Contract Amendment #2 with Washington State Health Care Authority BEFORE THE BOARD OF COUNTY COMMISSIONERS
OF LEWIS COUNTY, WASHINGTON
IN RE:
Approving Contract Amendment#2 between )
Washington State Health Care Authority and )
Lewis County ) RESOLUTION No. 18- 3-11>_
WHEREAS, the Board of County Commissioners (BOCC), Lewis County,
Washington, has reviewed contract amendment#2 to Program Agreement #1763-94259
between Lewis County and Washington State Health Care Authority (HCA), for the
period of November 1, 2018, through June 30, 2019; AND
WHEREAS, additional funding in the amount of$65,455 is available through the
Substance Abuse Block Grant (SABG), Dedicated Marijuana Account Fund, Partnership
for Success, and State Targeted Response to the Opioid Crisis to establish a Community
Prevention and Wellness Initiative (CPWI) in Centralia, WA; AND
WHEREAS, it appears to be in the best public interest to authorize the execution
of said contract for Lewis County;
NOW, THEREFORE BE IT RESOLVED that Contract 1763-94259, Amendment
#2 between HCA and Lewis County in the amount of $65,455 from November 1, 2018
through June 30, 2019 is hereby approved and the Director of Public Health & Social
Services is authorized to sign the same.
DONE IN OPEN SESSION this l u day of IQ( , 2018.
APPR• D AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jo. - han eyer, Prosecuting Attorney LEWIS COUNTY, WASHINGTON
..dIliti II -A'./-.TA _., -AA \4111 -0/
:y: Cullen atten E. a J. Fund, Chi,
Deputy Prosecuting Attorney
/ 14ted, L______,
ATTEST: ,0sc° o 9s Robert C. Jackson, Vice Chair
/. , ,, ®1/ SINCE ,o.
Rieva Lester, Clerk of the \ rd1845 J Vacant
Washington State HCA CONTRACT NUMBER.
Health Care- ut CONTRACT AMENDMENT 1763-94259
y Prevention Services Amendment No 02
This Contract Amendment is between the State of Washington Health Care Program Contract Number
Authority(HCA)and the Contractor identified below Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
Lewis County
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS ACD INDEX NUMBER
360 NW North St IDENTIFIER(UBI) 1227
Chehalis, WA 98532 212-002-978
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E MAIL ADDRESS
JP Anderson (360) 740-2787 Click here to enter text jp.anderson @lewiscountywa.go
v
HCA PROGRAM AREA HCA CONTRACT CODE
Division of Behavioral Health 1644CS-63
HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS
Sarah Mariani 4500 Tenth Ave SE
Program Administrator PO Box 45330
Olympia, WA 98504
HCA CONTACT TELEPHONE HCA CONTACT FAX HCA CONTACT E-MAIL ADDRESS
(360)725-3774 Sarah.Mariani @hca wa gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
Yes 93.243
AMENDMENT START DATE CONTRACT END DATE
11/01/2018 06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$222,000.00 $65,455.00 $287,455.00
REASON FOR AMENDMENT:
CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO
ATTACHMENTS When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference
® Additional Exhibits (specify). Exhbits B and N-0
This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms
and conditions agreed upon by the parties as changes to the original Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or
bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing
below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
CitiaCe —^ D e t.yb Ir - /a/s/bs
HCA SIG TURE PRINTED NAME AND TITLE DAT1 SIG ED
d 't'v W./ I Jim Gayton, HCA Contracts Administrator (Z Z( 701k.'
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7024PF HCA Custom Contract Amendment(5-2-2018)
This Contract between the State of Washington Health Care Authority (HCA) and the Contractor is hereby
amended as follows:
Federal Award Identification for Subrecipients (reference 2 CFR 200.331) - Strategic Prevention
Framework Partnerships for Success
(i) Subrecipient name(which must match the name Lewis County
associated with its unique entity identifier);
(ii) Subrecipient's unique entity identifier; (DUNS) 079272555
(iii) Federal Award Identification Number(FAIN); SP020155
(iv) Federal Award Date (see§200.39 Federal award 06/12/2015
date);
(v) Subaward Period of Performance Start and End 11-1-18 to 6-30-19
Date;
(vi) Amount of Federal Funds Obligated by this action; $24,935
(vii) Total Amount of Federal Funds Obligated to the $80,924
subrecipient;
(viii) Total Amount of the Federal Award; $2,207,505 FY16(09/30/15-09/29/16)
(ix) Federal award project description, as required to be Strategic Prevention Framework Partnerships for
responsive to the Federal Funding Accountability Success(PFS)
and Transparency Act(FFATA);
(x) Name of Federal awarding agency, pass-through SAMHSA,
entity, and contact information for awarding official, Washington State DSHS,
Chris Imhoff, Director
PO Box 45330
Olympia, WA 98504-5330
IMHOFC @dshs.wa.gov
(xi) CFDA Number and Name; the pass-through entity 93.243
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).
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Federal Award Identification (reference 2 CFR 200.331)— SOR Grant CFDA#93.788
(i) Subrecipient name(which must match the name Lewis County
associated with its unique entity identifier);
(ii) Subrecipient's unique entity identifier; (DUNS) 079272555
(iii) Federal Award Identification Number(FAIN); H79T1081705
(iv) Federal Award Date(see §200.39 Federal award 9/19/18
date);
(v) Subaward Period of Performance Start and End 11-1-18 to 6-30-19
Date;
(vi) Amount of Federal Funds Obligated by this $40,519
action;
(vii) Total Amount of Federal Funds Obligated to the $40,519
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
(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;
(xii) Identification of whether the award is R&D; and ❑ Yes ® No
(xiii) Indirect cost rate for the Federal award (including de minimis (10%)
if the de minimis rate is charged per§200.414
Indirect(F&A)costs).
HCA Contract Services Page 3
7024PF HCA Custom Contract Amendment(5-2-2018)
1. The Contract maximum is increased by $65,455 from $222,000 to $287,455. Source of funds for this
amendment is the Prevention Framework Partnerships for Success (PFS), CFDA#93.243 and State
Opioid Response (SOR), CFDA#93.788. The Awards and Revenues (A&R) is attached as Exhibit B.
2. Amend Section 1. Definitions by adding Subsections gg. and hh. As follows:
gg. "Partnership for Success" or "PFS" means the Federal Substance Abuse and Mental Health
Services Administration (SAMHSA) Grants Funding Opportunity SP-18-008 supporting
implementation of this state grant project. Anticipated start date 9/30/2018; length of project period
is up to five years. More information can be found at:
https://www.samhsa.00v/sites/default/files/qrants/pdf/spf pfs final 5.7.18.pdf.
a. "State Opioid Response" or"SOR" means the Federal Substance Abuse and Mental Health
Services Administration (SAMHSA) Grants Funding Opportunity TI-18-015 supporting
implementation of this state grant project. Anticipated start date 9/30/2018; length of project period
is up to two years. More information can be found at:
https://www.samhsa.gov/sites/default/files/q rants/pdf/sorfoafinal.6.14.18.pdf.
3. Amend Special Terms and Conditions Section 8. Applicable Exhibits by deleting and replacing with the
following:
8. Applicable Exhibits.
The following table lists the included exhibits in the Contract and the Contractors to which they apply.
Exhibit Title of Exhibit Applicable to the Following
Contractors
Exhibit A Data Security Requirements All Contractors
Exhibit B Awards and Revenue (A&R) All Contractors
Exhibit C PFS Advanced Community King County, San Juan County,
Surveillance Project—Year 5 City of Prosser, Tekoa School
September 30, 2017 to September 29, District
2018
Exhibit D PFS Secure Medicine Take-Back City of Prosser, Garfield County,
Year 5 September 30, 2017 to King County, Lewis County,
September 29, 2018 Tekoa School District; Grant
County
Exhibit E PFS Community Coalition Sector City of Prosser, Garfield County
Sharing Project - Year 5 September
30, 2017 to September 29, 2018
Exhibit F PFS Increase Capacity, Outreach, and King County, City of Prosser
Programming to LGBTQ Community -
Project Year 5 September 30, 2017 to
September 29, 2018
Exhibit G State Targeted Response to the Opioid Whatcom County, Pacific County,
Crisis (STR) Community Prevention Spokane Tribal Network, Cape
and Wellness Initiative (CPWI) Flattery School District, Skagit
Expansion Community -August 15, County
2017—April 30, 2019*
Exhibit H PFS Community Coalition Mentoring ESD 112
Project- Year 5 September 30, 2017 to
September 29, 2018
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Exhibit I PFS Secure Medicine Take-Back ESD 112
Year 5 September 30, 2017 to
September 29, 2018 -
Exhibit J PFS Carryover Funds To Enhance San Juan County, Mt. Adams
Prevention Services Carryover ending School District, Wapato School
September 29, 2017 District
Exhibit K PFS Carryover Funds for NPN City of Prosser, Clark County,
Conference Support Carryover ending Grant County; Mt. Adams School
September 29, 2017 District
Exhibit L State Targeted Response to the Opioid Grays Harbor County
Crisis(STR)
Community Prevention and Wellness
Initiative (CPWI) Expansion
Community
August 15, 2017—April 30, 2019*
Exhibit M Video: "Prevention Tools, What Works, Monroe School District
What Doesn't"
May 15, 2018—June 30, 2018
Exhibit N Partnership for Success (PFS) and Pend Oreille County, Grant
State Opioid Response (SOR) County; Jefferson County, Mason
Community Prevention and Wellness County, ESD 101, Benton
Initiative (CPWI) Expansion County, ESD 112, Skagit County,
Community Lewis County, ESD 105
November 1, 2018—June 30, 2019
Exhibit 0 State Opioid Response (SOR) Mason County
Community-based Prevention Services
November 1, 2018—June 30, 2019
Exhibit P State Opioid Response (SOR) Chelan-Douglas TOGETHER for
Community-based Prevention Services Youth
November 1, 2018—June 30, 2019
4. Amend Special Terms and Conditions Section 9. Consideration first paragraph only by deleting and
replacing with the following:
Total consideration payable to the Contractor for satisfactory performance of the work under this
Contract is increased by$65,455, up to a maximum of$287,455 including any and all expenses, and
shall be based as outlined in Exhibit B: Awards and Revenue.
5. Amend Special Terms and Conditions Section 9. Consideration Subsection a. (1) (c) by deleting and
replacing with the following:
(c) The Contractor shall use no more than eight percent(8%) of the DMA, SOR, and PFS
allocation for administrative costs.
6. Amend Special Terms and Conditions Section 10. Billing and Payment Subsection e. by deleting and
replacing with the following:
a. Claims for Payment.
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7024PF HCA Custom Contract Amendment(5-2-2018)
The Contractor shall:
(1) Submit invoices for costs due and payable under this agreement that were incurred prior to the
expiration date within ninety (90) days of the date services were provided.
(2) Submit final billing for services provided within forty-five (45) days after the end of the State
Fiscal Year.
(a) Final PFS and SOR billing shall be submitted within forty-five (45) days of end of each
Federal Fiscal Year.
(b) Final STR billing shall be submitted by June 30th, annually for each fiscal year.
7. Amend Special Terms and Conditions by replacing Exhibit B as follows on the next page:
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. . . ., . .
Exhibit B
i -
AWARD AND REVENUES
2017-2019 Biennium
i I
CONTRACTOR NAME Lewis County
CONTRACT NUMBER 1763-94259 Amend#2
)
COUNTY Lewis i..
:
The above named Contractor is hereby awarded the following amounts for the purposes fisted.
REVENUE SOURCE
TYPE OF SERVICE AWARD AMOUNTS •
•
CODE: . ..•
•
•
5FY18 SFY19 Total 17-19
•
. • Biennium :: !
...
333.99.59 SABG Prevention(7.1.17-5.30.19) •;$ 40,488 $ 70,290 $ 110,778
334.04.6X OF State Admin for SABG Prevention) $ 3,521 $ 6,112 $ 9,633
SFY 18(7.1.17-6.30.18) $ 3,521
STY 19(7.1.18-6.30-19) :$ 6,112
334.04.6X :Dedicated Marijuana Account-Fund 315-State $ 22,800 $ 22,800 $ 45,600
STY 18(7.1.17-6.30.18) 5 22,803
SFY 19(7.1.18-6.30-19) $ 22,800
i
!333.92.43 I PFS-Total $ 43,191 $ 37,733 $ 80,924
1 Year 4 FFY16(7.1.17-9.29.17) $ 10,798
Year 5 FFY17(9.30.17-9.29.18) $ 32,393.$ 12,798
' I Year 1 FFY18(11.1.18-6.30.19): $ 24,935
333.37.88 ISSIt-Total S - $ - $ -
FFY 17(8.15.17-4.30.18) $
. .
FFY18(5.1.18-4.30.19) $ - $ _
! ..'
1333.37.88 iSOR-Total $ 40,519 $ 40,519
! i •
•
FFY18(11.1.18-6.30.19)i $ ._ 40,519
- .••'
4..
Total Federal Funds 1 -$ 83,679 $ 148,542 $ 232,221
•
'Total State Funds $ 26,321 $ 28,912 $ 55,233
TOTAL ALL AWARDS $ 110,000 $ 177,455 $ 287,455
...............
Federal CFDA: .
---
SABG-Substance Abuse Block Grant-CFDA 93.959 Substance Abuse and Mental Health Services Administration(SAMHSA)
SABG Prevention: i
Funding period(s): 7.1.17-6.30.19 .•
. l k
--)
Funds may be used in SFY 18 or SFY 19;up to the Total 17-19 Biennium award,as indicated above.
• :
CF-State-Admin(for SABG Prevention):
Funding period(s): 7.1.17:6.30.18 and 7.1.18-6.30.19 .
Funds must be used only in the SFY in which they are awarded,as indicated above.
i . 1
.i. .
Dedicated Marijuana Account-Fund 315 State: --1- i
Funding period(s): 7.1.17-6.30.18 and 7.1.18-6.30.19 !
Funds must be used only in the SFY in which they are awarded,as indicated above. i )
PFS-Partnerships for Success-CFDA 93.243 Substance Abuse and Mental Health Services Administration(SAMHSA) '
PFS: .•
:
Year 4 funding: 7.1.17-9.29.17 .. : ..
i i
Year 5 funding: 9.30.17-9.29.18 i
...
year 1 funding: '11.1.18-6.30.19
i
Funds must be used in the FFY in which they are awarded,as indicated above. I .
Beginning 9.30.17,funds for Year 5 may be used in SFY 18 or SFY 19,until 9.29.18.
STR-State Targeted Response to the Opioid Crisis-CFDA 93.788 Substance Abuse and Mental Health Services Administration(SAMHSA)
STR:
FFY17 8.15.17-4.30.18
FFY18 .5.1.18-4.30.19
Funds must be used in the FFY in which they are awarded,as indicated above.
Beginning 5.1.18,funds for FFY18 may be used in SFY 18 or SFY 19,until 4.30.19.
SOR-State Opioid Response-CFDA 93.788 Substance Abuse and Mental Health Services Administration(SAMHSA)
SOR:
FFY18 :11.1.18-6.30.19
Funds must be used in the FFY in which they are awarded,as indicated above.
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8. Amend Special Terms and Conditions by adding Exhibit N as follows on the next page:
HCA Contract Services Page 8
7024PF HCA Custom Contract Amendment(5-2-2018)
Exhibit N
Partnership for Success (PFS) and State Opioid Response (SOR)
Community Prevention and Wellness Initiative (CPWI) Expansion Community
November 1, 2018—June 30, 2019
1. Purpose. The purpose of this Exhibit N is to implement Community Prevention and Wellness Initiative
(CPWI) services in the community and school district or High School Service Area identified in selected
Washington State PFS and SOR Grant for CPWI Expansion RFA# K3054 application. This Exhibit
applies to the Contractors listed in Section 8—Applicable Exhibits. This Exhibit supplements but does
not replace the existing contract and contractual obligations within the existing contract remain.
2. Performance Statement of Work. The following requirements are added in this amendment.
The Contractor shall ensure the provision of CPWI services in accordance with the CPWI Community
Coalition Guide located on the Athena Forum website https://www.theathenaforum.orq/cpwi-
community-coalition-guide which outlines the minimal standards to participate in the CPWI. Contractor
shall plan to reach the ideal benchmarks related to the community coalition's efforts and staffing to
include but not limited to:
a. Hire or identify a minimum of one (1) part-time (0.5 FTE) staff member to serve as qualified
coordinator upon contract execution. Post position no later than November 15, 2018. Full-time
employment(1.0 FTE)for the community coordinator is allowable and is strongly recommended in
order to meet the scope of the project.
(1) Ensure new hire Community Coalition Coordinator(s) meet required position qualifications and
workstation requirements found in the CPWI Community Coalition Guide.
(2) Contractor shall submit a completed Community Coalition Coordinator Qualification Checklist to
Contract Manager or designee for review. HCA shall review and respond within five (5) business
days.
b. Participate in contract and program orientation provided by HCA on January 7, 2019 and January 8,
2019 or as otherwise directed by HCA staff.
c. Contractor contact on page one (1) of this Contract and primary fiscal staff or their designee(s) shall
attend annual contractor training on November 26, 2018 or as otherwise directed by HCA staff.
d. By December 31, 2018 the contractor will:
(1) Hold first community coalition meeting.
(2) Hold at least one local Town Hall meeting to educate community members about local youth
substance use issues identified using local community-level data and engage expanded
participation in coalition meetings.
(3) Provide Key Leader Orientation to gain feedback and support.
e. For year 1, develop and submit a community-based, data-driven Strategic Plan and an annual
Action Plan and Budget with projected expenditures (including salary and benefits for HCA funded
prevention staff, program costs, training and travel)to the Contract Manager or designee, by April 1,
2018 or within thirty (30) days upon request. A template will be provided.
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f. Ensure sixty-percent(60%) of programs supported by HCA funds will be replications or adaptations
of"Evidence-based Practice" substance abuse prevention programs as identified in the list provided
by DBHR. Ensure that all of the programs supported by HCA meet the Center for Substance Abuse
Prevention's (CSAP) Principles of Substance Abuse Prevention, found on the Athena Forum
Website: https://www.theathenaforum.orq/csao-principles-effectiveness-prevention.
g. HCA reserves the right to add reporting requirements based on requirements of grants including
any SOR or PFS specific reporting requirements per SAMHSA.
h. Food costs are generally unallowable during program implementation except within the following
parameters:
(1) Light refreshment costs for training events and meetings lasting longer than two (2) hours in
duration are allowable.
(2) Ensure that light refreshment costs do not exceed $2.50 per person.
(3) Meals are not allowable costs with either PFS or SOR funds.
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9. Amend Special Terms and Conditions by adding Exhibit 0 as follows on the next page:
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7024PF HCA Custom Contract Amendment(5-2-2018)
Exhibit 0
State Opioid Response (SOR)
Community-based Prevention Services
November 1, 2018—June 30, 2019
1. Purpose. The purpose of this Exhibit is to implement Community-based Prevention Services in selected
Washington State SOR Grant for RFA# K3055 application. This Exhibit applies to the Contractor listed
on page one (1). This Exhibit supplements but does not replace the existing contract and contractual
obligations within the existing contract remain.
2. The Contractor shall ensure:
a. The implementation of the Work Plan submitted in Project Narrative as part of RFA and/or as
approved by DBHR to include:
(1) Approved programs and communities from the RFA and approved by DBHR as it applies to
Mason County: North Mason— Guiding Good Choices.
(a) Services, defined as a direct service program, implementation, training, or dissemination of
a media campaign, must begin on or before December 31, 2018.
(b) Program(s)will be implemented for target audience in which they are designed in an
ongoing cycle in communities as designated in approved Work Plan.
(c) Participation in the National Drug Take-Back Days held in April and October each year of
the contract period, and implementation of the Starts with One opioid public education
campaign.
(2) Ensuring funds are used to support program costs including staff for program planning, training,
implementation, reporting and evaluation.
(3) Program implementation must be in alignment with the approved Action Plan and Budget
submitted with the RFA, including approved program(s), dates &timelines, scope, dosage,
target audience(s), leadership, and responsible parties.
(4) Enter approved implementation Work Plan into designated prevention reporting system
(Substance Use Disorder Prevention and Mental Health Promotion Management Information
System (Minerva)) within 30 days of executed contract.
(5) Complete monthly program or strategy services reporting by the 15th of the month following the
month of services, including required pre/post-test data.
(6) Participate in monthly check-in phone calls with contract manager or designee.
b. Contractor contact on page one of this Contract and primary fiscal staff or their designee(s) shall
attend annual contractor training that will be scheduled for four(4) hours in duration, or as
determined by HCA staff. For year 1, the annual contractor training is scheduled for November 26,
2018.
c. Contractor shall ensure that a regular annual schedule of direct prevention services
d. Budget adjustments that total ten percent(10%) or more from the approved budget shall submit a
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7024PF HCA Custom Contract Amendment(5-2-2018)
budget revision for approval to CM or designee at least fifteen (15) days prior to expending adjusted
budget items. Approval must be granted prior to expending funds.
e. Ensure program facilitators are formally trained or certified trainers are used for the approved
program(s) selected, if indicated as necessary by the program.
f. Ensure program is implemented with full fidelity. Specified adaptations must be submitted in writing
to Contract Manager or designee for approval no less that twenty (20) days in advance of program
implementation. Specific adaptations may not affect the core components of the program.
g. Community-based mentoring programs must be implementing the 4th edition of the Elements of
Effective Practice for Mentoring found here: https://www.mentorinq.orq/program-
resources/elements-of-effective-practice-for-mentorinq/
h. Food costs are generally unallowable during program implementation except within the following
parameters:
(1) Light refreshment costs for training events and meetings lasting longer than two (2) hours in
duration are allowable.
(2) Ensure that light refreshment costs do not exceed $2.50 per person.
(3) Meals are not allowable costs with SOR funds.
(4) No more than a total of$1,000 of funds contracted for prevention services by DBHR may be
spent on food or light refreshments per contract per year as designated in application and
approved Work Plan.
i. Participate in monthly HCA DBHR scheduled learning community meetings.
j. Participate in monthly check-in phone calls with Contract Manager or designee.
k. HCA reserves the right to add reporting requirements based on requirements of grants including
any SOR specific reporting requirements per SAMHSA.
I. Prevention Training.
(1) The Contractor shall participate in all required training events identified by HCA.
(2) Non-Required Training
(a) Training paid for by HCA shall be approved by Contract Manager or designee prior to
training and meet the approved goals and objectives related to approved programs in
Minerva.
(b) The Contractor shall ensure any requests for training that are not in the Work Plan are
requested in writing and sent directly to the Contract Manager or designee a minimum of ten
(10)working days before the date of the proposed training expenses are to occur.
(c) The Contractor shall bill for training events on an A-19 per billing code according the
Program/Fiscal Requirements and record training events in the HCA Substance Use
Disorder Prevention and Mental Health Promotion Online Reporting Systems or Minerva in
accordance with the monthly reporting requirements and Prevention Report Schedule/Due
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Dates.
m. Media Materials.
(1) Media materials and publications developed with HCA funds shall be submitted to the Contract
Manager or designee for approval prior to publication (HCA will respond within five (5) working
days). HCA must be cited as the funding source in news releases, publications, and advertising
messages created with or about HCA funding. The funding source shall be cited as:
Washington State Health Care Authority. The HCA logo may also be used in place of the above
citation.
Exceptions: The Contractor does not need to submit the following items to or designee:
(a) Newsletters and fact sheets.
(b) News coverage resulting from interviews with reporters. This includes online news
coverage.
(c) Newspaper editorials or letters to the editor.
(d) Posts on Facebook, YouTube, Tumblr, Twitter, Instagram, Snapchat and other social media
sites.
(e) When a statewide media message is developed by HCA is localized if the only change is the
local CBO information.
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10. Amend Special Terms and Conditions by adding Exhibit P as follows on the next page:
HCA Contract Services Page 15
7024PF HCA Custom Contract Amendment(5-2-2018)
Exhibit P
State Opioid Response (SOR)
Community-based Prevention Services
November 1, 2018—June 30, 2019
1. Purpose. The purpose of this Exhibit is to implement Community-based Prevention Services in selected
Washington State SOR Grant for RFA # K3055 application. This Exhibit applies to the Contractor listed
on page one (1). This Exhibit supplements but does not replace the existing contract and contractual
obligations within the existing contract remain.
2. The Contractor shall ensure:
a. The implementation of the Work Plan submitted in Project Narrative as part of RFA and/or as
approved by DBHR to include:
(1) Approved programs and communities from the RFA and approved by DBHR as it applies to
Chelan-Douglas TOGETHER for Youth: East Wenatchee Eastmont School District— Life Skills.
(a) Services, defined as a direct service program, implementation, training, or dissemination of
a media campaign, must begin on or before December 31, 2018.
(b) Program(s) will be implemented for target audience in which they are designed in an
ongoing cycle in communities as designated in approved Work Plan.
(c) Participation in the National Drug Take-Back Days held in April and October each year of
the contract period, and implementation of the Starts with One opioid public education
campaign.
(2) Ensuring funds are used to support program costs including staff for program planning, training,
implementation, reporting and evaluation.
(3) Program implementation must be in alignment with the approved Action Plan and Budget
submitted with the RFA, including approved program(s), dates &timelines, scope, dosage,
target audience(s), leadership, and responsible parties.
(4) Enter approved implementation Work Plan into designated prevention reporting system
(Substance Use Disorder Prevention and Mental Health Promotion Management Information
System (Minerva)) within 30 days of executed contract.
(5) Complete monthly program or strategy services reporting by the 15th of the month following the
month of services, including required pre/post-test data.
(6) Participate in monthly check-in phone calls with contract manager or designee.
b. Contractor contact on page one of this Contract and primary fiscal staff or their designee(s) shall
attend annual contractor training that will be scheduled for four (4) hours in duration, or as
determined by HCA staff. For year 1, the annual contractor training is scheduled for November 26,
2018.
c. Contractor shall ensure that a regular annual schedule of direct prevention services
d. Budget adjustments that total ten percent (10%) or more from the approved budget shall submit a
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7024PF HCA Custom Contract Amendment(5-2-2018)
budget revision for approval to CM or designee at least fifteen (15) days prior to expending adjusted
budget items. Approval must be granted prior to expending funds.
e. Ensure program facilitators are formally trained or certified trainers are used for the approved
program(s) selected, if indicated as necessary by the program.
f. Ensure program is implemented with full fidelity. Specified adaptations must be submitted in writing
to Contract Manager or designee for approval no less that twenty (20) days in advance of program
implementation. Specific adaptations may not affect the core components of the program.
g. Community-based mentoring programs must be implementing the 4th edition of the Elements of
Effective Practice for Mentoring found here: https://www.mentorinq.orq/program-
resources/elements-of-effective-practice-for-mentorinq/
h. Food costs are generally unallowable during program implementation except within the following
parameters:
(1) Light refreshment costs for training events and meetings lasting longer than two (2) hours in
duration are allowable.
(2) Ensure that light refreshment costs do not exceed $2.50 per person.
(3) Meals are not allowable costs with SOR funds.
(4) No more than a total of$1,000 of funds contracted for prevention services by DBHR may be
spent on food or light refreshments per contract per year as designated in application and
approved Work Plan.
i. Participate in monthly HCA DBHR scheduled learning community meetings.
j. Participate in monthly check-in phone calls with Contract Manager or designee.
k. HCA reserves the right to add reporting requirements based on requirements of grants including
any SOR specific reporting requirements per SAMHSA.
I. Prevention Training.
(1) The Contractor shall participate in all required training events identified by HCA.
(2) Non-Required Training
(a) Training paid for by HCA shall be approved by Contract Manager or designee prior to
training and meet the approved goals and objectives related to approved programs in
Minerva.
(b) The Contractor shall ensure any requests for training that are not in the Work Plan are
requested in writing and sent directly to the Contract Manager or designee a minimum of ten
(10)working days before the date of the proposed training expenses are to occur.
(c) The Contractor shall bill for training events on an A-19 per billing code according the
Program/Fiscal Requirements and record training events in the HCA Substance Use
Disorder Prevention and Mental Health Promotion Online Reporting Systems or Minerva in
accordance with the monthly reporting requirements and Prevention Report Schedule/Due
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7024PF HCA Custom Contract Amendment(5-2-2018)
Dates.
m. Media Materials.
(1) Media materials and publications developed with HCA funds shall be submitted to the Contract
Manager or designee for approval prior to publication (HCA will respond within five (5) working
days). HCA must be cited as the funding source in news releases, publications, and advertising
messages created with or about HCA funding. The funding source shall be cited as:
Washington State Health Care Authority. The HCA logo may also be used in place of the above
citation.
Exceptions: The Contractor does not need to submit the following items to or designee:
(a) Newsletters and fact sheets.
(b) News coverage resulting from interviews with reporters. This includes online news
coverage.
(c) Newspaper editorials or letters to the editor.
(d) Posts on Facebook, YouTube, Tumblr, Twitter, Instagram, Snapchat and other social media
sites.
(e) When a statewide media message is developed by HCA is localized if the only change is the
local CBO information.
All other terms and conditions of this Contract remain in full force and effect.
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7024PF HCA Custom Contract Amendment(5-2-2018)
BOCC A E N DA ITEM SUM lIARY
Resolution: BOCC Meeting Date: Dec 10, 2018
Suggested Wording for Agenda Item: Agenda Type: Consent
Approving Contract Amendment#2 between Washington State Health Care Authority and Lewis County
Contact Danette York Phone: 2774 RECI V1 D
Department: Public Health and Social Services
Action Needed: Approve Resolution
NOV 2 9 2018
LEWIS
PROSECUTING ATTCOUNTY ORNEY
Description
This amendment provides additional funding to establish a Community Prevention and Wellness Initiative
(CPWI) in Centralia,WA (Centralia Coalition). Using a combination of Substance Abuse Block Grant(SABG),
Dedicated Marijuana Account Fund, Partnership for Success, and State targeted Response to the Opioid Crisis,
this agreement provides funding for substance abuse prevention services from November 1, 2018 through June
30, 2019.
Approvals:
User Group Status
York,Danette 'Pending
Whiton,Wayne Pending
Cvw
Cover Letter To
Sarah Mariana
4500 Tenth Ave SE
PO Box 45330
Olympia,WA 98504
Additional Copies
Sandi Andrus
JP Anderson
Stacey Loflin
Wayne Whiton
Suzette Smith
Amanda Migliaccio
Tina Hemphill
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