson County Public Health and the Kitsap Health
District, in consultation with the Court, for statistical and program data collection.
f) Jefferson County Superior Court will ensure that quarterly electronic reports for each
Therapeutic Court are sent to Amanda Tjemsland of Kitsap County Health District, at:
Amanda.Tjemsland(ablichealth.org and that a copy of each electronic report is
also sent to Anna McEnery of Jefferson County Public Health at
amcenerykco jefferson.wa.us.
o Quarterly reports will be reviewed by Public Health and Kitsap County Health
District for accuracy. Any questions will be referred back to the Court.
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EXHIBIT B
Drug Court and Family Therapeutic Court Logic Model page 1
Inputs
Drug Court Team
• Judge
• Prosecution
• Defense
• JCSO
• Safe Harbor
Family Therapeutic
Court Team
• Judge
• Safe Harbor
• GAL Program
Coordinator
• OlyCAP
• Children's
Administration
Drug Court Team
• Referral -
Defense or
Prosecution
• Prosecution
determines
eligibility
• Substance
abuse
significant in
criminal
history
• Client agrees
to D.0
requirements
Family Therapeutic
Court Team
• Referred by
Ct, parents,
atty, dept.
• FTC
coordinator
screens for
eligibility
Substance
abuse a
significant
factor in
dependency
action
Client agrees
to FTC
requirements
Drug Court Team
• Judge accepts client
into Drug Ct.
• Client evaluation
• Client treatment
• Client accesses
services -housing,
GED, mental health
• Weekly staffing &
reviews to support
services & monitor
compliance
Family Therapeutic Court
Team
• Judge accepts client
into FTC
• Compliance/follow
program rules
• Client treatment
• Housing, Basic needs
being met
• Education,
employment
• Weekly staffing &
reviews
GOALS:
• Increase access to treatment and support services that promote recovery and stability for adults
and youth.
• Provide education, screening, referral and brief intervention services in the community.
• Reduce inappropriate use of county, municipal, and community resources by individuals who
have co-occurring mental health and chemical dependency issues.
• Reduce future involvement in the court system.
• Family change- Address family interaction patterns that maintain the presenting problems;
build problems solving and communication skills. Reduce family conflict.
• Rehabilitate drug dependent offenders through court mandated treatment.
• Promote cost effectiveness in the justice process and the community.
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EXHIBIT B
Drug Court and Family Therapeutic Court Logic Model page 2
Drug Court Team
•
Participant
connected with
housing and
treatment
•
Drug avoidance
skill
development.
•
Abstinence
from
substances
Family Therapeutic
Court Team
•
Youth remain in
home/reduced
time out of
home
placement
•
Improved family
functioning
•
Reduce
delinquent
behavior
•
Client access to
housing &
offered services
•
Develop
•
substance
avoidance skills
•
Abstain from
substances.
•
Maintain and
deepen
relationship with
children
Drug Court Team
• Increased
accountability
for behavior;
motivation to
comply with
program;
respect for
court process
• Decrease drug
use
Family Therapeutic Ct
Team
• Address
physical and
mental health
• Abstinence
from substance
abuse
• Motivated to
succeed
• Develop
parenting skills
• Connect with
family
resources
• Family
involved in
treatment or
counseling
• Safe, Staple
Housing/Trans
port
• In home
dependency
• Plan for
economic
security
Drug Court Team
• Criminal Justice System
saves money processing
cases & jail time.
• Increased pro -social
indicators
• Decreased recidivism
Family Therapeutic Court Team
• Recovery for substance
abuse
• Increased pro family lifestyle
• Increased parenting skills
• Increased health and safety
of children
• Community involvement and
support network
• Prevent future involvement
with substance abuse
• Reunification Achieved
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EXHIBIT C:
JEFFERSON CO 1/10th of 1% Behavioral Health Sales Tax; (Fund 131)
SPREADSHEET
FAMILY THERAPEUTIC COURT-2021
FAMILY THERAPEUTIC COURT TOTAL AWARD: $8,000.00
Month of
Vendor Svc Date Paid Amount Description/Service
Total FTC Court YTD
Expended $0.00
Total FTC Court Remaining $0.00
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EXHIBIT C:
JEFFERSON CO 1/101' of 1% Behavioral Health Sales Tax; (Fund 131)
SPREADSHEET
FAMILY THERAPEUTIC COURT-2022
FAMILY THERAPEUTIC COURT TOTAL AWARD: $8,000.00
Month of
Vendor Svc Date Paid Amount Description/Service
Ve
Total FTC Court YTD
Expended $0.00
Total FTC Court Remaining $0.00:
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EXHIBIT C:
JEFFERSON CO 1/10'h of 1 % Behavioral Health Sales Tax; (Fund 131)
SPREADSHEET
DRUG COURT-2021
DRUG COURT TOTAL A WARD: $42,000
Month of
Vendor Svc Date Paid Amount Description/Service
Total DRUG Court YTD
Expended $0.00
Total DRUG Court
Remaining $0.00
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EXHIBIT C:
JEFFERSON CO 1/1011 of 1% Behavioral Health Sales Tax; (Fund 131)
SPREADSHEET
DRUG COURT-2022
DRUG COURT TOTAL AWARD: $42,000
Month of
Vendor Svc Date Paid Amount Description/Service
Total DRUG Court YTD
Expended $0.00'
Total DRUG Court
Remaining $0.00
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ATTACHMENT A
JEFFERSON COUNTY 1/10th of 1% BEHAVIORAL HEALTH SALES TAX FUNDING
MATCH POLICY
Definitions:
Match: is a requirement for the grantee to provide contributions of a specified amount or
percentage to match funds provided by another grantor. Matching can be in the form of cash
or in -kind contributions.
Regulations: The specific requirements for matching funds are unique to each federal or state
program. The A-102 Common Rule provides criteria for acceptable costs and contributions in
regard to match.
Jefferson County Policy:
In 2005, the Washington State Legislature created an option for counties to raise the local sales tax by
0.1 percent, (the 1/IOth of 1% sales tax initiative) to augment state funding for behavioral health
treatment. Jefferson County collects and distributes the 1/101h of 1% Behavioral Health Sales Tax
fund. Services purchased by the County are allocated through a formal Request for Proposal (RFP)
process, review and contracting; staffed by Jefferson County Public Health, overseen by Jefferson
County Behavioral Health Advisory Committee and adopted by the Board of County Commissioners,
(BOCC). BOCC does not assume any fiscal responsibility/liability for any of the Contractors they
contract for services with.
Jefferson County reserves the first right to use as match the 1/101h of 1% Behavioral Health Sales Tax
funds and the services funded by them for purposes of qualifying for additional funding and grants.
County may make available to the Contractor the 1/IOth of 1% Behavioral Health Sales Tax funds for
the Contractor to propose as match to state, federal or other entities, at the County's sole discretion.
Contractor shall not use the 1/101h of 1% Behavioral Health Sales Tax funds for match without prior
authorization by the Jefferson County Administrator and County fiscal team. To request
authorization of availability of the funds for match, Contractor must apply to the County
Administrator in writing, and include their match formula and allocation plan and may include other
documentation to support their request. The County Administrator will authorize or deny the
availability of match funds in writing within 30 days of the application.
If the County informs the Contractor of the availability of the 1/101h of 1% Behavioral Health Sales
Tax funds for match, then the Contractor shall be solely responsible for compliance with all state and
federal laws and regulations, including, but not limited to DSHS, CMS and BIRR funding rules,
applicable to the use of 1 /l Oth of 1% Behavioral Health Sales Tax funds as match. Following state,
federal and local guidelines for match is the responsibility of the Contractor.
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For example, if a Contractor provides Title XIX Medicaid services (the Policy 19.50.02 or 42CFR
430.30) they are required by those rules to actually bill Medicaid for the services at the same time. If
no Medicaid billing exists, the match would not comply with state and federal guidelines for match.
Concurrent with its request for authorization of the availability of match, Contractor shall document it
has met its responsibility to follow state, federal and local guidelines for match by submitting in
writing to the County Administrator their match formula, allocation plan, and other documentation
made mandatory pursuant to this Agreement and this Attachment A. At a minimum, the Contractor
shall also provide the following to the County Administrator:
1. DSHS requires contractors to complete and submit a "Local Match Certification" form
(DSHS 06-155) or a form that has equivalent data elements prior to any agreement for
DSHS services. Submit a copy of this application and form when requesting match
availability from the County and at each monthly billing.
2. Submit the current administrative policy within WA State regulating your services and
the use of local match.
3. Submit to the County your last financial audit showing your use of match, County
funds and tracking systems.
4. Submit to the County the terms of the agreement showing the 1/1 Oth of 1% Behavioral
Health Sales Tax fund allocation is an allowable source of match.
5. Provide documentation that your financial reporting system tracks matching funds at a
level that meets the level of documentation required by federal or state statutes.
The County may reject permission for Contractor to utilize the 1/101h of 1% Behavioral Health Sales
Tax funding as match.
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