Loading...
HomeMy WebLinkAboutAgreements/Contracts - Renew (003)AOM%k Grant Behavioral Health 6 Wellness September 20.,2022 Board of Grant County Commissioners PO Box 37 Ephrata., WA 98823 Re: Signature for Beneficiary Agreement with Health Care Authority — Agreement G248 Dear Board of County Commissioners: Please see the attached Beneficiary Agreement for review and approval. 840 E. Plum Street Moses Lake, WA 98837 Phone: (509) 765-9239 Fax: (509) 765-1582 Contractor: Health Care Authority Term of Contract: Agreement End Date — 6/30/23 Payment Amount: $128,,286.79 Purpose: These funds are being distributed by Washington State Health Care Authority for Behavioral Health workforce stabilization efforts for recruitment and retention. I am requesting permission to Docu-Sign electronically with Health Care Authority. Thank you for your consideration. Dell Anderson, M.Ed,, LMHC Executive Director Ext. 5472 SEP' 2 0 2022 = N =-e� w5. w ri n W w 4i1 0 a 0 0 0 a= 0• a DocuSign Envelope ID: 121A083D-3964-4C13-AB35-6B204DF7D32A e% K22-207 This Beneficiary Agreement ("Agreement") is made by and between the Washington State Health Care Authority ("HCA") and the non -hospital-based community behavioral health treatment agency ("Beneficiary") identified below. HCA and Beneficiary may be individually referred to as a "party" or collectively referred to as "parties." To be valid, this Agreement must be signed by Beneficiary's authorized representative and returned electronically to HCA before midnight October 31, 2022. Beneficiaries may rely on DocuSign's verification or their sent email timestamp as verification of receipt by HCA. Additional information and the timelines for Agreements after October 31, 2022 will be posted to HCA's website at: https://www.hca.wa.gov/billers-providers-partners/program-information-providers/contractor-and-provider-resources BENEFICIARY NAME DOING BUSINESS AS (DBA) HCA Agreement Number: Washington State BENEFICIARY AGREEMENT G248 Health Care.. uthorit�r Behavioral Health Workforce Stabilization Funding Beneficiary National PI Number: 1982792537 This Beneficiary Agreement ("Agreement") is made by and between the Washington State Health Care Authority ("HCA") and the non -hospital-based community behavioral health treatment agency ("Beneficiary") identified below. HCA and Beneficiary may be individually referred to as a "party" or collectively referred to as "parties." To be valid, this Agreement must be signed by Beneficiary's authorized representative and returned electronically to HCA before midnight October 31, 2022. Beneficiaries may rely on DocuSign's verification or their sent email timestamp as verification of receipt by HCA. Additional information and the timelines for Agreements after October 31, 2022 will be posted to HCA's website at: https://www.hca.wa.gov/billers-providers-partners/program-information-providers/contractor-and-provider-resources BENEFICIARY NAME DOING BUSINESS AS (DBA) Grant County Renew BENEFICIARY ADDRESS CITY STATE. ZIP + 4 840 E Plum St Moses Lake WA 98823 BENEFICIARY CONTACT BENEFICIARY CONTACT EMAIL Dell Anderson daanderson@grantcountywa.gov HCA ADDRESS CITY STATE ZIP +4 Cherry Street Plaza 626 8th Avenue SE PO Box 42730 Olympia WA 98504-0001 HCA. CONTACT HCA CONTACT EMAIL Kimberly Wright Behavioral Health Policy and Planning Supervisor HCADBHRinformation@hca.wa.gov AGREEMENT START DATE AGREEMENT END DATE BEHAVIORAL HEALTH WORKFORCE STABILIZATION FUNDING PAYMENT 06/30/2023 $128,286.79 I. RECITALS WHEREAS, the COVID-19 public health emergency created ongoing behavioral health treatment access issues resulting from workforce shortages and adverse impacts of the emergency; and WHEREAS, the American Rescue Plan Act of 2021 established the Coronavirus State Fiscal Recovery Fund and Coronavirus Local Fiscal Recovery Fund, which together make up the Coronavirus State and Local Fiscal Recovery Funds ("SLFRF") program; and Page 1of6 DocuSign Envelope ID: 121A083D-3964-4C13-AB35-6B204DF7D32A WHEREAS, the SLFRF program provides support to state, territorial, local, and tribal governments responding to the economic and public health impacts of COVID-19; and WHEREAS, in Laws of 2022, Chapter 297, Section 215(104) the Washington State Legislature appropriated a portion of SLFRF for one-time assistance payments ("Behavioral Health Workforce Stabilization" funds, or "BHWS") to non -hospital- based community behavioral health treatment providers receiving payment for Medicaid services contracted through the Medicaid managed care organizations or behavioral health administrative service organizations; and WHEREAS, beneficiaries of the BHWS include Indian health care providers that have received payments from managed care organizations or behavioral health administrative organizations with or without a contract; and WHEREAS, HCA notified Beneficiary of its eligibility to receive BHWS funds ("Payment") and Beneficiary affirmed its desire to receive Payment and provided HCA with the National PI Number in this Agreement. THEREFORE, the Parties agree as follows: II. AGREEMENT 1. AMENDMENTS. Beneficiary agrees to execute amendments to this Agreement if HCA determines it is necessary to comply with state or federal requirements. 2. COMPLIANCE WITH LAWS, REGULATIONS, AND GUIDANCE. 2.1. AUDITS. Beneficiary will cooperate in audits or reviews conducted by HCA, other state officials, and federal officials, or their designees, to ensure compliance with this Agreement. 2.2. CERTIFICATIONS. Beneficiary will notify HCA immediately if, during the term of this Agreement, Beneficiary learns its certification to any of the statements in Section III of this Agreement (Beneficiary Certifications) was erroneous on the date their authorized representative signed this Agreement or has become erroneous due to a change in circumstances. 2.3. CONFLICTS BETWEEN REGULATIONS. The parties intend this Agreement will comply with local, state, and federal laws, regulations, executive orders, policies, procedures, and directives regarding Beneficiary's receipt and use of the Payment funds. Should there be conflict between any of those authorities and this Agreement, the most restrictive will govern. 2.4. FEDERAL ASSISTANCE LISTING 21.027 CORONAVIRUS STATE AND LOCAL FISCAL RECOVERY FUNDS. Beneficiary understands its use of Payment funds must adhere to official federal guidance issued or to be issued for Federal Assistance Listing 21.027 Coronavirus State and Local Fiscal Recovery Funds, incorporated by reference in this Agreement. Additional information can be found at the U.S. Department of Treasury website at www.treasury.gov/slfrp and the official U.S. Government website SAM.gov at https:llsam.gov/fal/873dl8612d254bl9b9a535ec690lb5a 2.5. GOVERNING LAW. This Agreement will be construed and interpreted in accordance with Washington State laws, rules, policies, and executive orders. 2.6. INCORPORATION BY REFERENCE. All statutes and regulations referenced in this Agreement are incorporated by reference, with the same force and effect as if they were given in full text. Additionally, the exclusion of a specific applicable provision of any such statute or regulation from this Agreement does not relieve the parties from their obligation to comply with any such applicable provisions. 2.7. UNIFORM GUIDANCE. The Payment is "other financial assistance" as defined in 2 C.F.R. § 200.1 administered as direct payments for specified use. Beneficiary is responsible for compliance with the applicable provisions of 2 C.F.R. Part 200, including conflict of interest requirements. Page 2of6 DocuSign Envelope ID: 121A083D-3964-4C13-AB35-6B204DF7D32A 3. DISCLAIMER. HCA disclaims all responsibility or liability to Beneficiary or third persons for the actions of Beneficiary or third persons resulting in any way from Beneficiary's acceptance or use of the Payment. 4. DISPUTES AND REMEDIES. 4.1. ATTORNEYS' FEES AND COSTS. The parties will bear their own costs, expert fees, attorneys' fees, and other fees incurred in connection with this Agreement and any action or proceeding arising out of or relating to this Agreement. 4.2. DISPUTE PROCESS. The dispute resolution process in this section will precede any action in a judicial or quasi- judicial tribunal. 4.2.1. Requests for dispute resolution must be emailed simultaneously to the parties as identified in Section II Subsection 9 Notices. 4.2.2. Requests for dispute resolution must clearly state: The disputed issue(s); and An explanation of the positions of the parties; and Additional facts if necessary to describe the nature of the dispute; and The relief requested. 4.2.3. The non -requesting party in the dispute may provide a rebuttal, following the format in Section II Subsection 4 Disputes and Remedies §4.2.1 and 4.2.2. 4.2.4. The HCA Director or their delegate will determine the date, time, duration, and format for the parties to present their views on the disputed issue(s) (Dispute Resolution Conference). The HCA Director or their delegate will consider the information provided during the conference and will provide a written decision on the disputed issue(s) within thirty (30) calendar days of the conference. The Director or Director's delegate may require an additional sixty (60) calendar days for their review. If the additional time is needed, they will notify the parties in writing and provide the anticipated completion date. 4.2.5. The HCA Director may appoint a delegate to represent them at the dispute conference. The HCA Director will retain final decision-making authority regarding the disputed issue(s). Under no circumstances will the HCA Director's delegate issue a final decision on the disputed issue(s) without approval of the HCA Director. 4.3. RECOUPMENT. 4.3.1. Payment funds are subject to recoupment if, after investigation or audit, HCA, other state officials, or federal officials determine Beneficiary provided HCA false or misleading information pertinent to this Agreement, including if Beneficiary does not meet the criteria specified in Section III, Subsection 1 through 3.5; or Beneficiary used Payment funds in a manner other than authorized by this Agreement, and/or federal requirements for receipt and/or use of SLFRF. 4.3.2. Beneficiary will receive an initial written notice of recoupment with an opportunity to request reconsideration before HCA provides a final notice of recoupment. If Beneficiary receives an initial notice of recoupment and does not submit a request for reconsideration perthe instructions in the notice or does not request dispute resolution as allowed in this Agreement, the initial notice will be deemed the final notice. 4.3.3. The final notice of recoupment will constitute a debt to HCA. The debt is delinquent if it has not been paid by the date specified in RCA's written notice to Beneficiary unless other satisfactory arrangements have been made. Interest, penalties, and administrative fees may accrue on delinquent debt, as allowed by law. 4.3.4. Funds for payment of the debt must not come from federally sponsored programs. 4.3.5. HCA may pursue other forms of remediation in conjunction with, or as an alternative to, recoupment. Page 3of6 DocuSign Envelope ID: 121A083D-3964-4C13-AB35-6B204DF7D32A Nothing in this Agreement limits HCA's ability to recover Payment funds through judicial or other processes under law. If HCA seeks judicial or other processes under law to recover Payment funds, then to the extent permitted by law, RCA's rights and remedies under this Agreement are cumulative to, and not exclusive of, rights or remedies otherwise available to HCA. 4.4. VENUE. The venue for any action between the parties relating to this Agreement is the Superior Courtin Thurston County, Washington. 5. FUNDING PROVISIONS. 5.1. COST SHARING. There are no matching, level of effort, or earmarking compliance responsibilities associated with the Payment. 5.2. DELIVERY OF PAYMENT. If Beneficiary's National PI number can receive funds through ProviderOne, HCA will disburse the Payment to Beneficiary's ProviderOne account. If Beneficiary does not have a ProviderOne account, or the applicable ProviderOne account cannot receive payments, Beneficiary will provide the HCA Contact with Beneficiary's Statewide Vendor Number to receive the Payment. 5.3. USE OF PAYMENT FUNDS. 5.3.1. ELIGIBLE USE. In accordance with Laws of 2022, Chapter 297, Section 215(104)(c), Beneficiary will use Payment funds only to cover costs during the Eligible Use Timeframe (defined below) that: a. Support immediate workforce and retention and recruitment needs; or b. Are incurred due to the COVID-19 public health emergency; or c. Support other recruitment efforts to begin adding new staff and rebuilding lost capacity; or d. Are necessary investments to help stabilize the community behavioral health workforce, including, but not limited to, childcare stipends, student loan repayment, tuition assistance, or relocation expenses. 5.3.2. ELIGIBLE USE TIMEFRAME. a. Expenses identified in Section II Subsection 5 Funding Provisions §5.3.1 Eligible Use incurred by Beneficiary on or after March 3, 2021 are eligible under this Agreement. "Incurred" means Beneficiary has incurred an obligation, which has the same meaning given to "financial obligation" in 2 CFR 200.1. b. Beneficiary will expend all Payment funds received by June 30, 2023. 6. HEADINGS. The headings or captions of sections or subsections in this Agreement are for convenience and are not intended to define or limit their contents, nor are they to affect the construction of or to be taken into consideration in interpreting this Agreement. 7. INTEGRATION. Any amendment to this Agreement shall be in writing and shall be signed by Beneficiary's authorized representative and an authorized representative of HCA. No other understandings, oral or otherwise, regarding the subject matter of this Agreement will be deemed to exist or to bind either Party. 8. NO ASSIGN MENT. Beneficiary shall not assign this Agreement to a third party without the prior written consent of HCA. HCA may withhold its consent at its sole discretion. 9. NOTICES. Whenever one party is required to give notice to the other under this Agreement, it will be deemed given if delivered by email, as follows: 9.1. In the case of notice to the Beneficiary, notice will be sent to: Beneficiary contact name Dell Anderson Beneficiary contact email daanderson@grantcountywa.gov Page 4of6 DocuSign Envelope ID: 121A083D-3964-4C13-AB35-6B204DF7D32A 9.2. In the case of notice to HCA, send notice to both email addresses below: Attention: Contract Administrator Health Care Authority, Division of Legal Services contractsPhca.wa.gov and HCADBHRinformation@hca.wa.gov 9.3. Notices are effective on the date delivered as evidenced by the sender's email system or the date returned to sender for non -deliverable address. 9.4. Either party may change its address for notification purposes by sending notice in accord with this section, stating the change and its effective date, which shall be effective no earlier than the tenth (10th) business day following the effective date of the notice. 10. RECORD KEEPING, ACCESS, AND DISCLOSURE. 10.1. DISCLOSURE. This Agreement is a "public record" as defined by Washington's Public Records Act, RCW 42.56.010(3). Beneficiary consents to HCA, other state officials, and the federal government publicly disclosing details of this Agreement, the Payment, and Beneficiary's use of the Payment, without notice to Beneficiary. 10.2. MAINTENANCE OF AND ACCESS TO RECORDS. "Records" are all records created, utilized, or maintained, including cost documentation, and information required to substantiate Beneficiary's use of Payment funds and compliance with Beneficiary's obligations in this Agreement, whether paper or electronic. 10.2.1. Beneficiary will maintain records in a manner consistent with 2 CFR §200.334, as applicable. 10.2.2. Beneficiary will provide access to records described in this section, during reasonable hours, to HCA, other state officials, federal officials, and their designees. 10.2.3. Unless otherwise notified by HCA, Beneficiary will maintain all records related to this Agreement for a period of six (6) years after Payment funds have been expended by Beneficiary or returned to HCA. 11. REPORTING. Beneficiary will comply with reporting obligations once established by HCA, on Beneficiary's use of Payment funds. 12. SEVERABILITY. If any provision of this Agreement is held invalid, such invalidity will not affect the other provisions of this Agreement that can be given effect without the invalid provision, and to this end the provisions this Agreement are declared severable. 13. SURVIVORSHIP. Provisions in this Agreement which by their nature are intended to survive the expiration, cancellation, or termination of this Agreement will survive the expiration, cancellation, or termination of this Agreement. 14. WAIVER. Waiver of any breach or default of this Agreement is not a waiver of any prior or subsequent breach or default. No provision of this Agreement will be held to be waived, modified, or deleted except by written agreement signed by authorized authorities of the parties. - III. BENEFICIARY CERTIFICATIONS By signing this Agreement, the authorized representative of the Beneficiary is providing the certifications set out below. Nothing contained in the Beneficiary Certifications will be construed to require establishing a system of records to render in good faith the Beneficiary Certifications. The knowledge and information of the Beneficiary's authorized representative is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. If Beneficiary's authorized representative is unable to certify the statements set out below, please notify HCA. 1. Beneficiary is a small business, public nonprofit institution/organization, private nonprofit institution/organization, or an Indian health care provider receiving payment from managed care organizations or behavioral health administrative service organizations with or without a contract. Page 5 of 6 Certificate Of Completion Envelope Id: 121 AO83D39644Cl 3AB356B204DF7D32A Status: Sent Subject: Please DocuSign: Provider Relief Workforce Stabilization Contract - Grant County Dba Renew Business Name: Grant County Dba Renew Source Envelope: Document Pages: 6 Signatures: 0 Envelope Originator: Certificate Pages: 4 Initials: 0 Meagan Metzger AutoNav: Enabled 626 8th Ave SE Envelopeld Stamping: Enabled Olympia, WA 98501 Time Zone: (UTC -08:00) Pacific Time (US & Canada) meagan.metzger@hca.wa.gov IP Address: 147.55.195.70 Record Tracking Status: Original Holder: Meagan Metzger Location: DocuSign 9/19/2022 7:01:55 PM meagan.metzger@hca.wa.gov Signer Events Signature -Timestamp Dell Anderson Sent: 9/19/2022 7:01:56 PM daanderson@grantcountywa.gov Viewed: 9/20/2022 9:03:25 AM Executive Director County of Grant Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Accepted: 9/20/2022 9:03:25 AM I D: 9a7906b0-67b3-49c1 -92a4-72335a305a41 In Person Signer Events -Signature, Timestamp Editor Delivery Events 'Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified DeliveryEvents Status Timestamp Carbon Copy Events Status Timestamp Kimberly Wright HCADBHRinformation@hca.wa.gov Security Level: Email, Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 9/19/2022 7:01:56 PM Certified Delivered Security Checked 9/20/2022 9:03:25 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 5/22/2019 6:49:33 AM Parties agreed to: Dell Anderson ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, CloudPWR OBO Washington State Health Care Authority -Sub Account (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to this Electronic Record and Signature Disclosure (ERSD), please confirm your agreement by selecting the check -box next to `I agree to use electronic records and signatures' before clicking `CONTINUE' within the DocuSign system. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after the signing session and, if you elect to create a DocuSign account, you may access the documents for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per -page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact C1oudPWR OBO Washington State Health Care Authority -Sub Account: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: todd.stone@hca.wa.gov To advise C1oudPWR OBO Washington State Health Care Authority -Sub Account of your new email address To let us know of a change in your email address where we should send notices and disclosures electronically to you, you must send an email message to us at todd.stone@hca.wa.gov and in the body of such request you must state: your previous email address, your new email address. We do not require any other information from you to change your email address. If you created a DocuSign account, you may update it with your new email address through your account preferences. To request paper copies from C1oudPWR OBO Washington State Health Care Authority - Sub Account To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an email to todd.stone@hca.wa.gov and in the body of such request you must state your email address, full name, mailing address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with CloudPWR OBO Washington State Health Care Authority -Sub Account To inform us that you no longer wish to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your signing session, and on the subsequent page, select the check -box indicating you wish to withdraw your consent, or you may; ii. send us an email to todd.stone@hca.wa.gov and in the body of such request you must state your email, full name, mailing address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process.. Required hardware and software The minimum system requirements for using the DocuSign system may change over time. The current system requirements are found here: https://support.docusign.com/guides/signer-guide- signing-system-requirements . Acknowledging your access and consent to receive and sign documents electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please confirm that you have read this ERSD, and (i) that you are able to print on paper or electronically save this ERSD for your future reference and access; or (ii) that you are able to email this ERSD to an email address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format as described herein, then select the check -box next to `I agree to use electronic records and signatures' before clicking `CONTINUE' within the DocuSign system. By selecting the check -box next to `I agree to use electronic records and signatures', you confirm that: • You can access and read this Electronic Record and Signature Disclosure; and • You can print on paper this Electronic Record and Signature Disclosure, or save or send this Electronic Record and Disclosure to a location where you can print it, for future reference and access; and • Until or unless you notify CloudPWR OBO Washington State Health Care Authority -Sub Account as described above, you consent to receive exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you by CloudPWR OBO Washington State Health Care Authority -Sub Account during the course of your relationship with CloudPWR OBO Washington State Health Care Authority -Sub Account.