HomeMy WebLinkAboutWashington State Health Care Amend No 4 - 121823 erry ) 01.3
Doc ign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
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CONTRACT HCA Contract No.: K4880 0
Washington State AMENDMENT Amendment No.: 4
Health CareAuthority Abuse Treatment in Prisons
and Jails
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 of Jefferson County Jail
CONTRACTOR ADDRESS CONTRACTOR CONTRACT MANAGER
79 Elkins Road Name: David Fortino
Port Hadlock, WA 98339-9700 Email: dfortino(a�co.jefferson.wa.us
AMENDMENT START DATE CONTRACT END DATE
October 1, 2023 September 30, 2024
Prior Maximum Contract Amount Amount of Increase Total Maximum Compensation
$438,731 $155,400 $594,131
WHEREAS, HCA and Contractor previously entered into a Contract for Residential Substance Abuse Treatment
in Prisons and Jails, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3, Amendments, to extend
the term, add funding for federal fiscal year 2024, update HCA Contract Manager, and update attachments and
schedule;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Section 3.2, Term, Subsection 3.2.1 is amended to extend the end date from September 30, 2023 to
September 30, 2024.
2. Section 3.3, Compensation is amended to increase the Total Maximum Compensation by $155,400.00,
from $438,731.00 to $594,131.00. All internal references to the Total Maximum Compensation amount
are updated accordingly.
3. Section 3.6, Contractor and HCA Contract Managers, Subsection 3.6.3 is amended to change the HCA
Contract Manager as follows:
Health Care Authority
Contract Manager Information
Name: Rachel Brandhorst
Title: Department of Justice Grants Administrator
Phone: (360) 725-1889
Email: rachel.brandhorst(a hca.wa.gov
4. Section 3.8, Incorporation of Documents and Order of Precedence is amended to read as follows:
3.8 Incorporation of Documents and Order of Precedence
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID.49D5168F-3988-48FD-8F7A-94DC39B03758
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 Recitals;
3.8.3 Special Terms and Conditions;
3.8.4 General Terms and Conditions:
3.8.5 Attachment 6: Office of Justice Programs (OJP)Award Terms,
3.8.6 Attachment 1: Federal Compliance, Certifications, and Assurances;
3.8.7 Attachment 2: Federal Funding Accountability and Transparency Act(FFATA) Data Collection
Form;
3.8.8 Attachment 8: Standards of Care for Opioid Use Disorder;
3.8.9 Schedule A: Statement of Work;
3.8.10 Schedule A-1: Statement of Work, October 1, 2023- September 30, 2024;
3.8.11 Attachment 7: Quarterly Report Template; and
3.8.12 Any other provision, term or material incorporated herein by reference or otherwise incorporated.
5. Attachment 4, Federal Subaward Identification, K4880-04, is incorporated herein and attached hereto.
6. Attachment 7, Quarterly Report Template, is replaced in its entirety and is incorporated herein and
attached hereto.
7. Attachment 8, Standards of Care for Opioid Use Disorder, is incorporated herein and attached hereto.
8. Schedule A-1, Statement of Work, October 1, 2023- September 30, 2024, is incorporated herein and
attached hereto.
9. This Amendment will be effective October 1, 2023 (''Effective Date").
10. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract.
11. 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 both parties.
DATE SIGNED
Greg Brotherton f 2 hg-/Z3
HCLSIGpi RE Anc riTaowaErt rD TITLE DATE SIGNED
w "` Deputy Contracts Administrator 12/4/2023
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
Philip Huns icker- Approved as to form only
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
ATTACHMENT 4
Federal Subaward Identification
K4880-04
1. Federal Awarding Agency Department of Justice
2. Federal Award Identification Number (FAIN) 2019-J2-BX-0022
3. Federal Award Date 09-28-2019
4. Assistance Listing Number and Title 16.593 Residential Substance Abuse
Treatment for State Prisoners
5. Is the Award for Research and Development? ❑ Yes ® No
Michael Langer, Acting Assistant Director
WA State Health Care Authority
6. Contact Information for HCA's Awarding Official Division of Behavioral Health and Recovery
Michael.langer@hca.wa.gov
360-725-5252
7. Subrecipient name (as it appears in SAM.gov) Jefferson, County of
8. Subrecipient's Unique Entity Identifier (UEI) LP11 B7JKFN38
9. Subaward Project Description Residential Substance Abuse Treatment
(RSAT) for State Prisoners Program
10. Primary Place of Performance 98339-9700
11. Subaward Period of Performance 10/1/2023-9/30/2024
12. Amount of Federal Funds Obligated by this Action $155,400
13. Total Amount of Federal Funds Obligated by HCA $302,131
to the Subrecipient, including this Action
14. Indirect Cost Rate for the Federal Award 10%
(including if the de minimis rate is charged)
This Contract is subject to 2 CFR Chapter 1, Part 170 Reporting Sub-Award and Executive Compensation Information. The
authorized representative for the Subrecipient identified above must answer the questions below. If you have questions or
need assistance, please contact subrecipientmonitoring@hca.wa.gov.
1. Did the Subrecipient receive (1) 80% or more of its annual gross revenue from federal contracts, subcontracts,
grants, loans, subgrants, and/or cooperative agreements; and (2) $25,000,000 or more in annual gross revenues
from federal contracts, subcontracts, grants, loans, subgrants, and/or cooperative agreements?
❑ YES [rg,NO
2. Does the public have access to information about the compensation of the executives in your business or
organization 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?
`, YES LINO
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
ATTACHMENT 7
Quarterly Report Template
Program Characteristics
-Program Characteristics
4. Does your RSAT program use evidence-based treatment services? Yes
A. Select Yes or No
B. If yes,please describe the evidence-based treatment services. No
Cognitive-Behavioral Therapy
5. Please enter the number of treatment staff who work directly with participants in the RSAT program.When
answering'A',please count all treatment staff regardless of funding source.
A. Number of treatment staff
B. Of those reported in'A',how many are paid for at least
partially using BJA program funds,including matching
funds?
6. Please enter the amount of funds from all sources(in dollars)spent in your RSAT program during the reporting
•eriod for the followin• areas:
Funds Spent during Quarter BJA Funds Non-BJA Funds(All Other Sources)
Personnel
Fringe benefits
Supplies
Equipment
Contract/consultant fees
Construction
Indirect costs
1,
Other
Jail-Based Programs
-Jail-Based Programs
7. During the reporting period,using BJA program funds including matching funds,did you pay for training for
treatment staff to be cross trained in the Jail-based portion of the RSAT program?
A. Select Yes or No(Yes/No) Yes r No
8. Please enter the number of treatment staff members who were cross trained in the Jail-based portion of the
RSAT program.
A. Number of treatment staff cross trained(numeric)
9. During the reporting period,using BJA program funds including matching funds,did you pay for training for
custody staff to be cross trained in the Jail-based portion of the RSAT program?
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39803758
A. Select Yes or No(Yes/No) t"` Yes r No
10. Please enter the number of custody staff members who were cross trained in the Jail-based portion of the RSAT
program.
A. Number of custody staff cross trained(numeric)
-Risk Assessment and Treatment Planning
11. Of those who entered the Jail-based portion of the RSAT program during the reporting period,please enter the
number of Jail-based participants who were administered a risk and/or needs assessment.
A. Number of Jail-based participants administered a risk and needs
assessment(numeric)
12. Please name the risk assessment instrument(s)that is used to assess risk/need.
A. Risk assessment instrument(s)used:
13. Of those who entered the Jail-based portion of the RSAT program during the reporting period, please enter the
number of such individuals who were identified as having high criminogenic risks and/or high substance abuse
treatment needs.
A. Number of Jail-based participants with high criminogenic
risks/needs(numeric)
14. Of those who entered the Jail-based portion of the RSAT program during the reporting period,please enter the
number with an individualized substance abuse treatment plan.
A. Number of Jail-based participants with an individualized treatment
plan(numeric)
-Number of Participants Receiving Services
15. Please enter the total number of Jail-based participants enrolled in the RSAT program as of the last day of the
reporting period.
A. Total number of Jail-based participants enrolled as of the last day of
the reporting period(numeric)
16. Please enter the number of NEW Jail-based participants admitted during the reporting period.
A. Number of NEW Jail-based participants admitted(numeric) 1
-Services Provided
17. Please enter the number of Jail-based participants who were provided services during the reporting period with
BJA program funds,including matching funds,through the following treatment components:
A. Substance abuse and treatment services(numeric)
B. Cognitive and behavioral services (cognitive behavioral services
include interventions that address criminal thinking and antisocial
behavior) (numeric)
C Employment services (numeric)
D. Housing services (numeric) Y�
E. Mental health services(numeric) j-
F. Other services(numeric)
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
G. Please explain other services
18. Please enter the number of Jail-based participants who wereprovided with transitional planning services with BJA
program funds,including matching funds, during the reporting period.
A. Number of Jail-based participants receiving transitional plan fling
services (numeric)
— Medication Assisted Treatment(RSAT)
19. If your treatment program includes medication assisted treatment,which of the following medications are you
utilizing?Check all that apply. r
A. We do not provide MAT(Skip next question)
B. We do not have access to MAT(Skip next question)
r-
C. Naltrexone(Vivitrol®,depot naltrexone)
D Buprenorphine or Buprenorphine/Naloxone(Bup/NX)(Suboxone®,) t—
E. Methadone r
20. Of the total participants enrolled in your program,how many were deemed eligible for medication-assisted
treatment and of those eligible,how many received MAT during the reporting period?
A. Individuals Eligible for MAT: (numeric)
B. Individuals receiving at least one treatment: (NUMERIC)
Program completion
21. Please enter the number of participants who successfully completed all requirements of the Jail-based portion of your
RSAT program during the reporting period.
A. Number of Jail-based successful completers(NUMERIC)
22. Of those Jail-based participants who successfully completed all program requirements,please enter the number who
were released to the community during the reporting period.
A. Number of Jail-based successful completers released to the
community(NUMERIC)
B. Of those reported in 'A', how many individuals were released under
correctional supervision. (NUMERIC)
C. Of the number of successful completers released to the community,
how many individuals were referred to an aftercare program.
Aftercare programs are defined in 42 U.S.C. 3796ff-1(c) (numeric)
23. Of those Jail-based program completers released to the community,please enter the number with a continuity of care
arrangement or reentry or transitional plan.
A. Number of Jail-based successful completers with confirmed continuity
of care arrangements(numeric)
24. Please enter the number of individuals who did not complete the Jail-based portion of the RSAT program for the
categories below.
Jail-based Incompletes Number
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
� I
Number of participants no longer in the program due
to termination for a new charge
Number of participants no longer in the program due to release
or transfer to another correctional facility
Number of participants no longer in the program due
to death or serious illness
Number of participants no longer in the program due to voluntary f
drop out ' l
Number of participants no longer in the program due to failure to r ``
meet program requirements
Number of participants no longer in the program due to violation
of institutional rules
Number of participants who did not complete the program '
for other reasons
Please specify other reasons
25. Of those Jail-based participants who left the RSAT program successfully,please enter the number who
completed the program during the following timeframes.
A 0 to 3 months(numeric)
8 4 to 6 months(numeric)
C. 7 to 9 months(numeric)
D 10 months or more(numeric)
26. Of those Jail-based participants who left the RSAT program unsuccessfully or did not complete the program,
please enter the number who left the program during the following timeframes.
A 0 to 3 months(numeric) " LL`
8 4 to 6 months(numeric)
C 7 to 9 months(numeric)
D 10 months or more(numeric)
I_ Alcohol and Substance Involvement
27. Please enter the number of Jail-based participants who were administered an alcohol/drug test(e.g.,urinalysis
test) before admission into your RSAT program.
A Number of Jail-based participants tested before admission
' 28. Of those enrolled in the Jail-based portion of the RSAT program,please enter the total number of participants
tested for alcohol or illegal substances during the reporting period.
A Total number of Jail-based participants tested for alcohol or illegal substances
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
29. Of those enrolled in
the
Jail-based
d portion of the RSAT program,please enter the number of participants who
tested positive for the presence of alcohol or illegal substances during the reporting period.
A. Number of Jail-based participants who tested positive for alcohol or illegal substances
30. During the reporting period,please enter the number of participants who were administered an alcohol/drug
test(e.g.,urinalysis test)within 30 days after successfully completing your residential drug treatment program
and are still under supervision of the program.
A. Number of Jail-based participants tested after program completion
B. Of that number,how many tested positive for alcohol or illegal substances after program
completion
Upon funding year close out, please answer the following questions:
Court and Criminal involvement XIXXXXXXXXXXX
Court aid Criminal Involvement:Jail ila,rd
29. 5ince;he start of the RSA'OM award hcw marry)aq trased participants;
A. Are sO'I partKrpatng in the Ja!-based RSAT program?
8. Have st.ccessfuey completed the lair-based RSAT program and released into the community?
C. Did not Complete the)ail-cased RSAT program and released,nto the ccmmuntty?
D. Were released into a mandated aftercare program,Aftercare prrxprams are defined m 42 U.S.C.
3796f?(c)
30. E...Lt&Iiiart of the FLSAT BJA awrrard,•enty t.:t tGii rdkLof)a i• ,' rn .'.-- ?m III:V-w�S�4 tT�[SKlf3aCitS���1€aSSL �ttk,..syL .5< �
svccessfylly completed and un uccecchl ty exited and were rer-carcerate+l:
Measure Reincarcerabed basal on a firerRanc.rcer:.ted based on a Revocation
Criminal Charge for a Technical Violation
Participants released into the Community feircfucanq mandated
aftercare programs)r.l o successfully completed the la t based
program
Partlopants released vrto the community(excludag mandated
aftercare programs)who participated but unsucc4ssfu,ty aet d
the program
Cafacial
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
I��
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
ATTACHMENT 8
Standards of Care for Opioid Use Disorder
1. Purpose.
To provide evidence-based substance use treatment to participants in the RSAT program both in custody and
in the community who are identified with an opioid use disorder(OUD). Standard of care for participants with
opioid use disorder(OUD) must include a full MOUD program with the following elements: an OUD screening,
discussion of MOUD options between the incarcerated individual and provider, initiation prior to the onset of
withdrawal or continuation of MOUD, release and reentry planning to include connection with continued
treatment, same day release appointment when possible or MOUD to bridge patient until next appointment and
naloxone upon release. Reentry planning may also include assisting the incarcerated individual with sign-up of
Medicaid, reestablishing Medicaid and connection with the Managed Care Organizations (MCOs).
Health Equity -This project also intends to address inequities in OUD treatment and recovery services by
providing medically necessary treatment for opioid use disorder to incarcerated individuals. The RSAT program
should understand cultural barriers and provide culturally appropriate services and recognize the need for
inclusion of people with lived experiences in the development of the RSAT programs. Additionally, this project
intends to identify stigma and educate staff to ensure ongoing collaboration and openness to change.
2. Performance Work Statement.
The Contractor shall ensure funds are responsibly used towards the jail or prison based RSAT Program
and provide the standard of care core components which include:
a. FDA approved medication for opioid use disorder(MOUD) must be available and offered to all
incarcerated individuals who are identified with OUD at intake. Individuals with OUD may decline
MOUD at any time, but ongoing discussions on MOUD may be offered.
b. Methadone, buprenorphine, naltrexone should all be offered unless: (a) an opioid treatment
program (OTP) is not within reasonable driving distance from the jail or the community in which the
patient will likely release, in which case the jail is not required to offer methadone as an option; or
(b) there is no available buprenorphine provider in the community to which the patient will likely
release, in which case the jail is not required to offer buprenorphine as an option. Naltrexone may
be provided in oral formulation while the patient is incarcerated, but injectable long-acting
naltrexone must be offered as an option prior to release. Long-acting injectable buprenorphine can
also be offered.
c. MOUD must be continued for those who are already taking MOUD upon entering the facility.
MOUD is continued using the same medication, at the same dose unless ordered otherwise by the
prescriber based on clinical need (documented in the patient's medical record)with the exception
of injectable long-acting naltrexone which may be converted to an equivalent oral dose until just
prior to release and the injectable form is restarted. Methadone may be transitioned to
buprenorphine if the jail is not a licensed opioid treatment program (OTP) and the nearest OTP is
not within reasonable driving distance from the jail. The presence of other illicit or controlled
substances should not result in discontinuation of MOUD (consistent with the 2020 ASAM National
Practice Guideline for the Treatment of Opioid Use Disorder) Please also review and implement the
newly released (June 2023), Bureau of Justice Assistance, Guidelines for Managing Substance
Withdrawal in Jails .
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
d. Screening for risk of acute withdrawal must be done upon intake. Screening for opioid use disorder
(OUD) absent a risk of acute withdrawal must also be done, but it may be done after intake, as long
as the delay does not impair the ability to begin treatment prior to release. The incarcerated
individual must be educated on treatment choices and the process for continuation of access to
MOUD, during incarceration, and upon release. (See resources for validated tool suggestions.)
e. Individuals entering the facility who are physically dependent on opioids, must be offered MOUD
treatment; withdrawal (including withdrawal using buprenorphine or methadone) is not acceptable
unless the patient provides an informed refusal of treatment or the patient elects MOUD treatment
with naltrexone, in which case withdrawal is clinically required. Use of other medications (clonidine,
anti-emetics, anti-diarrheals, analgesics) may be used as adjuncts or may be used in place of
opioid agonist or partial agonist if the individual so chooses, but they may not be the only
withdrawal treatment available.
f. Methadone and buprenorphine must be administered daily or more frequently. Alternate-day
("Balloon") dosing of buprenorphine may be used in rare cases based on a clinical need, the
decision for which is arrived at jointly between the healthcare provider and patient and is well-
documented in the patient's medical record.
g. Release planning and reentry coordination completed as soon as possible to ensure an effective
plan is in place prior to release or in the event of an unexpected release of an incarcerated
individual who needs continued treatment and services.
h. Provide at least 2 doses of naloxone and naloxone administration training to all incarcerated
individuals with OUD upon release, pending availability of supplies.
i. If jail's Naloxone supply becomes depleted, work with HCA Contract Manager to assist in
identifying alternative sources for Naloxone.
i. Schedule the first community appointment with a treatment facility.
j. Provide— in hand upon release and at no cost to the individual — sufficient doses of MOUD to
bridge patient until scheduled MOUD follow-up appointment at community treatment facility (does
not apply to patients treated with injectable MOUD).
i. Individuals who are at risk of being released directly from court are informed, prior to going to
court, that they may request to be transported back to the jail by staff to receive these
medications prior to going home.
ii. In situations where an appointment cannot be made, e.g., after-hours bail-out, resident is
given enough medication to last until the next available appointment at the community
treatment facility. If that date is unknown, the individual is given a minimum of a 7-day
supply.
iii. In situations where medications cannot be provided upon release, e.g., unscheduled release
at a time when medical staff are not present in the jail, the individual is informed that he/she
may either return to the jail in the morning to receive bridge medications or, if no medical
staff are present the following day, will have a prescription for the same bridging medication
called to a local pharmacy, at no cost to the individual.
k. Ensure policies and procedures are in place to mitigate medication diversion.
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
SCHEDULE A-1
Statement of Work
October 1, 2023 - September 30, 2024
1. Work Requirements
a. Engage incarcerated individuals in the RSAT program, both in-custody and in the community.
1. Focus on incarcerated individual's substance use disorder and mental health diagnosis and
other behavioral health-related needs.
2. Use a standardized, risks and needs screening instrument to help determine program
eligibility.
3. Determine necessary services in accordance with an American Society of Addiction Medicine
(ASAM) assessment.
4. Develop the RSAT offender's cognitive, behavioral, social, vocational, and other skills to
solve the substance abuse and related problems.
5. Provide staff of a chemical dependency treatment staff certified by the State of Washington
per Washington Administrative Code (WAC) 388-805.
i. Contractors can subcontract with a known and credible behavioral health treatment
agency to best coordinate the identification of, and treatment for, individuals who are
currently in custody and in need of behavioral health treatment.
ii. Contractors can hire their own behavioral health staff, who hold and maintain a
Substance Use Disorder Professional license in the State of Washington, or holds and
maintain a Substance Use Disorder Professional Trainee license AND have an
approved Substance Use Disorder Professional Supervisor, fully licensed in the state of
Washington, on staff in the facility. (Please see Title 18 RCW for further details in
licensure requirements).
6. Provide evidence-based substance use treatment, including medications to treat opioid use
disorder and withdrawal management, in accordance with Attachment 8, Standard of Care for
Opioid Use Disorder.
7. Develop individualized treatment plans that are periodically update with progress and
amended accordingly.
i. Provide Medications for treatment of Opioid Use Disorder(MOUD).
ii. Provide a designated housing space, separate from the general population, for RSAT
participants.
iii. Require random urinalysis and/or other proven reliable forms of drug and alcohol
testing for the RSAT participants throughout the duration RSAT program.
Wa
shington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
iv. Assess for aftercare needs and schedule follow-up appointments with community
agencies prior to individual's departure.
v. Prepare inmates for successful community reintegration, including scheduled and
confirmed post-release appointments for after care treatment and services.
vi. Ensure each RSAT offender is enrolled in aftercare services upon their release from jail
with an outpatient community substance abuse treatment facility certified by the State of
Washington per Washington Administrative Code (WAC) 388-805.
vii. Track the re-offense records of RSAT graduates for one (1)year.
2. Reporting Requirements
a. Program Plan Report. Contractor will provide report to HCA Contract Manager for approval.
Report will include, but not limited to, the following:
1. Current staffing/hiring;
2. Purchase of program supplies;
3. Status of subcontracts or Memorandums of Understanding (MOU);
4. Other components, as approved by HCA Contract Manager.
b. Quarterly Reports.
1. HCA Contract Manager will provide Contractor with report template within 10 days of contract
execution.
2. Contractor will use template to complete reports and provide to HCA Contract Manager for
approval.
3. Contractor will comply with the following DOJ/BJA reporting requirements in collaboration
with the HCA DBHR.
i. No personal identifiable information;
ii. Numbers served/completing the program are required;
iii. Recidivism data, to include probation violation and new arrest convictions;
iv. HCA will report this information to the DOJ/BJA as part of the reporting requirements of
the grant.
c. Report Components. The following is a list of required report components, in accordance with
the federal Bureau of Justice Assistance (BJA) all of which are elaborated on in Attachment 7,
Quarterly Report Template.
1. Average treatment cost per individual who receives program services.
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
DocuSign Envelope ID:49D516BF-39BB-48FD-8F7A-94DC39B03758
2. Average length of stay in the program for incarcerated individuals completing the program.
3. Number of participants carried over from the previous reporting period and number of new
participants.
4. The number of participants who successfully completed the program and number of
participants who were terminated or dropped out.
5. The number of new treatment beds and the percentage of them funded with DOJ grant.
6. The number of days of residential treatment provided.
7. The number of participants completing the program who passed drug-testing.
8. The number of participants who were screened or enrolled in Medicaid.
9. Criminal recidivism of participants who successfully completed the program.
10. Criminal recidivism of participants who were unsuccessfully discharged from the program.
d. Narrative. Narrative program analysis/evaluation reports responding to the following questions:
1. What were your accomplishments during this reporting period?
2. What goals were accomplished as they relate to your grant application?
3. What problems/barriers did you encounter, if any, within the reporting period that prevented
you from reaching your goals or milestones?
4. Is there any assistance that BJA can provide to address any problems/barriers identified in
question #3?
5. Are you on track to fiscally and programmatically complete your program as outlined in your
grant application? (Please answer YES or NO and if no, please explain.)
6. What major activities are planned for the next 6 months?
7. Based on your knowledge of the criminal justice field, are there any innovative
programs/accomplishments that you would like to share with BJA?
3. Deliverables Table
1. Deliverables applicable for the period of October 1, 2023 to September 30, 2024.
# Description Date Range Due Date Rate Max Payment
1 Program Plan Applies to Quarters 1-4 10 days after $24,731 x 1 $24,731
Report contract execution report
2 Quarterly Q1: 10/1/2023- 12/31/2023 15th business day $32,667.25 $130,669
Reports Q2: 1/1/2024-3/31/2024 of each month per report x 4
Q3: 4/1/2024-6/30/2024 following the end reports
Q4: 7/1/2024-9/30/2024 of each quarter
Maximum Compensation for HCA Contract K4880-04 $155,400
Washington State Substance Abuse Treatment Services
Health Care Authority HCA Contract No. K4880-04
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, County Administrator
FROM: David Fortino
DATE: December 18, 2024
SUBJECT: Amendment to HCA Grant Contract for the Residential Substance Abuse
Treatment Program.
STATEMENT OF ISSUE:
This Amendment to the HCA grant contract for Residential Substance Abuse Treatment will allow work to
continue that has helped address behavioral health and substance use disorders among the inmate population
of the Jefferson County Jail.
ANALYSIS:
This contract continues the Residential Substance Abuse Treatment program at the Jefferson County Jail that
provides an opportunity for incarcerated individuals in our community to engage in inpatient treatment
services locally, and gain a head start on their road to recovery. Additionally,this program enhances existing
Substance Use Disorder(SUD) services, such as Relapse Prevention and Substance Use Disorder
Assessments, as well as Behavioral Health Services.
FISCAL IMPACT:
The HCA Grant Contract Provides $155,400 along with $38,850 in matching county funds.
RECOMMENDATION:
Approve Contract Amendment- Washington State Healthcare Authority—Residential Substance Abuse
Treatment in Prisons and Jails
REVIEWED BY:
/a/, / /Z3
Mark McCaule ounty Administrator Date
CONTRACT REVIEW FORM
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Washington State Health Care Authority K4880 #4
(Name of Contractor/Consultant) Contract No.
ci9wYDEPAMOtti'
'vo'fr/it Persou'l Pay:0 Fortino
-360-144:043
dfortinoRco,iefferson.wa„us
—
AMOUNT: 155,400.00 PROCESS: Exempt from Bid Process
Revenue: - Cooperative Purchase
Expenditure: Competitive Sealed Bid
Matching Funds Required: $38,850 Small Works Roster
Sources(s)of Matching Funds MH Mileage fund Vendor List Bid
x RFP or RFQ
Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPLIANCE WITH JCC 3.55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: 111 N/A:U David Fortino ITT2T14071°5714.47070a 12/4/2023
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBARRED BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: rut N/A: E David Fortino Dvic;r24:;,r2tralv 12/4/2023
Signature Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 12/7/2023.
Amendment adding funding.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 12/6/2023.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED),
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL