HomeMy WebLinkAboutGrant Related - Sheriff & Jail (002)GRANT COUNTY
COMMISSIONERS AGENDA MEETING
REQUEST FORMy 1
(Must be submitted to the Clerk of the Board b 2.00pm on Thursday)
REQUESTING DEPARTMENT: Sheriffs Office
REQUEST SUBMITTED BY: Phillip Coats DATE: OT/OZ/2Q24.
CONTACT PERSON ATTENDING ROUNDTABLE -Phillip Coats PHONE: ext 2021
CONFIDENTIAL INFORMATION: DYES ®NO
❑Agreement / Contract
❑Bids / RFPs / Quotes Award
[]Computer Related
❑ Facilities Related
[]Invoices / Purchase Orders
❑ Minutes
❑ Policies
❑ Recommendation
❑Tax Levies
❑AP Vouchers
❑ Bid Opening Scheduled
❑County Code
❑ Financial
*Grants — Fed/State/Count
El Ordinances
y
❑Proclamations
EJ Professional Sery/Consultant
❑Thank You's
ElAppointment / Reappointment
❑Boards /Committees
❑AR PA Related
❑ Emergency Purchase❑Budget
❑Funds
❑ Employee Rel.
❑
EJLeases Hearing
❑ Out of State Travel
❑ MOA / MOU
❑Request for Purchase
El Petty Cash11❑
Resolution
Support Letter
❑Tax Title Property
p rty
[]Surplus Req.
❑ WS LC B
NAM ►Permission for Chief Depillilm"Ass"Aah"11ii
Ut Phillip Docu-Siq.n
,
Coats to Or,14.�,.
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.%,L„JI ILy I LU[dyency Agreement for Reent Demo - --- .,�.�.1 , ovai�� 1 %dre
ry nstration Initiative Pro'e
maximum contract amount of $2.25n nnn nn F,,.. _,. __ 1 Ct• TOtal
• --- ..A..vu11 oc1 1L reviewed by accounting?
❑ YES ❑ NO
- -- I „ ► uviewed by legal? Iw1 vr= c w
um I C Ut- ACTION: ` O
4/23/24
DEFERRED OR CONTINUED TO:
WITHDRAWN:
THIS AGREEMENT is made by and between Washington
Count Jail(Contractor),shington State Health Care Authority(HCA)and
Y pursuant to the authority ran
y g ted by Chapter 39.34 RCW.
I T41 A ..
Grant
The parties signing below warrant that they have read and understand this Contract, have authority to execute this
Contract. This Contract will only be binding upon signature b
9 y both parties. The parties may execute this contract in
multiple counterparts, each of which is deemed an original and all of
which constitute only one agreement. E-mail
(electronic mail) transmission of a signed copy of this contract shall be the same as delivery of an original.
I T!1 A
1. DEFINITIONS
Washington State Page 1 of 24
Health Care Authority HCA IAA K7841
"Accountable Community of Health" or "AC
H11 means a regional coalition consistingof le
a variety of different sectors working together to buil leaders from
g d capacity to work collaboratively, developregional
health improvement plans, jointly implement or egional
p advance local health projects, and advise state'
on how best to address health needs within its region. agencies
"Authorized Representative" means a person •
p to whom signature authority has been deleat '
writing acting within the limits of the person's authority. g ed in
"Capacity Building Application" means a formal application for specific ca acct buildi
specifications of how these funds will be spent b facilities p Y ng funds and
detailed Ian of how p Y on IT and non -IT needs. It also include
p the work will be implemented. s a
"Centers for Medicare and Medicaid Services" `� ��
s or CMS means the federal office under the
Secretary of the United States Department of Health and Human Services, responsible for the '
and Medicaid programs. Medicare
"Confidential Information" means information that may be exempt from disclosure to the public
other unauthorized persons under chapter 42.56 p blit or
p RCW or chapter 70.02 RCW or other state or
statutes or regulations. Confidential Information in federal
cludes, but is not lirn ited to, any information
identifiable to an individual that relates to a natural'
person's health, i
finances, education busin
or receipt of governmental services, names, addresses,� ess, use
telephone numbers, social securit numbers
driver license numbers, financial profiles credit c • Y
and numbers, financial identifiers and an other
identifying numbers, law enforcement records Y
,HCA source code or object code, or HCA or
security information. State
"Contract" or "Agreement" means the entire written ritten agreement between HCA and the contrac
including any exhibits, documents, or materials i .tor,
incorporated by reference. Contract and A reement
may be used interchangeably. g
"Contractor" means Grant Count Jail its Y employees and agents. Contractor includes anf'
erf y irm,
provider, organization, individual or other entity performing ing services under this Agreement. It also
includes any Subcontractor retained by Contractor asermi
p tted under the terms of this Agreement.
"Data" means information disclosed, exchanged or used by Contractor in meefiin re uirem
this Agreement. Data may also include Confidential Information as dg q ents under
defined in this Contract.
Financial Executor Portal" or "FE Portal"
means the payment portal where incentive funds flow
federal Center for Medicare and Medicaid Servicesfrom
through the Delivery System Reform Incentive
Payment program. e
"Health Care Authority" or "HCA" means the'
Washington State Health Care Authority,an division,
section, office, unit or other entity of HCA, or an of y division,
HCA. Y the officers or other officials lawful) representing
Y p ng
"Health -Related Social Needs" or "HRSN"
means the social and economic needs that individual
experience that affect their ability to maintain their h s
health and well-being. These include needs suc
employment, affordable and stable housing,health has
utilities. y food, personal safety, transportation, and affordable
Washington State Page 2 of 24
Health Care Authority HCA IAA K7841
"Implementation Plan" means how the Contractor'
describes how the facility will supportre-releas
services, as outlined in the Statement of Work Attachment 1; #3 p e
.
"Interim and Final Progress Report" means a re •
port that includes information on both the initial
progress and the outcomes of the Reentry Demonstration Initiative Opportunity
"Information and Communication Technology""
or ICT11 means information technolog and other
equipment, systems, technologies, or processes for w Y
hich the principal function is the creation
manipulation, storage, display, receipt, or transmission'
of electronic data and information, as well as an
associated content. Examples include computers and peripheral equipmenty
p p s; information kiosks and
transaction machines; telecommunications equipment;
office customer premises equipment; multifunction
machines; software; applications; websites; videos; and
electronic documents.
"Letter of Intent" means a document that provides specific '
to participate in the Initiative.
p specific information and is a commitment
p
"Readiness Assessment" means a framework forassessi'
ng a Contractor's ability to go -live or full
participate in the Initiative and will include an attestation facility Y
that the facility has met all of the
requirements.
"Reentry" means a broadly defined demonstrationpopulation that includes otherwise eligible, soon-to-
be former incarcerated individuals as defined by the ReentrySection 11
15 Demonstration I ntitiative
Opportunity. It can include both pre-release andos - '
p t release services.
"Services" means all work performed orrovided
p by Contractor pursuant to this Contract.
"Statement of Work" or "SOW"
means a detailed description of the work activities the Contractor
required to perform under the terms and conditions is
of this Contract, including the deliverables and
timeline, and is included as Attachment 1.
"Subcontractor" means a person or entitythat is not of in the employment of the Contractor, who is
performing all or part of the business activities under this his Agreement under a separate contract with
Contractor. The term "Subcontractor" means subcon
tractors) of any tier.
"Subrecipient" shall have the meaninggiven in 4
g 5 C.F.R. 75.2, or any successor or replacement t
such definition, for any federal award from HHS; or 2 °
. .. C.F.R. 200.93, or any successor or replacement en
such definition, for any other federal award. p t to
"Third Party Administrator" or "TPA" is an entity that may provide implementation and adm inistra i
support to carceral facilities in support of reentry.
t ve
2. STATEMENT OF WORK
Contractor will furnish the necessary personnel equipment,
s necessary � q �pment, material and/or service(s) and otherwise
do all thin
g essary for or incidental to the performance of work set forth in Attachment 1.
3. PERIOD OF PERFORMANCE
Washington State Page 3 of 24
Health Care Authority HCA IAA K7841
Subject to its other provisions, theeriod of
last si natur p performance of this Contract will commenc
g e, and continue through July 31, 2028, unless t eon date of
written agreement between the parties.erm inated sooner or extended upon
on
4. PAYMENT
Compensation for the work provided in accordance with this Agreement has been est
the terms of
RCW 39.34.130. Compensation for services established under
following terms set forth i will be based in accordance with the
n the Statement of Work, Attachment 1.
5. PAYMENT PROCESS
5.1. HCA will pay the Contractor for the targeted m ilestones set forth in Attachm ent 1: S
Work. tafiement of
5.2. The milestone deliverables must be submitted '
tted per the instructions set forth in the Att
Statement of Work and must describe and document to HCA's achment 1:
satisfaction the re qui
red All milestone deliverable submissions quired
fissions will be reviewed and must be
approved by theContract Manager or designee prior to payment.
5.3. Once Contractor's submission of milestone'
deliverables have been accepted and approved through by
HCA, payments will distributed b
htt s://wafi y rough the Financial Executor (FE)Portal at
p nancialexecutor.com/.
5.4. FE Portal customer service telephone '
WA FE Fina p number is (844) 300-5040 or accessible b email
ncialServices@pcgus.com. Y mail at
5.5. Payment will be considered timet if
y m ade within thirty (30)calendar da s of rece'
completed invoices. Y ipt of properly
5.6. Upon expiration or termination an claims
Agreement Y ms for payment for costs due and a able u
g ent that are incurred prior to the expiration p Y nder this
sixtyGalen p date must be submitted by Contractor wi ' calendar days after the expiration d thin
that are submitted p ate. There will be no obligation to a an
d sixty-one (61) or more calendar days of pay Y claims
Claims"). Belated Claims � Y ter the expiration date ("Belated
will be paid at RCA's sole discretion and a
is contingent upon the availability of funds. any such potential payment
6. ACCESSIBILITY
6.1. REQUIREMENTS AND STANDARDS. Each information and communication technology
product or service furnished under this Contra (ICT)
with disabilities in Contract shall be accessible to and usable b individuals
accordance with the Americans with DisabilitiesY viduals
applicable Federal and S Act (ADA) and other
State laws and policies, includingOCIO
of this clause, Contractor shall b policy 188, et seq. For purposes
e considered in compliance with the ADA and o '
Federal and State laws if it satisfies the re Cher applicable
requirements (including exceptions) specified in the
regulations implementing Section 508 of the Rehabilitation ehabilitation Act, including the Web Conte
Accessibility Guidelines (WCAG) 2.1 Level AA Success Criteria and Conformance
nt
Washington State Page 4 of 24
Health Care Authority HCA IAA K7841
Requirements (2008), which are incorporated
criteria. by reference, and the functional performance
ce
6.2. DOCUMENTATION. Contractor shall maintain and retain, subject to review b HCA fu
documentation of the measures taken to ensure compliance with theY II
applicable requirements
and functional performance criteria, including records of any testing or simulations conducted.
6.3. REMEDIATION. If the Contractor claims that its products or services satisf the li
requirements and standards specified in this SectionY pp cable
and it is later determined by HCA that an
furnished product or service is not in compliance Y
will promptly inform p nce with such requirements and standards HCA
p Y m Contractor in writing of noncompliance. Con •'•
cost to HCA, repair or replace p tractor shall, at no additional
p p ce the non-compliant products or services within
by HCA. If the repair or replacement is the period specified
t p not completed within the specified time HCA
he contract, delivery, task order, or work order, � may cancel
liabilities or have an n , or purchase line item without termination
y necessary changes made or repairs performed b em
by another contractor, and Contractor shall reimburse HCA fY employees of HCA or
or any expenses incurred thereby.
6.4. INDEMNIFICATION. Contractor agrees to indemnify arisingout of g indemnify and hold harmless HCA from an c '
failure to comply with the aforesaid requirements.Y laom
7. AGREEMENT CHANGES MODIFICATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such amendments are not
binding unless they are in writing and signed by an Authorized Representative of each party.
8. SUBCONTRACTING
Neither the Contractor nor any Subcontractors •
contemplated hall enter into subcontracts for an of the w
p under this Agreement without obtainingHCA's Y work
no responsibilityfor an act' prior written approval. HCA shall have
y ion of any such Subcontractors.
9. SUBRECIPIENT
If the Contractor is a subrecipient (as defined in 45 C.F.R. 75.2 and 2 C.F.R. 200.93) of federal
awards, then the Contractor shall:
9.1. Comply with 2 C.F.R. 200.501 and 45 C.F.R. R. 75.501; and
9.2. Overpayments: If it is determined b HC
Co Y A, or during the course of a require audit t
ntractor has been paid unallowable costs un q ,hat
der this or any program agreement Contractor
ctor
will refund the full amount to HCA. In the event that overpayments or erroneous payments eats h
o the Contractor under this Contract, HCA willp Y have
been made t provide written notice to Contractor
and Contractor will ref
and the full amount to HCA within thirtyre � calendar days of the notice. If
the Contractor disagrees es with HCA's actions under this section then it
resolution provisions of Section 13, Disputes. maY invoke the dispute
10. ASSIGNMENT
Washington State Page 5 of 24
Health Care Authority HCA IAA K7841
The work to be provided under this Agreement and
or Bele able b , any claim arising thereunder, is not assi nable
g y either party in whole or in part, without the express g
party, which consent will unreasonably withheld
not be p s prior written consent of the other
.
11. CONTRACT MANAGEMENT
The Contract Manager for each of the parties named
f� on the face of this Contract, will be responsible
or and will be the
contact person for all communications and billings regarding garding the performance of
this Agreement. Either party mus
p y t notify the other party within thirty(30) of change
es i � ) da s Y nge of Contract
Management. Changes n Contract Management shall require an amendment.
12. DISALLOWED COSTS
The Contractor is responsible for any audit exceptions
ororganization or p s or disallowed costs incurred by its own
g that of its Subcontractors.
13. DISPUTES
In the event that a dispute arises under this Agreement, g nt, it will be determined by a dispute board in
the following manner. Each party to this Agreement will appoint one me
appointed willjointlyp tuber to the dispute board.
The members so app appoint an additional member to the dispute bo
dispute board will review the facts, A regiment term p ard. The
g sand applicable statutes and rules and make a
determination nation of the dispute. The dispute board will thereafter'
.The Bete decide the dispute with the majority
prevailing. determination of the dispute board will be final and binding•
an alternative to this process, either of the on the parties hereto. As
parties may request intervention by the Governor as
Governor's process will control
provided by RCW 43.17.334, in which event the Govern '
.
14. GOVERNANCE
This Agreement is entered into pursuant to and under•
the authority granted by the laws of the state of
Washington and any applicable federal laws. Theprovisions•
conform to those I of this Agreement will be construed to
laws.
In the event of an inconsistency in the terms of this
. Agreement, or between its terms and an
applicable statute or rule, the inconsistency will be resolved Y
order: Y Ived by giving precedence in the following
A. Applicable Federal and State of Washington statutes tutes and regulations;
B. Attachment 2: Federal Compliance Certifications and Assurances;
C. Attachment 1: Statement of Work;
D. Exhibit A: Centers of Medicare &Medicaid Services, Special Terms and Conditions; and
E. Any other provisions of the agreement including materials incorporated by reference.
15. INDEPENDENT CAPACITY
Washington State Page 6 of 24
Health Care Authority HCA IAA K7841
The employees or agents of each part who are en
not be considered Y gaged in the performance of this Agreement w'
sidered for any purpose to be employees or g ill
agents of the other party.
16. RECORDS MAINTENANCE
16.1. The parties to this Agreement will each maintain tarn books, records, documents and other
evidence which sufficiently and proper) reflect all °
art in the performance Y direct and indirect costs expended b either
party p ormance of the services described herein. The Y
inspection, review or audit b e se records will be subject to
y personnel of both parties, other personnel dui authorized
and f Y ed by
either party, the Office of the State Auditor,
records documents, , federal officials so authorized by law. All books
ents, and other material relevant to this Agreement '
after expiration and the Officeg will be retained for six years
of the State Auditor, federal auditors, and an
authorized by the parties will have full access Y persons duly
and the right to examine any of these materials
during this period.
16.2. Records and other documents, in an medium, m, furnished by one party to this Agreement to
other th
party, will remain the property of the furnishing party, unless otherwise agreed. Thereceiving party will not disclose or make available this material to any third parties without
firstg.ving notice to the furnishing party and giving it a reasonable
opportunity to respond.
Eachparty will use reasonable security procedures and protections to assure
that records and
documents provided by the other part not
Y are erroneously disclosed to third parties.
17. TREATMENT OF ASSETS
17.1. Ownership
HCA shall retain title to all property furnished b
all ro ert f Y HCA to Contractor under this contract. Title to
p p y urnished by the Contractor, for the cost of which the Contractor is entitled to
reimbursement as a direct item of cost under this contract, excludingintellectual
provided by the Contractor,. shall ass ctual property
Contractor. property Title to other property, the cost of which is p p �Y by the
reimbursable to the Contractor under this
Contract, shall pass to and vest in HCA (i) u on pissuance for use of such propertyin the
performance of this Contract, (ii) commencement of
this Contract or(iii)r ' use of such property in the performance of
reimbursement of the cost thereof b HC
occurs first. Y A, in whole or in part, whichever
17.2. Use of Property
Any property furnished to Contractor shall unless b t � s otherwise provided herein, or approved in
writing y he HCA Contract Manager, be used onlyfor the performance of and subject to the
terms of this Contract. Contractor's s use of the equipment shall be subject t
administrative and other requirements. J o H CA' s security,
17.3. Damage to Property
Contractor shall continuously protect and be responsible ponsible for any loss, destruction, or damage to
property which results from or is caused b Contractor' • g
liable to HCA for cost Y s acts or omissions. Contractor shall be
s of repair or replacement for propertyorequipment
destroyed or damaged b Contract that has been lost,
Y or or Contractor's employees, agents or subcontractors. Cost
Washington State Page 7 of 24
Health Care Authority HCA IAA K7841
of replacement shall be the current market value of the property and equipment on the date o
the loss as determined by HCA, f
17.4. Notice of Damage
Upon the loss of, destruction of, or damage to
HCA Contract M g any of the property, Contractor shall notif the
Manager thereof within one (1) Business Da and Y
to protect that propertyfrom further Y hall take all reasonable steps
her damage.
17.5. Surrender of Property
Contractor will ensure that the property will be
was furnished t p Y returned to HCA in like condition to that in which
o Contractor, reasonable wear and tear exce it
HCA all propertyupon the pied. Contractor shall surrender to
p earlier of expiration or termination of this Contract.
18. RIGHTS IN DATA
Unless otherwise provided, data which originates '
defined b the U.S. es from this Agreement will be "works for hire"
Y S. Copyright Act of 1976 and will be owned as
limited to, reports, documents, by HCA. Data will include, but not be
p m ents, pamphlets, advertisements, books magazines, � surveys, studies
computer programs, films, tapes and/or sound reproductions. Ownership includes the right
patent, register and the ability to transfer these to
copyright,
rights.
19. CONFIDENTIALITY
Each party agrees not to divulge, publish or otherwise make known to unauthorized persons
Confidential Information accessed under this Agreement. ent. Contractor agrees that all materials
containing Confidential Information received pursuant '
information derived p ant to this Agreement, including, but not limited
ed from or containing to
in in g,patient records, claimant file and medical case
reportformation, relations with H CA s clients and i management
is employees, and any other information whi
may be classified as confidential, shall not be disc) ch
disclosed to other persons without H CA's written
consent except as may be required by law.
20. SEVERABILITY
If any provision of this Agreement or an provision of any document incorporated by reference will
held invalids Y p si
such invalidity will not affect the other provisions ll be
rovi ' p sof this Agreement, which can be given
effect without the invalid
p sion if such remainder conforms to the requirements g
and the fundamental purpose of this agreement, q ements of applicable law
declared and to this end the provisions of this A ree
to be severable. g ment are
21. FUNDING AVAILABILITY
HCA's ability to make payments is contingent
federal or g on funding availability. In the event fundingfrom
other sources is withdrawn, reduced or limited m state,
prior to completion or � din any way after the effective date and
p expiration date of this Agreement, HCA at its s '
terminate the Agreement, in whole or � ole discretion, may elect to
part, or to renegotiate the Agreement subject to '
limitations and conditions. HCA may also elect J new funding
Y to suspend performance of the until Agreement g ti I HCA
Washington State Page 8 of 24
Health Care Authority HCA IAA K7841
determines the funding insufficiency is resolved
Y . HCA may exercise any of these options wit
notification restrictions. p h no
22. TERMINATION
Either party may terminate this Agreement upon 3
this A ree p 0 -
days a prior written notification to the other
g m ent is so terminated, the parties will be liable onlyp �y. If
incurred in accordance with the terms of this Afor performance rendered or costs
greement
rior to the effective p date of termination.
23. TERMINATION FOR CAUSE
If for any cause, either party does not fulfill in a timely and proper manner its obligations under this
Agreement, or if either party violates an of these • • is
the other a Y terms and conditions, the aggrieved art will '
party written notice of such failure or violation. The party give
responsible party will be given the
opportunity to correct the violation or failure within 30 days. may If failure or violation is not corrected this
y terminated immediately by written notice of the'
aggrieved party to the other.
24. WAIVER
A failure by either party to exercise its rights and '
subsequent e g under this Agreement will not preclude that art from
q exercise of such rights and will not constitute a waiver party
m
Agreement unless stated to be suchof any other rights under this
in a writing signed by an Authorized Representative
and attached to the original Agreement. p ntative of the party
25. ALL WRITINGS CONTAINED HEREIN
This Agreement contains all the terms and conditions itions agreed upon by the parties. No other
understandings, oral or otherwise, regarding the subject
exist or to b' g g matter of this Agreement will be deem
bind any of the parties hereto. ed to
26. SURVIVORSHIP
The terms, conditions and warranties contained i '
n this Agreement that by their sense and context tare
intended to survive the completion of the ' performance, expiration or termination of this Agreement
shall so survive. In addition, the terms of the sections titled Rights in D • g
g Data, Confidentiality, Disputes
and Records Maintenance shall survive the termination of this Agreement.
Attachments
Attachment 1: Statement of Work
Attachment 2: Federal Compliance, Certifications and Assurances
Exhibit A: Centers of Medicare &Medicaid Services, special terms and conditions
Washington State Page 9 of 24
Health Care Authority HCA IAA K7841
Washington State Page 10 of 24
Health Care Authority HCA IAA K7841
ATTACHMENT 1: STATEMENT OF WORK
The Contractor will provide the services and staff
incidental to, the erfor ,and otherwise do all things necessar for or
p mance of work, as described in this Schedule. Y '
I. Background
In June 2023, the Health Care Authoritywai received federal approval for a Medicaid
ver demonstration that includes the Initiative. This id
Transformation Project(IVITP)r s new Initiative under the Medicaid
J renewal known as the MTP 2.0. was a
Centers for Medicare and Medicaid Services (CMS) to provide essential services for
individuals leaving a state prison, count /cit jail, o •ort th Y Y r Youth correctional facility. The
Initiative will support e delivery of targeted pre-release services to Medicaid
and youth in state prisons, jails, and dicaid eligible adults
Medicaid youth carceral facilities that will be reimbursed b t
program known as Apple Health in Washington Y he
g State.
2. Purpose
The purpose of this project is to people prepare f
an p p p or a successful transition and reentryinto
their community d help them live their healthiest life, improve health
reducing rates of recidivism(re-offense),p Ith outcomes. , emergency department visits substance
death. To stabilize and treat common conditions � bstance use and
itions both prior and post release, so the
opportunity for a successful reentry is increased.
3. Project Objectives
Targeted Pre -Release Services. The first threes '
services listed below will be mandatory for
facilities to implement. The last four services are
implementation of a tar optional. Contractor must support the
targeted set of pre-release services, as described in'
and Conditions (STC) of MTP 2.0 and the -Reentry eentry Implementation Plan the Special Terms
an approd b CMS:
a. Case management veY
b. Medications for alcohol and opioid use disorder
c. 30 -day supply of medicationssupplies at release
d. Medications during the pre-releaseeriod
e. Lab and radiologyp
f. Services by community health workers withi
Physical and b I ved experience
g. Ph
Y behavioral clinical consultations
As appropriate, athird-party administratorTPA
Communities ( ) as well as regional Accountable
of Health (ACH) may assist the Contractor in the
planning and
implementation of these services, including the delivery of appropriate Health Relat
Social Needs (HRSN), and the milestones in Se • • ed
with facilities on solutions coon 4. Additionally, HCA will collaborate
ons for electronic health record(EHR)s stems •for Medicaid serv' Y and systems that bill
ices.
Activities for implementing reentry services must
include:
a. Communicating with HCA
regarding Initiative implementation
onb. Meeting cohort milestones as described
below.
c. Ensuring that a client receives targeted pre-release
feasible providing g p ase services and when
. , , p g HRSN services for clients reenteringa community.
d. An ability to support communication w' pity .
billing.
with community providers and Medicaid
Washington State 11
Health Care Authority HCA Contract #K7841
4. Milestones
The Contractor will developand implement TheC Project Objectives. act the following deliverables that
The Contractor will provide se execute the
activities necessaryfor o � p services and deliverables to perform
r incidental to the performance of w p all
SOW and described in the Waiver to work as set forth under this
achieve progress on the followingmile
es ones.
Milestone 1— Letter of Intent
Following the receipt of a Letter of
must meet the Intent documentation and a royal
e specifications outlined in the to pp by HCA, Contractor
determined b HCA for template provided to the Contractor as
Y each of the following four milestone
g
Participate in the next milestone. sin order to receive fundin and
Milestone 2 - Complete a Capacity Building ApplicationThe Capacity Building Application includes
an Implementation
The Implementation plan must Plan and a detailed budget.
describe how the facility will support
The detailed budget will representfacility's pp pre-release services.
and will specify p a formal application for capacity
how capacity building funds will p cifiY building funds
needs. Facilities in Cohortsbe spent by facilities on IT and non -IT
1 and 2 that identify the need for IT
Capacity Building Application may i additional time to Complete a
Capacity
uen Y m plem ent after the go live date of that p
subsequent cohort and complete milestones in ' at cohort or Join a
line with the deadlines for these cohorts.
Milestone 3 - Complete a Readiness Assessment
The Readiness Assessment report must include a f
readiness to go -live as part of the Initiative framework for assessing facility
read to o -lav iative and will include an attestation that� •
Y g e. HCA will provide a template forth the facility is
assessments and determinefacilityp e assessment and will .review submitted
readiness prior to the go -live matted
J date for each facility.
Milestone 4 - Submit Interim r Pro Jess Report
The Contractor will
be required to submit an Interim Pr
information on the initial implementation ogress Report to HCA with
Interim Progress p ation of the Initiative. HCA will provide
g s Report and will review and approve p e a template for the
pp submitted progress reports.
Milestone 5 — Submit Final Progress J ss Report
The Contractor will be required to submit a Final Progress
on the overall implementation progress gess Report to HCA with information
provide a tem p gess of the Initiative and outcomes for clients.
plate for the Final Progress Report ents. HCA will
progress reports. p and will review and approve submitted
d
Milestones deadlines will be based upon Cohort the cohort a Facility partici ates in. '
rt 1 are as follows: p Milestone
nvF+ Kesponsibilities
Washington State 1
Health Care Authority 2 HCA Contract
#K7841
HCA will provide IT infrastructure fundin
needed HCA g through the Capacity Buildin Program. .
will collaborate with facilities on solutions f g g If
systems and systems that bill for Medicaid services.or electronic health record (EHR)
HCA is soliciting for TPA to provide administrative
2025. The administrative strative support possibly startingas earl a
trative support may include but may not b li s 1
with Medicaid eligibility screeningan y e limited to assisting clients
as a d application, supporting providers to be
.Medicaid provider, and servingas a claim come enrolled
providers prepare an • clearinghouse that helps facilities and
p p d submit claims.
6. Capacity Building Program Funding
Contractors that complete
p e Milestone 2 — Capacity BuildingApplication, pP on, HCA will provide
capacity building funding to facilities to i support the planning for and implementation of t
g ble uses of the funding are available in A he
Demonstration. Eli
following activities: Appendix A, and include the
a. IT infrastructure funding to support systems p y s changes for data exchange, access to
virtual health
services, and other IT needs.
b. Reentry planning and implementation funding development to support planning expenses such
pment of process changes, protocols and
implementation and Kirin and training� procedures for
9 of staff.
Maximum funding for reentry planningand '
on their avers implementation will vary by facilitysize bas
average daily population for the period of time specified , � ed
Intent response. The table below in the Contractor s Letter of
delineates the maximum fundingamounts
facilities. The maximum IT infrastructure f for Tier 2
facility. funding will be $1 million for each artici ati
p p ng
7. Milestone Deliverables Compensation p Table
HCA will assess Contractor's progress towards achievingInitiative
specific mi the Initiative goals based on
achievement of s
p milestones and measured by these m ilesto
Capacity Building funding to Contractor is b nes. Distribution of
based on a Contractor's tier as described Belo
and is contingent upon their completion of the ' w
implementation milestones described below.
Milestones will be developed b the State i
of the public an y n consultation with stakeholders and me
p d approved by CMS. General) progress tubers
the following categories:
y p g milestones will be organized into
g
Planning Milestones Before Go -Live wi
Letter o ° th Pre -Release Servicesfun
1
) f Intent 10 /° of total RPP
Submission funding N/A
upon submission:
2) Capacity Building Tier 2: $125,000
Application Up
to 40% of totsI RPPUp to
funding
g upon approval. $500,000
Tier 2: Up to $500,000 upon
Due Date June 1, 2024
Funding Paid: July 2024
Due Date: October 1,
2024
Washington State 13
Health Care Authority HCA Contract #K7841
approval of Funding Paid: December
the 1, 2024
3) Readiness
Assessment
°
U p to 40 /o of total RPP
fundis upon a
g p approval:
Application
U to
p
Due Date. March T�2�025
Submission an d
Tier 2: Up to $500,000
$500,000
FundingPaid: July
ly 1,
Approval
upon
p n
2025
approval of
the
Readiness
Imiementatio' n Milestones
G - i
After Li
o ve with Pre -Release
Assessment
Services------
4) Interim Progress-
R Report Submission
U to 5°
p /o of total RPP funding
upon submission:
N/A
Due D ate: May 1, 2026
Tier 2:Funding
U p to $62500,
Paid: July 1,
2026
5) Final Progress
Report Submission
U to 5°
Up /o of total RPP funding
upon submission:
N/A
Due D ate. November 1,
Tier 2: U$62,5002026
p to
Funding'
Paid. January 1,
2027
Participating in the Evaluation
Contractor will support the Evaluation of the Initiative. HCA contracted with an independent
evaluator to evaluate the1
Waiver. The evaluator will use claims data from
to assess the effectiveness of this Initiative. Th mpre-release services
The evaluator stores and analyzes the data in a
secure environment. Facilities that participate are consenting to the use of this claims data for
evaluation. Facility y also be asked to participate in qualitative interviews
the independent evaluator regarding their experience performed by
evaluation. p Ce participating in the Initiative, to inform the
Washington State 14
Health Care Authority HCA Contract #K7841
Appendix A: Eligible Uses of Capacity Building Fundi
ng
Eligible uses of capacity building funds
• Development of protocols and procedures.
■ Expenditures to support the preparation/execution'
of policies and
procedures related to enrollment and suspension/unsus
and post -release reentrynavigation pension and pre -
Add' ' • � vigation services.
•
Additional activities to promote collaboration.
■ Expenditures for additional activities that will
advance collaborationamon stakeholders. This may include conferences
and meetings
convened with the agencies, organizations, g
g ns, and stakeholders involved in
the initiative.
• Expenditures for planning to focus on developing g processes and informationsharing protocols to:
■ Identify uninsured individuals who areotentiall p y eligible legible for Medicaid/
Children's
Health Insurance Program (CHIP).
• Assist with the completion of an application.
• Submit an application to the county social services department for
coordinating suspension/unsuspension.
• Screen for eligibility for pre-release services and reentry planning
in a period for up to 90 days immediate) prior to t
date of release.Y p he expected
• Deliver necessary services to eligible individuals is immediately n a period for up
to 90 da
Y ately prior to the expected date of release and
care coordination to support reentry.
• Establish ongoing oversight and monitoringprocess
p ss upon
implementation.
Hiring of staff and training to:
■ Assist with the coordination of enrollment/sus en
■ Provide reentryp sion/unsuspension.
navigation services during the 90 -day pre-releaseerio
and to support reentry.
p d,
■ Provide overall guidance on how to work with juste - and appropriately.
J ce involved individuals
effectively
■ Support an environment appropriate forrovisio -pre-release
p n of 90 day
services.
■ Accommodations for private space, such as correctional facility -grade
moveable screen walls, desks, and chairs to conduct as
interviews within carceral settings. assessments and
Eligible uses of IT infrastructure funding
• Electronic interfaces for prisons, jails, andouth facilities
Y to support
enrollment/
suspension.
• Enhancements to existing IT systems to create
and improve data -exchange to
support reentry navigation services in the 90 -da -rele
period. Y p re ase and post -release
• Adoption of system upgrades to ensure compatibility
p lity with Epic's data sharing
platform. Any additional expenses related to upgrades—including
the billing
Washington State 15
Health Care Authority HCA Contract 4K7841
module or new platforms—not covered b Health
Y Care Management and
Coordination
System (HCMACS) which will likel not be
2025. Y a vailable until mid-
• Installation of audio-visual equipment or other
technology to support provision of
pre-release services delivered via telehealth in a ere
immediately prior period for up to 90 days
p to the expected date of release and care coordination
support reentry. enation to
Washington State 16
Health Care Authority HCA Contract #K7841
ATTACHMENT 2: FEDERAL COMPLIANCET CERTIFICATIONS AND ASSURANCES
1. FEDERAL COMPLIANCE -The use of
federal funds requires additional compliance
mechanisms to be in place. The followingrepresents p ance and control
may applyto an federal p esents the of compliance elements t
y al funds provided under this contract. F that
these elements or details specific to the f or clarification regarding any of
Contract Ma federal funds in this contract, contact: HCA A D B H R
a. Source of Funds: This Contract is beingf
Medicaid Transformation ended through Washingtons State's five-year
mation Project 2.0 approved under section 1 Y ar
Security Act by the Center for Medicare 115(a) of the federal Social
Security
dicare and Medicaid Service(CMS)on J0304/0 and 21-W-00071/0. June 30, 2023, No.
b. Period of Availability of Funds: Funds'
will become available to Contractor or Su
commencing on the date of final signature of the Co brecipient
through June 30, 2028. Contract to which is attached and continuing
C. Single Audit Act: This section applies to s °
for -prof hospitals pp ubrecipients only. Subrecipient(includingp p Is and non -prof it institutions s i private,
Management an ) hall adhere to the federal Office of
g d Budget (OMB) Super Circular 2 CFR
Subrecipient who expends 200.501 and 45 CFR 75.501. A
p $750,000 or more in federal awards •
shall have a single or program -s -specific during a given fiscal year
OMB Super p audit for that year in accordance with theprovisions'
p Circular 2 CFR 200.501 and 45 CFR 75.501. of
d. Modifications: This Contract may not be modified
be waived or disc Y m odif ied or amended, nor may an term or provision
discharged, including this particular Paragraph, Y . • provision
by both parties. g aph, except in writing, signed upon
1) Examples of items requiringHealth C
but are n � are Authority prior written approval include,
of limited to, the following: de,
j
i. Deviations from the budget and Project ect plan.
ii. Change in scope or objective of the Contract.
ntract.
iii. Change in a key person specified in the
Contract.
iv. The absence for more than one(1)mon �Pro'ect the or 25 /o reduction in time b
Project Manager/Director. y the
V. Need for additional funding.
vi. Inclusion of costs that require prior
cost principles. q p approvals as outlined in the ro riate
p nciples. pp p
vii. Any changes in budget line items
the tot () of greater than twenty percent 200
al budget in this Contract. ( /o) of
2) No changes are to be implemented_ royal i by the Sub awardee until a written notice
pp s received from the Health Care Authority.ce of
a
Sub-Contractin : The Co
e. g Contractor or Subrecipient p hall not enter into asub-contract for an
under this Contract without obtainingthe prior Y of
the work performed and p or written approval of the
Health Care Authority. If sub -contractors
are approved by the Health Care Authority,the
subcontract, shall contain, at a minimum, se
Suspended Vendors ..coons of the Contract pertaining to Debarred
Lobbying certification, Audit requirements, g d and
Federal, state, and local requirements. q ents, and/or any other project
f . Condition for Receipt of Health Care
Authorityto Authority Funds: Funds provided b He
the Contractor or Subrecipient under thisY Heath Care
Contractor or Subrecipient Contract may not be used b the
p nt as a match or cost provision y
g p n to secure other federal
Washington State 17
Health Care Authority HCA Contract #K7841
monies without prior written approval b the Health th Care Authority.
g. Unallowable Costs: The Contractor or Subrec'
ipient s expenditures shall be subject to
reduction for amounts included in an invoice '
Y or prior payment made which determined b
allowable costs on the basis of audits review Y
HCA not to constitute
Contract. s, or monitoring of this
h. Supplanting Compliance: SABG: If SABG f •
funds support this Contract, the Block Grant will
supplant State funding of alcohol and other drug
not be used to su prevention and treatment
programs. (45 CFR section 96.123(a)(10)).
i. Federal Compliance: The Contractor or Subrecipient recipient shall comply with all applicable State
and Federal statutes, laws, i
rules, and regulations ' ' g n the performance of this Contract,
whether included specifically in this Contract or not.
j. Civil Rights and Non -Discrimination Obligati
Contractor or S ons. During the performance of this Contract the
ubrecipient shall com ply with all current and f u '
nondiscrimination. These include b Lure federal statutes relating to
but are not limited to: Title VI of the Civil Rights A
(PL 88-352), Title IX of the Education Amend g ct of 1964
Amendments of 1972 (20 U.S.C. §§ 1681-1683 and
1685-1686), section 504 of the Rehabilitation Act of 1973 (29 U.S.C. § 794) the Age
Discrimination Act of Drug A
1975 (42 U.S.C. §§ 6101- 6107 , the g
9 - ) g buse Office and Treatment
Act of 1972(PL 2 255), the Comprehensive Alcohol A '
Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (PL 91-616), §§523 and 527 of t
Service Act of 1912 (42 U.S.C.§§290dd-3 a _ he Public Health
and 290ee 3), Title VIII of the Civil
1968 (42 U.S.C. §§3601 et se I Rights Act of
1 q ), and the Americans with DisabilityAct(422101 et seq.) http://www.hhs, ov/ocr/civi U.S.C., Section
g Irights.
HCA Federal Compliance Contact Information
Washington State Health Care Authority
Post Office Box 42710
Olympia, Washington 98504-2710
II. CIRCULARS 'COMPLIANCEMATRIX- .
MATRIX The following compliance ma identifies
Circulars that contain the requirements which p matrix identifies the OMB
hich govern expenditure of federal funds. Th
requirements apply to the Washington State HealthThese
recipient of federal Care Authority (HCA), as the primary
p I funds and then follow the funds to the sub- Y
The federal Circulars which provide the awardee, Grant County Jail.
p applicable administrative requirements cost '
and audit requirements are identified b sub-aw principles
Y ardee organization type.
OMB CIRCULAR
ENTITY TYPE
State. Local and Indian
Tribal Governments and
Governmental Hospitals
Non -Profit
Organizations and Non -
Profit Hospitals
Colleges or Universities
and Affiliated Hospitals
For -Prof it Organizations
ADMINISTRATIVE COST AUDIT REQUIREMENTS
REQUIREMENTS PRINCIPLES
OMB Super Circular 2 CFR 200.501 and 45 CFR 75.501
Washington State 18
Health Care Authority HCA Contract #K7841
III. STANDARD FEDERAL CERTIFICATIONS AND
ASSURANCES -Following are the Assurances
Certifications, and Special Conditions that apply to
Contracts admin'Washington
pp Y all federally funded (in whole or in art
administered by the Washin ton State Health p )
g Ith Care
a. CERTIFICATION REGARDING DEBARMENT A
offici ND SUSPENSION :The undersi ned
(authorized al signing for the contracting organization)• • g
knowled e and belief, t g • certifies to the best of his or her
g that the contractor, defined as the prima participant '
with 45 CFR Part 76, and its principals: are n � p pant in accordance
debarment,p of presently debarred, suspended, proposed for
declared ineligible, or voluntarily excluded from c p
Federal Department ora enc have covered transactions by any
. agency not within a 3 -year period preceding this contract
convicted of or had a civil judgment rendered against them been
criminal offense in conn g em for commission of fraud or a
connection with obtaining, attempting to obtain, orerform'
(Federal, State, or local) transaction or contract un p ung a public
Federal or State antitrust statutes or der a public transaction; violation of
commission of embezzlement, the
falsification or destruction of records �ft, forgery, bribery,
are not r ,making false statements, or receiving stolen roe
presently indicted or otherwise criminally or civil) ch property; t
(Federal, State, or local w' Y Y charged by a governmental entity
with comm ission of any of the offenses enumerated aced in Section 2 of
this certification; and have not within a 3-
public transactions 3-year period preceding this contract had one or more
p sactions (Federal, State, or local) terminated for cause or default.
Should the Contractor or Subrecipient not be able tcertification,
o provide this an explanation
i
as to why should be placed after the assurances page p g n the contract.
The contractor agrees by signing this contract that it will include, without modification, the
clause above certification in all lower tier covered transactions (i.e., transactions with sub -
grantees and/or contractors) and in all solicitations for to '
lower tier covered transactions in
accordance with 45 CFR Part 76.
b. CERTIFICATION REGARDING DRUG-FREE
ned(authorizedWORKPLACE REQUIREMENTS: The
undersig official signing for the contracting organization) certifies that the
contractor will, or will continue to, provide a drug-free workplace in accordance with 45
Part 76 by: CFR
1. Publishing a statement notifying ees em to th
dis ensin osse p y at the unlawful manufacture, distribution,
p g, p ssion or use of a controlled substance isrohibite }
the action p din the grantee's
workplace and specifying s that will be taken against employees for vio latio
of such prohibition; Establishing an ongoing drug-free n
employees about g g g ree awareness program to inform
i. The dangers of drug abuse in the workplace;
ii. The contractor's policy of maintainingdrug-free a g ree workplace;
iii. Any available drug counseling, rehabilitation
and ,and employee assistance programs;
iv. The penalties that may be imposed upon employees for drug abuse violationsoccurrin in the workplace;
2. Making it a requirement that each employee to •
contract be given be engaged in the performance of the
g a copy of the statement required by (1) paragraph above•
,
3. Notifying the employee in the statement required
cI q ed by paragraph (I), above, that, as a
condition of employment oym ent under the contract, the employee Will—
i. Abide by the terms of the statement; and
ii. Notify the employer in writing of his or her conviction for a violation of a criminal
drug statute occurring in the workplace no later than five (5) calendar days after
such conviction;
Washington State 19
Health Care Authority HCA Contract #K7841
4. Notifying the agency in writingwithin fi
paragraph(111)(b) en calendar days after receiving notice andg p from an employee or otherwise receiving under
conviction. Employers of convicted actual notice of such
title to employees must provide notice including position
every contract officer or other designee on whose c ng position
convicted employee was working, contract activity the
point for the unless the Federal agency has designated
p e receipt of such notices. Notice shall include • • g a central
each affected grant; the identification num ber(s) of
5. Taking one of the following actions, within thirty (30) calendar days of receiv—
ing notice paragraph (III) (b), with respect to any employee who is so convictedi.
Taking appropriate personnel action against gainst such an employee, up to and
including termination, consistent with the r
1973, as amended; or equirements of the Rehabilitation Act of
ii. Requiring such employee toartici at
rehabilitation r p P e satisfactorily in a drug abuse assistance or
p ogram approved for such purposes by a Federal St
health, law enforcement, or other a pproate agency, ri ate, or local
p
6. Making a good faith effort to continue to'
n adrug-free workplace through
implementation of maintai
paragraphs (1) through (V). g
For purposes of paragraph (V) regarding agency notification of criminal drug convictions,Authority has designated the following central point for receipt of
such notices:
Legal Services Manager
WA State Health Care Authority
PO Box 42700
Olympia, WA 98504-2700
c. CERTIFICATION REGARDING LOBBYING: Title 31, United States Code, Section
n on use of appropriated funds to influence 1352,
entitled "Limitation certain Federal contracting and
financial transactions," prohibits recipients of Federal r
from using Federal (appropriated)funds fExecutive
g ants and cooperative Contracts
Fe , or lobbying the Executiveor Legislative
Federal Government in connection with a SPE g lative Branches of the
also requires that SPECIFIC grant or cooperative Contract. Section
q at each person who requests or receives a Fe on 1352
must disclose lobbyingundertaken Federal grant or cooperative Contract
with non -Federal (non-appropriated)requirements apply to grants and coo funds. These
CFR Part 93). cooperative Contracts EXCEEDING $100, 000 in total costs (45
signing g for the contracting organization certifies
The undersigned (authorized official si
her knowledge and belief, that:) , to the best
of his or
,
1. No Federal appropriated funds have be
undersi ned to an en paid or will be paid, by or on behalf of the
g y person for influencing or attempting to , a Member p g influence an officer or
employee of any agency, ber of Congress, an officer or employee
ress i of Congress,
or an employee of a Member of Con
Federal contract the g n connection with the awarding of an
making of any Federal grant, the makin of a Y
g any Federal loan, the
entering into of any cooperative Contract, and the extension, continuation, renews
modification of any Federal contract grant, I'
Contract. , g nt, loan, or cooperative
2. If any funds other than Federal) a ro '
any erson for in Y pp priiated funds have been paid or will be aid t
p fluencing or attempting to influence an of p °
agency, a Member of Con officer or employee of any
Congress, an officer or employee of Congress, or an em
of a Member of Congress in connection withemployee
cooperative Cont this Federal contract, grant, loan or
Contract, the undersigned shall complete and sub '
"Disclosure of LobbyingActivities," ' mit Standard Form -LLL,
in accordance with its instructions.If needed,
eded,
Washington State 20
Health Care Authority HCA Contract #K7841
Standard Form -LLL, "Disclosure of Lobbying
continuation sheetY g its instructions, and
are included at the end of this application form.)
orm.)
3. The undersigned shall require that the la ' •
language of this certification be included in the
award documents for all subcontracts at all tiers(includingand contracts un subcontracts, subcontracts
. der grants, loans and cooperative Contracts '
recipients shall certifyand disclose )and that all sub -
recipients se accordingly.
This certification is a material representation p of fact upon which reliance was laced when '
transaction was made or entered into. Submission • • certification
en this
of this certification is a prerequisite for mak'
or entering into this transaction imposed b Section making
the required certific Y 1352, U.S. Code. Any person who fails to file
q afion shall be subject to a civil penaltyof not$10,000
le
than $100,000 for each such less than and not more
failure.
d. CERTIFICATION REGARDING PROGRAM FRAUD CIVIL REMEDIES ACT(PFCRA):g (authorized official signing for the contra ..The
statements herein are true c contracting organization) certifies that the
complete, and accurate to the best of his or her k
he or she is aware that any false, fictitious orf knowledge, and that
her to criminal civil o � raudulent statements or claims may subject him
r administrative penalties. The undersigned y or
organization will comply with the Public g agrees that the contracting
contract is Health Service terms and conditions of award and if a
e. CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE: Public Law 103-227
the Pro -Children Act of 1994 (Act), re uires ,portion of an indoo q that smoking not be permitted i
Y r facility owned or leased or contracted for b p n any
regularly for the provision of health da Y an entity and used routinely or
y care, early childhood development services education
library services to children under thea e of 1 ation or
either directlyor g 8, if the services are funded by Federal programs
through State or local governments, b Feder p grams
guarantee. The law also applies Y al grant, contract, loan, or loan
pp to children's services that are provided in indoor
constructed, operated, or maintained with such Fe that are
children's services Federal funds. The law does nota I to
provided in private residence, portions of facilitiespp Y
alcohol treatment, service providers used for inpatient drug or
p whose sole source of applicable Federal fun '
or Medicaid, or facilities where WIC coupons e ons ar redeemed.ds is Medicare
Failure to comply with the provisions of • .
penalty p the law may result in the im position of a civ'
p y of up to $1,000 for each violation and/or the imposition it monetary
order on the responsible of an administrative compliance
p le entity.
By signing the certification, the undersigned certifies
with the requirements g that the contracting organization will co
q m ents of the Act and will not allow smoking within comply
used for the provision of services g n any portion of any indoor facility
for children as defined by the Act.
The contracting organization agrees that it wi
included in ll require that the language of this certificati
any subcontracts which contain provisions for c on be
recipients shall certify� children's services and that all sub -
recipients accordingly.
The Public Health Services strongI enco '
workplace and y urages all recipients to provide asmoke-fre
p promote the non-use of tobacco products. T e
mission to protect and a p his is consistent with the PHS
advance the physical and mental health o •
f the American people.
f. CERTIFICATION REGARDING OTHER RESPONSIBILITY MATTFR-q
1.
The inability of a person to provide the certification •
kation required below will not necessarily
result in denial of participation in this covered transaction.
shall submit an explanation The prospective contractor
p of why it cannot provide the certification set below. The
Washington State
Health Care Authority
21
HCA Contract #K7841
certification or explanation will be considere
agenc 's determ in din connection with the department or
Y ation whether to enter into this transactio
• • n. However, failure of the
prospective contractor to furnish
a certification or an explanation shall dis ualif
person from participation in this transaction. q Y such
2. The certification in this clause is a material
ce
was laced when real representation of fact upon which relic
p n the department or agency determined to nn.
it is later determined that theprospectiveenter into this transaction. If
certification,• • contractor knowingly rendered an err
in addition to other remedies available erroneous
department ora enc may to the Federal Government, the
agency y terminate this transaction for cause of default.
3. The prospective contractor shall provide agencyto who p e immediate written notice to the de artment o
m this contract is submitted if at an time p r
learns that its certification was Y he prospective contractor
erroneous when submitted or has become erroneou
reason of changed circumstances. s by
4. The terms covered transaction debarr
transaction a ,
ed, suspended, ineligible, lower tier cover,
p rticipant, person, primary covered transactioned
voluntarily excluded, as used ' , principal, proposal, and
in this clause, have the meanings set out in
g the
Definitions and Coverage sections of the rules ales implementing Executive order 12549
You may tact the person to whom this contract is submittedubm fitted for assistance on
obtaining a copy of those regulations.
5. The Prospective contractor agrees by submitting this contract that, should theproposed covered transaction
be entered into, it shall '
lower tier covered transaction w' not knowingly enter into any
with a person who is debarred, suspended,
ineligible, or voluntarily excluded from a declared
authorized b participation on this covered transaction unless
y Authority. ss
6. Nothing contained in the foregoing shall
system g g II be construed to require establishment
Y of records in order to render in good faith of a
clause. The knowledge an g the certification required by this
g d information of a participant is not required
which is normally possessed b a prudent q ed to exceed that
dealings. Y p person in the ordinary course of business
s
7. Except for transactions authorized under paragraph 6 of these instructions if a
Participant in a covered transaction knowingly '
transaction with a person g Y enters into a lower tier covered
p n who is suspended, debarred, ineligible, or '
excluded from participation in this transaction • • g � voluntarily
to the Federal Government,, in additson to other remedies available
HCA may terminate this transaction for
cause or default.
CONTRACTOR SIGNATURE REQUIRED
SIGNATURE OF AUTHORIZED CERTIFYING OFFIC
TITLE:
PLE EALSO PRINT OR TYPE NA.Ui;
V �Ce
Cindy Carter, Chair
/�6 Jo4p c
Washington State 22
Health Care Authority HCA Contract #K7841
ORGANIZATION NAME: (if applicable)
DATE
Washington State 23
Health Care Authority HCA Contract#K7841
EXHIBIT A: CENTERS OF MEDICARE &MEDIC
AID SERVICES9 SPECIAL TERMS AND CONDITIONS
The Special Terms and Conditions onion of the
and is incorporated p MTP 2.0 Waiver is an integral part of this Co
p herein by this reference and is not attached but i nom t
HCA Contract Manager. s available upon request from the
Washington State 24
Health Care Authority HCA Contract #K7841