Board of County Commissioners

Board of County Commissioners
Board of County Commissioners
Cathy Wolfe , District 1  Sandra Romero , District 2  Bud Blake , District 3
Agenda for Meeting Date:
Tuesday, March 3, 2015
Summary of Timed Items
2:00 p.m.)
Call Meeting to Order
2:05 p.m.)
Presentation
5:30 p.m.)
Public Hearing
2:00 p.m.) Call Meeting to Order

Pledge of Allegiance to be led by Vice-Chair Blake

Approval of the Tuesday, March 3, 2015 Agenda

Approval of the Board Meeting Minutes from: February 24, 2015
2:05 p.m.) Presentation
Dept: Commissioners
Description: Update on the Timberland Regional
Contact: Cheryl Heywood, Executive Director, Timberland
Regional Library
Action: n/a
1)
Opportunity for the Public to Address the Board
2)
County Manager's Update
a)
Item Description: Follow-up on citizen issues
b)
Item Description: Other current issues
Thurston County - Board of County Commissioners Agenda
File Attachment
Page 1 of 6
3)
Consent Item(s) "a" through "c"
a)
Dept: Central Services
Description: Approve the extension of the Microsoft Premier
Services Agreement for assistance with
Sharepoint and other Microsoft software
Contact: Martin Casey, Director
Action: Move to approve the Microsoft Premier
Support Services Extension and authorize the
Central Services Director to sign the
agreement in the amount of $62,240 for one
year.
b)
Dept: Treasurer
Description: Treasurer - A resolution changing the salary
range of position 04R00103 in the Thurston
County Management Technical Pay Plan.
Contact: Shawn Myers, Treasurer
Action: Move to approve the resolution changing the
salary range of position 04R00103 Investment
and Banking Officer in the Thurston County
Management Technical Pay Plan. The
difference between the top salaries is $674 or
a 9% increase.
c)
Dept: Auditor - Financial Services
Description: Approval of the Voucher List
Contact: Darren Bennett, Financial Services Division
Manager
BoCC-AIS-2015-03-03CentralServicesBrianFerris-1622.pdf
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BoCC-AIS-2015-03-10HumanResourcesNadineSordahl-1501.pdf
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File Attachment
Action: Move to approve the voucher list for the week of
March 3, 2015.
Department Items
4)
Auditor
Description: April Special Election Local Voters' Pamphlet
Contact: Mary Hall, Auditor
Action: Move to authorize the Thurston County
Auditor to publish and distribute a local voters'
pamphlet for the April 28, 2015 Sp ecial
Election.
Thurston County - Board of County Commissioners Agenda
BoCC-AIS-2015-03 -03Auditor-TillieNaputiPullar1537.pdf
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5)
Public Health and Social Services
a)
b)
Description: Approval of an Amendment to the Washington
State Department of Commerce Contract for
the Consolidated Homeless Grant Program
Contact: Gary Aden, Social Services Program Specialist
III
Action: Move to approve an amendment to the
Washington State Department of Commerce
contract to provide additional homeless
housing funding through the Consolidated
Homeless Grant for an additional $45,000, for
a revised total maximum amount of
$2,661,894; and authorize the Director of
Public Health and Social Services Department
to sign the amendment.
Description: Peer Support Program Contract Amendment
between Capital Clubhouse d/b/a Capital
Recovery Center and Thurston County.
Contact: Mark Freedman, Social Services Division
Director
Action: Move to approve an amendment to the
existing Peer Support Program contract
between Thurston County and Capital
Clubhouse d/b/a Capital Recovery Center
extending services for mental health recovery
programing from January 1, 2015 through
December 31, 2015, in an amount of
$392,856, for a revised total maximum
consideration not to exceed $874,418, and
authorize the Director of Public Health and
Social Services to execute this amendment as
well as future amendments that do not change
this approved dollar amount or duration by
more than 50 percent.
Thurston County - Board of County Commissioners Agenda
BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-LydiaHodgkinson1428.pdf
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BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-KristyLysell-1649.pdf
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c)
Description: Outpatient Service Program Contract
Amendment between Behavioral Health
Resources and Thurston County.
Contact: Mark Freedman, Social Services Division
Director
Action: Move to approve an amendment to the
Outpatient Program Service contract for
children and adult mental health services
between Thurston County and Behavioral
Health Resources extending services from
January 1, 2015 through December 31, 2015,
in an amount of $8,739,873 for a revised total
maximum consideration not to exceed
$17,685,963, and authorize the Director of
Public Health and Social Services to execute
this amendment as well as future
amendments that do not change this approved
dollar amount or duration by more than 50%.
d)
BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-KristyLysell-1654.pdf
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Description: Professional Service Contract between
ProtoCall Services Inc. and Thurston County.
Contact: Mark Freedman, Social Services Division
Director
Action: Move to approve a Professional Service
contract for inpatient utilization management
services b etween Thurston County and
ProtoCall Services Inc. from March 01, 2015
through December 31, 2015, for a total
maximum consideration not to exceed
$70,000, and authorize the Director of Public
Health and Social Services to execute this
contract as well as future amendments that do
not change this approved dollar amount or
duration by more than 50%.
Thurston County - Board of County Commissioners Agenda
BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-KristyLysell-1657.pdf
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e)
Description: Mental Health Block Grant amendment
between Department of Social and Health
Services and Thurston County.
Contact: Mark Freedman, Social Services Division
Director
Action: Move to approve the amendment to the
Mental Health Block Grant for the co-occurring
pilot program in a school-based setting
between Thurston County and the Washington
State Department of Social and Health
Services extending services from January 1,
2015 through June 30, 2015, in the amount of
$99,777 for a revised total maximum
consideration not to exceed $701,681, and
authorize the Director of Public Health and
Social Services to execute the amendment.
Further authorize the Director to execute the
Co-Occurring Pilot Program Contract between
Thurston County and ESD 113 True North
from January 1, 2015 through June 30, 2015,
for a total maximum consideration not to
exceed $99,777.
f)
Description: Evaluation and Treatment Program Contract
between Behavioral Health Resources and
Thurston County.
Contact: Mark Freedman, Social Services Division
Director
Action: Move to approve the Evaluation & Treatment
Program contract for voluntary/involuntary
inpatient services, crisis stabilization,
community based crisis services which
includes supportive housing paired with “rapid
re-housing” between Thurston County and
Behavioral Health Resources from January 1,
2015 through December 31, 2015, for a
maximum consideration not to exceed
$7,995,738. Further authorize the Director of
Public Health and Social Services to execute
the contract as well as future amendments
that do not change this approved dollar
amount or duration by more than 50%.
Thurston County - Board of County Commissioners Agenda
BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-KristyLysell-1700.pdf
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BoCC-AIS-2015-03 -03PublicHealthandSocialServ
ices-KristyLysell-1647.pdf
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6)
Resource Stewardship
Description: A resolution authorizing the Resource
Stewardship Director to designate Code
Enforcement Officers and authorize Code
Enforcement Officers to issue Civil Infractions
for violations of Thurston County Code
Contact: Scott Clark, Director
BoCC-AIS-2015-02 -24ResourceStewardshipChristinaChaput-1044.pdf
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Action: Move to adopt the resolution authorizing the
Resource Stewardship Department Director to
designate Code Enforcement Officers by job
title or special ap pointment by memorandum
and authorize Enforcement Officers to issue
civil infractions for Thurston County Code
violations.
7)
Commissioners' and County Manager Items
a)
Description: Office of Assigned Council Budget Increase
Contact: Robin Campbell, County Manager, Assistant
Action: Move to approve the transfer of $40,000 in
appropriation authority from General Fund
Non-Departmental to the Office of Assigned
Counsel.
b)
BoCC-AIS-----CommissionersShawnMcDonald-1839.pdf
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Item Description:
Commissioners will report on board work sessions and assigned committee meetings
providing updates on actions taken as well as upcoming issues.
c)
Item Description:
The County Manager will review the Board of County Commissioners schedule for the
week of March 03, 2015 .
d)
Item Description:
Adjournment - Motion: Move to adjourn the Board of County Commissioners meeting of
March 03, 2015 .
5:30 p.m.)
Public Hearing
Dept: Resource Stewardship
Description: Public Hearing - Title 26, a New Enforcement
Code
Contact: Katie Pruit, Planner, Associate
Action: Move to close the public hearing.
Thurston County - Board of County Commissioners Agenda
BoCC-AIS-----ResourceStewardshipKatiePruit-1208.pdf
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Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/12/2015
Agenda Item #: 3a
Brian Ferris, IT Technical Manager - Central Services - 786-5539
Martin Casey, Director - Central Services - 75 4-2974
Item Title:
Approve the extension of the Microsoft Premier Services Agreement for assistance with
Sharepoint and other Microsoft software
Action Needed: Execute Contract
Class of Item: Consent
List of Exhibits
20150223_090508.pdf
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b PAO
c
d
e
f
g
g Budget Office
c
d
e
f
Notes:
c FinSvcs
d
e
f
g
c HR
d
e
f
g
g CAO
c
d
e
f
g Other
c
d
e
f
Recommended Action:
Move to approve the Microsoft Premier Support Services Description and authorize the Central
Services Director to sign the agreement.
Item Description:
In 2014 as part of the Office 365 migration project, the Board of County Commissioners approved
Central Services to enter into an ag reement with Microsoft for support. The agreement, known as
Microsoft Premier Services, proved to be very beneficial in assisting staff with the project. Premier
Services allows county Information Technology staff to interact directly with Microsoft consultants and
to receive tailored training on the products that the county uses.
Central Services is recommending extending the Premier Services agreement for another year. The
county will be implementing Sharepoint Enterprise in 2015 and it is expected that the consulting from
Microsoft will again be very helpful in support of that project. The service will also help with support of
all other components of Microsoft Office 365, including Outlook. The cost for the Microsoft Premier
Services is $62,240 for one year. This amount is included in Central Services 2015 budget and is
funded by rates charged to all Offices and Dep artments.
Date Submitted: 2/23/2015
Board of County Commissioners
AGENDA ITEM SUMMARY
Date Created: 2/23/2015
Agenda Date: 03/03/2015
Created by:
Presenter:
Agenda Item #: 3b
Nadine Sordahl, Human Resources Specialist - Human Resources - 786-5451
Shaw n Myers, Treasurer - Treasurer - 786-5770
Item Title:
Treasurer - A resolution changing the salary range of position 04R00103 in the Thurston
County Management Technical Pay Plan.
Action Needed: Pass Resolution
Class of Item: Consent
List of Exhibits
Resolution - TR Increase
Invest&BankingOfficer
031015.doc
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c PAO
d
e
f
g
c Budget Office
d
e
f
g
Notes:
c FinSvcs
d
e
f
g
b HR
c
d
e
f
g
c CAO
d
e
f
g
c Other
d
e
f
g
Recommended Action:
Move to approve the resolution changing the salary range of position 04R00103 Investment and
Banking Officer in the Thurston County Management Technical Pay Plan. The difference between the
top salaries is $674 or a 9% increase.
Item Description:
The Treasurer’s Office is requesting to change the salary range of the Investment and Banking Officer
classification. A recent market and salary analysis conducted with the assistance of Human Resources
indicates the requested increase is in line with comparable positions in other counties as well as within
our current classification system. One of the most important responsibilities of the Treasurer ’s Office is
to manage the cash and investments, currently over $600 million, for the County and other taxing
districts. This investment pool is similar to ten other counties in Washington and the Treasurer ’s current
performance ranks near the middle of these peers. Maintaining this rank requires daily monitoring of
market conditions to assure that informed investment decisions are being made on behalf of the pool.
The investment pool activities are budgeted in fund 1120; participants ’ fees within the pool support
investment costs including the funding of this position. There is no cost to the General Fund for this
position.
The current salary range for the Investment and Banking Officer is $5,619 - $7,492. The recommended
salary range is $6,125 - $8,166 per month. The difference between the top salaries is $674 or a 9%
increase.
Date Submitted: 2/24/2015
RESOLUTION NO. ______
A RESOLUTION changing the salary range of position 04R00103 in the Thurston County Management
Technical Pay Plan.
WHEREAS, it has been brought to the attention of the Thurston County Commissioners that a
recent market study has reestablished the salary for the above position, and;
WHEREAS, it has been brought to the attention of the Thurston County Commissioners that the
Thurston County Management Technical Pay Plan should be amended as follows;
NOW, THEREFORE, the Board of County Commissioners of Thurston County, State of
Washington, does resolve as follows:
Section 1. The Thurston County Management Technical Pay Plan should be amended as listed below:
Office/Department: Treasurer
Previous Position
Position No.:
Classification:
Spec. No.:
FTE:
Range:
New Position
04R00103
Investment and Banking
Officer
0732
1.0
490 (MTP) ($5,619 - $7,492)
Position No.: 04R00103
Classification: Investment and Banking Officer
Spec. No.:
FTE:
Range:
0732
1.0
562 (MTP) ($6,125 - $8,166)
ADOPTED: ____________________________
ATTEST:
BOARD OF COUNTY COMMISSIONERS
Thurston County, Washington
Clerk of the Board
Chair
APPROVED AS TO FORM:
Vice-Chair
Lauren Spurgeon
Interim Human Resources Director
Commissioner
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 4
Tillie Naputi-Pullar, Election Manager - Auditor - 754-2940
Mary Hall, Auditor - Auditor - 786-54 01
Item Title:
April Special Election Local Voters' Pamphlet
Action Needed: Pass Motion
Class of Item: Department
List of Exhibits
File Attachment
Recommended Action:
Move to authorize the Thurston County Auditor to publish and distribute a local voters' pamp hlet for
the April 28, 2015 Special Election.
Item Description:
The City of Tumwater has indicated their intent to place an issue on the ballot and opting in for a local
voters' pamphlet. Pursuant to County Code of Ordinances, Chapter 2.108.010, "… a local voters'
pamphlet may be published and distributed for a primary or special election if authorized by the b oard
of county commissioners by motion or resolution."
Date Submitted: 2/20/2015
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5a
Lydia Hodgkinson, Administrative Assistant II - Public Health and Social Services - 8672503
Gary Aden, Social Services Program Specialist III - Public Health and Social
Services - 867-2532
Item Title:
Approval of an Amendment to the State Department of Commerce Contract for the
Consolidated Homeless Grant Program
Action Needed: Pass Motion
Class of Item: Department
List of Exhibits
File Attachment
File Attachment
Recommended Action:
Move to approve an amendment to the Washington State Department of Commerce contract to
provide additional homeless housing funding through the Consolidated Homeless Grant for an
additional $45,000 for a revised total maximum amount of $2,661,894; and authorize the Director
of Public Health and Social Services Department to sign the amendment.
Item Description:
The State of Washington, Department of Commerce has provided to Thurston County an additional
$45,000 for Rapid Rehousing funding serving TANF families (Temporary Assistance for Needy
Families) who are currently homeless. TANF is a State of Washington Department of Social and Health
Services program that provides temporary cash for families in need. This amendment if approved will
add an additional amount ($45,000) to the current Consolidated Homeless Grant (CHG) Program for a
revised total maximum amount of $2,661,894. This request is to approve the revenue portion of the
contract between the county and the state Department of Commerce.
The HOME Consortium at their regularly scheduled, March 9, 2015 meeting will be asked to select
recipients of this funding to be spent before December 30, 2015.
Thurston Thrives Housing Strategies ad dressed in the Washington State Department of Commerce
contract for the Consolidated Homeless Grant Program include the creation of a cohesive crisis response
system to serve those who are homeless.
Date Submitted: 2/19/2015
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5b
Kristy Lysell, Social Services Program Specialist I - Public Health and Social Services 867-2560
Mark Freedman , Social Services Division Director - Public Health and Social
Services - 867-2558
Item Title:
Peer Support Program Contract Amendment between Capital Clubhouse d/b/a Capital
Recovery Center and Thurston County.
Action Needed: Execute Contract
Class of Item: Department
List of Exhibits
2014-640CR-02.pdf
Adobe Acrobat Document
97.6 KB
2015 RSN Capital
clubhouse contract
030315.pdf
Adobe Acrobat Document
579 KB
Recommended Action:
Move to approve an amendment to the existing Peer Support Program Contract between Thurston
County and Capital Clubhouse d/b/a Capital Recovery Center extending services for mental health
recovery programing from January 1, 2015 through December 31, 2015, in an amount of $392,856,
for a revised total maximum consideration not to exceed $874,418, and authorize the Director of
Public Health and Social Services to execute this amendment as well as future amendments that do
not change this approved dollar amount or duration by more than 50 percent.
Item Description:
This request is for an amendment to the Peer Support Program Contract between Capital Clubhouse
d/b/a Capital Recovery Center and Thurston County for mental health recovery services. The p urp ose of
this amendment is to extend the contract and funding for an ad ditional twelve (12) months, for a new
contract end date of December 31, 2015. The only other change is the addition of a new staffing report,
all other previous contract requirements will continue.
This amendment is consistent with the objectives and goals of the Thurston Thrives Clinical and
Emergency Care Team, including increased use of proven/evidence based preventive services,
maintaining the safety net for non-Medicaid individuals, educating and influencing people to make
better health choices, and increasing access to appropriate behavioral health treatment.
The original contract duration was January 01, 2014 through December 31, 2014. The duration of this
amendment is January 01, 2015 through December 31, 2015. This amendment increases the contract
by $392,856 for a revised total maximum consideration not to exceed $874,418. Funding is fully
supported by Thurston Mason RSN’s Medicaid Contract and Mental Health Block Grant.
Thurston Mason RSN is requesting the Board of County Commissioners delegate authority to the
Director of Public Health and Social Services to execute this amendment as well as any future
amendments that do not change this approved dollar amount or duration of this amendment by more
than 50 percent.
Date Submitted: 2/23/2015
AMENDMENT #2
PEER SUPPORT
PROGRAM CONTRACT
Contract Number: 2014-640CR
Kristy Lysell, Provider Network Coordinator
Thurston Mason RSN Contract Manager:
Address: 412 Lilly Road NE, Olympia WA 98506
Contact Phone:
Information: 360.867.2560
Email:
[email protected]
Contractor: Capital Clubhouse d/b/a Capital
Recovery Center
Contact: Ann Rider, Executive Director
Address: 1000 Cherry St SE Olympia WA 98501
Contact Phone:
Information: 360.357.2582
Email:
[email protected]
Is this contractor a Subrecipient for purposes of this contract?
ORIGINAL CONTRACT AMOUNT:
$240,781
Prior Contract Amount
Increase
$481,562
N
NA
$420,000
Amendment Start Date:
January 01, 2015
Medicaid
Exhibit B.1 - Compensation
93.958
$874,418
State
$
CFDA #:
New Contract Total
$392,856
Federal
Fund Source:
$209,618
Amount:
Exhibits:
Decrease
Y
TST
$
Inter-Gov
$
Reserves
$76,800
Contract End Date:
Attachments:
Local
$168,000
December 31, 2015
Quarterly Staffing Report [Excel]
This Program Services Contract Amendment, including all Exhibits and other attachments incorporated by reference, contains all of
the terms and conditions agreed upon by the parties as changes to the original contract. No other understandings and 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 Program Services 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. By their
signatures below, the parties hereto agree to this Program Services Contract Amendment and execute it in duplicate originals.
Contractor Signature:
Printed Name and Tile:
Date:
Thurston County Signature:
Printed Name and Title:
Date:
Don Sloma, Director
Contract Amendment 2014-640CR-02
Page 1 of 2
The Peer Support Service Contract 2014-640CR, between Thurston Mason RSN and the Contractor is hereby
amended as follows:
1. Extend the current contract for an additional 12 months for a new contract end date of December 31,
2015.
2. Add an additional 12 months of funding in the total amount of $392,856 for a new maximum
consideration not to exceed $874,418.
3. Revise the current language under Section 12.2 to read as follows:
The Contractor shall monitor and provide reports upon request per Section 18 to TMRSN on the following
performance measures;
4. Delete Section 18.4. – 18.4.1.1. in its entirety with no replacement.
5. Replace Section 18.7 under Exhibit A with the following:
18.7 Staffing Report
18.7.1 The Contractor shall submit the staffing report, provided by TMRSN as an Excel
document, per 18.1 on a quarterly basis. All columns of the report must completed or an N/A
must be entered.
6. Move and replace the deliverable table from Section 18.7 to 18.8 under Exhibit A with the following
table:
Deliverable
Submitted
Report Period Example
Active employees as of
the 1st of each month
Report Due Date
By the 10th of each
month
April 10, 2015
July 10, 2015
Oct 10, 2015
January 10, 2016
Format
Excluded Provider
Monthly
Staffing Report
Quarterly
Active employees
Staff Training
As provided
Employees in attendance
at each training
After each training
Provider List
MHBG Report
Monthly
Jan 1 – Jan 31
March 10th
TMRSN Provided
Word File
Excel File
TMRSN Provided
Excel File
7. Replace Exhibit B with Exhibit B.1, attached herein.
Except as expressly provided by the Amendment 2014-640CR-02, all other terms and conditions of the original
Peer Support Program Contract remain in full force and effect.
Contract Amendment 2014-640CR-02
Page 2 of 2
EXHIBIT B.1
Peer Support Services Program Contract
COMPENSATION
1.
COMPENSATION ........................................................................................................................................2
2.
OTHER FUNDING SOURCES....................................................................................................................4
3.
FISCAL MANAGEMENT............................................................................................................................4
4.
PRODUCTIVITY ..........................................................................................................................................4
5.
ACCOUNTING AND REPORTING REQUIREMENTS .........................................................................4
6.
BILLING PROCEDURE AND INVOICE SCHEDULE ...........................................................................5
7.
DELIVERABLES ..........................................................................................................................................5 Exhibit B.1 – Compensation 2015-640CR
Page 1 of 6
1. COMPENSATION
1.1. Program funding is based on the services as set forth in the Program Contract.
1.2. The Contractor shall use all funds provided pursuant to this Contract, including interest earned to
support only the services as described within this Contract.
1.3. The Contractor shall bill for services, as described below, to provide Peer Support Mental Health
Services, subject to the limitations described in this Exhibit.
1.3.1. For Medicaid Peer Support services: Exhibit A – Statement of Work: the Contractor shall
be funded based on a fee for service (FFS) model. The FFS is based on the number of
service hours provided per month to active enrolled TMRSN authorized clients.
Compensation is based on: $139.80 per hour for an individual service and $100.20 per hour
for a group service.
1.3.2. For MHBG Peer Support services: Exhibit A – Statement of Work: the Contractor shall
be funded the full MHBG amount based on minimum services provided. The Contractor
must serve a minimum of twenty-five (25) MHBG consumers per month and provide a
minimum of four (4) unduplicated groups per month. If the minimum services provided fall
below the required numbers, the Contractor will receive a reduced payment of 75% of total
MHBG funds.
1.4. Compensation rate will be reviewed every six (6) months of service and may be adjusted based on
actual costs and service productivity through an amendment. TMRSN reserves the right to adjust the
compensation by increasing or decreasing amount per the outcome of the review.
1.5. A portion of funding that supports this contract comes from Mental Health Block Grant funds from
the Department of Health and Human Services (DHHS), Catalog of Federal Domestic Assistance
(CFDA) # 93.958. Mental Health Block Grant Funds cannot be used for:
1.5.1. Services and programs that are covered under the capitation rate for Medicaid covered
services to Medicaid enrollees;
1.5.2. Inpatient mental health services;
1.5.3. Construction and/or renovation;
1.5.4. Capital assets or the accumulation of operating reserve accounts;
1.5.5. Equipment costs over $5,000.00;
1.5.6. Cash payments to consumers; or
1.5.7. State match for other federal funds.
1.6. Each month, TMRSN shall establish the total number of eligible clients seen and peer service hours
performed. Eligible service hour meets all of the following conditions:
1.6.1. Is provided by a certified peer counselor in Washington State;
1.6.2. Meets all federal and state staff credential requirements for service provided;
1.6.3. Is supervised by an mental health professional (MHP);
1.6.4. Is an RSN allowable service as described in Appendix E3, Service Activity Codes (SAC)
table of the TMRSN Data Dictionary or any successors, incorporated herein by reference;
1.6.5. Follows DBHR and TMRSN reporting guidelines with respect to provision of services,
reporting of services, and Medicaid or MHBG funding stipulations;
1.6.6. Client is defined as eligible in this Program Contract;
1.6.7. Client has a current authorization and is enrolled in services as described in the Program
Contract;
1.6.8. Has not exceeded the authorization period. (Unless under a grievance/appeal).
Exhibit B.1 – Compensation 2015-640CR
Page 2 of 6
1.7.
Payment shall be based on the following table. It is the responsibility of the Contractor to monitor their
monthly expenses and ensure that they do not go over the annual contract lid for each fund source. In
addition, any funds identified in an attachment must be used only for the service indicated and shall not be
used to supplement any other programs, services, tax debt, or capital investments.
TMRSN Compensation Rate Table: Medicaid and MHBG Peer Support Services
Payment Period: January 01, 2015 through December 31, 2015
NOTE: MHBG Funding is only for six (6) months – January 01, 2015 through June 30, 2015.
Service
Designation
Rate Method
Fund
Source
Project
Code
Not to Exceed
Twelve (12) Month Total
$210,000
$84,000
Subtotal: $294,000
Peer Support
Individual Hour: $139.80
Group Hour: $100.20
Medicaid
Reserves
41408
41499
Peer Support
Lump Sum for:
 Must serve a minimum of 25 clients
per month
 Must provide 4 unduplicated groups
per month
*MHBG
41401
$60,456
TC HIV Program
Space
Flat Rate
Local
$41499
$38,400
Total Contract Lid:
$392,856
1.7.1.
1.8.
1.9.
Medicaid funding can only fund services to those clients who are Medicaid mental health
benefit eligible. All services provided or purchased for mental health benefit eligible
Medicaid enrollees must be those identified in the benefit section of this contract.
1.7.2. TMRSN shall compensate the Contractor for providing peer services as specified in
Program Contract, Statement of Work, for this Contract. Required services provided to
Medicaid eligible individuals that are not an allowable Medicaid benefit shall be funded
under the MHBG as resources are available.
1.7.3. Medicaid service funding shall have a compensation lid in total and may be evaluated for
adjustment if the upper target is exceeded.
1.7.4. Technical support funding is for purchasing and/or upgrading hardware and software, and
support and consulting services on administrative and/or operational management. Items and
services must only be purchased for the services provided under this contract. The
Contractor must provide a receipt or proof of purchase for reimbursement of this funding.
Funding can be accessed through the duration of the contract.
In addition, as noted in the table above, each program attachment shall have an upper payment target.
Utilization beyond the target in any individual month shall result in a review by TMRSN and joint
action by TMRSN and the Contractor to review cost and decide on any adjustment if indicated.
A fee-for-service event shall only be funded if:
1.9.1. There is complete and accurate data in the Contractor and TMRSN MIS databases for all
service encounters.
1.9.2. The service encounter data matches the documentation in the clinical record.
1.9.3. The service provided accurately corresponds to the level of care and treatment plan as
authorized by TMRSN.
Exhibit B.1 – Compensation 2015-640CR
Page 3 of 6
2.
3.
4.
5.
1.10. Any monitoring process, including TMRSN encounter validation audits that show encounter
invalidation shall result in corrective action and funding reconciliation. Funding shall be reconciled
if the service event data does not comply with DBHR Encounter Instructions; does not comply with
TMRSN reporting guidelines; or does not match or is missing from the clinical record.
1.10.1. Corrective action and funding reconciliation shall occur for any missing or inaccurate
encounters received from the Contractor. Reconciliation for outstanding invalid encounters
shall occur fifteen days (15) after the Contractor has received notification of errors. Within
this fifteen day period, the Contractor may resolve errors, and unresolved invalid encounters
shall then be reconciled. Overall encounter validation accuracy outcome expectation is
100% after necessary corrections.
OTHER FUNDING SOURCES
2.1. The Contractor shall make all reasonable effort to collect from Third Party Insurers when available,
TMRSN recognizes this is not typical for peer services. The Contractor shall report monthly the total
collections of third party reimbursement. The Contractor shall be able to show by individual, those
clients eligible for third party benefits, including which services, how much was billed by service,
and how much was collected. This information shall be provided to TMRSN on a monthly basis
prior to the invoicing date for that month (see Section 6 – Billing Procedure/Invoice Schedule).
FISCAL MANAGEMENT
3.1. The Contractor shall provide services in the most effective, efficient and economical manner possible
to establish a prudent financial management system. This shall include, but not be limited to:
3.1.1. Establishing a sliding fee scale per licensing requirements. The sliding fee scale schedule
shall be posted and accessible to staff and clients and may not require payment from clients
with income levels equal to or below the grant standards for the general assistance program.
3.1.2. In accordance with Federal and State regulations and statutes, ensuring Medicaid or other
RSN funds are not utilized to support administrative and/or direct services to non-Medicaid
TMRSN authorized clients.
3.2. The Contractor shall ensure that Medicaid enrollees are not charged or held liable for any of the
following:
3.2.1. Medicaid services covered under the terms of this Contract (42CFR447.15);
3.2.2. Contractor’s debts in the event of insolvency;
3.2.3. Covered services provided to the enrollee for which DSHS does not pay TMRSN;
3.2.4. Services for which DSHS or TMRSN does not pay the individual or health care provider
that furnishes the services under a contractual, referral or other arrangement;
3.2.5. Any service provided under contract, on referral, or other arrangement, which exceeds what
TMRSN would cover if TMRSN provided the services directly.
PRODUCTIVITY
4.1. The Contractor is expected to function at a productivity level based on the most current actuarial
study authorized by DSHS.
ACCOUNTING AND REPORTING REQUIREMENTS
5.1. The Contractor will submit service event encounters through the MIS system per the TMRSN Invoice and
Data Send Calendar. All data will be certified as accurate per this contract.
5.2. The Contractor shall apply the TMRSN Reporting Guidelines, as set forth in TMRSN Policy. These
guidelines are required to be utilized to determine allowable services that includes, but is not limited to
the following: applicable funding source, appropriate service modality and service, location of service,
and appropriate staff credentials. TMRSN will monitor for billing and data accuracy to these reporting
Exhibit B.1 – Compensation 2015-640CR
Page 4 of 6
requirements.
5.3. Funding for this program is only to be used to provide the services, as depicted in the Program Contract,
and may not supplement any other programs or fund sources.
5.4. A minimum of 85 percent of the amount paid for outpatient funding to the Contractor shall be used for
direct mental health services; the Contractor shall fully cooperate to assure compliance with this
requirement.
6. BILLING PROCEDURE AND INVOICE SCHEDULE
6.1. TMRSN shall prepare an invoice each month based on encounter data entered in the RSN MIS for
services provided. Payment shall not exceed the total amount of this Contract.
6.2. The Contractor will certify and verify for accuracy each and all batch submissions to TMRSN. Before
any event send, the Contractor will perform checks to verify for accuracy. The Contractor will use the
appropriate TMRSN Data Certification form according to policy (see the Manual) and provide a copy of
the signed form to the TMRSN MIS Coordinator via Email or by fax to certify each batch submission.
The Contractor will maintain a copy of the signed original certification form for at least one year from the
end of this contracting period.
6.3. TMRSN reserves the rights to amend, delete, or add to the billing or reporting forms required in this
Exhibit.
6.4. TMRSN shall not release payment until the Contractor provides required reports identified in this
Contract.
6.5. Payment for outpatient services will be made based on all claims/encounters (services) accepted by
TMRSN for a given month, per the TMRSN MCO Invoice Deadline and Payment Schedule for CY2014,
attached herein or as otherwise stated according to 100.01 TMRSN Invoice and Data Send Calendar.
7. DELIVERABLES
7.1. The Contractor shall submit a budget vs actual report with each monthly invoice. Invoices submitted
without the report will not be processed until the report is received.
7.2. The Contractor will submit Certification that the Administrative Costs incurred by the Contractor are no
more than ten percent (10%) of the annual revenue under this contract. Certification must be submitted to
the TMRSN by August 14, 2015.
7.3. The Contractor shall have an annual independent audit performed by an outside Accounting Firm at
the end of each financial fiscal year. A copy of the audit report shall be submitted to TMRSN within
fifteen (15) days after the final report is provided to the Contractor by the Accounting Firm.
7.4. Financial Statements that include Contractor assets, liabilities, fund balances, and third party payers
when applicable, must be submitted to the TMRSN upon the agency’s fiscal year end or annual audit,
whichever occurs first, for this contracting period. An individual financial statement for services set
forth in this contract shall be itemized. Financial Statements may be sent electronically or via mail.
Exhibit B.1 – Compensation 2015-640CR
Page 5 of 6
TMRSN MCO Invoice Deadline and Payment Schedule for CY2015
Month of Payment (Paid 2 days before Last Day of Month):
2015
2016
Revised 12-14 (lk)
Inclusive Service Dates
Svs Dates
Payment Type:
12/1/14-12/31/14
For svs approved by Jan 9th - DEC Svs Actual:
1/1/15-1/31/15
For svs approved by Feb 6th - JAN Svs Actual:
*1/1/14-12/31/14
*Semi-Annual Reconciliation to begin Feb 6th:
2/1/15-2/28/15
For svs approved by Mar 6th - FEB Svs Actual:
3/1/15-3/31/15
For svs approved by Apr 3rd - MAR Svs Actual:
4/1/1-4/30/15
For svs approved by May 8th - APR Svs Actual:
5/1/15-5/31/15
For svs approved by Jun 5th - MAY Svs Actual:
6/1/15-6/30/15
For svs approved by Jul 10th - JUN Svs Actual:
7/1/15-7/31/15
For svs approved by Aug 7th - JUL Svs Actual:
*1/1/15-6/30/15
*Semi-Annual Reconciliation to begin Aug 7th:
8/1/15-8/31/15
For svs approved by Sep 4th - AUG Svs Actual:
9/1/15-9/30/15
For svs approved by Oct 9th - SEP Svs Actual:
10/1/15-10/31/15
For svs approved by Nov 6th - OCT Svs Actual:
11/1/15-11/30/15
For svs approved by Dec 4th - NOV Svs Actual:
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN
12/1/15-12/31/15 For svs approved by Jan 8th (TBD) - DEC Svs Actual:
Semi-Annual Reconciliation Schedule
TMRSN's semi-annual (twice/year) reconciliation schedule
for 2015 is as follows.
This reconciliation schedule is subject to change.
Reconciliation Due Date
February 6, 2015
August 7, 2015
February 2016 (TBD)
Service Months Reconciled
January 1, 2014 - December 31, 2014
January 1, 2015 - June 30, 2015
January 1, 2015 - December 31, 2015
Exhibit B.1 – Compensation 2015-640CR
Page 6 of 6
2015 Budgeted Revenue
1 PIHP/SMHC
2 Other State
Contracts (WISe)
$5.4m
m
(state & federal Medicaid)
$19.9m
3 Other Federal
Contracts (PATH/MHBG)
$361k
$6.2m
5 Dedicated
Millage
$293k
$306k
4 Treatment Sales Tax
(County)
$748k
6 Intergovernmental
/Other
$727k
7 Reserves
$2.4m
Thurston Mason RSN Provider Network
$29.8m
Budgeted expenditures and
actual subcontract
amounts may fluctuate.
Infrastructure Support
$1.7m -10.25 FTE
(1,2,4,5,7)
Includes: Administration, Management
Info Systems and Utilization
Management/Quality Assurance
amounts may vary
Outpatient Services
$16.4m
Community
Youth
Services
(1,2,4,7)
Capital
Recovery
Center
(1,3,5,7)
St. Peter
Hospital
(1,7)
Sea Mar
(1)
Catholic
Community
Services
(1,2,4,7)
Behavioral Health
Resources (BHR)
(1,6,7)
Kids MH Liaison
Multisystemic
Therapy (MST)
Mentally Ill
Juvenile
Offender
PATH
Homeless
Peer
Support
Intensive
Outpatient
Program
Wraparound
ITA Court
WISe
Kids Crisis
WISe and TAY
[Type text]
Program of
Assertive
Community
Treatment (PACT)
Professional Services
Additional Expenses
$9.1 (1,3,4,6,7)
$894k (1,2,3,4,7)
$1.7m (1,6,7)
Providence
St. Peter
Hospital
SMHC: State Mental Health Contract
DCFS: Department of Children and Family Services
FAMH: Family Alliance for Mental Health
.
ITA: Involuntary Treatment Act
UM: Utilization Management
TAY: Transition Aged Youth
PATH: Projects for Assistance to Transition from
Homelessness
TC E&T
Facility
Operated by
BHR
DSHS - WSH
Jet Computer
Grays Harbor
Timberlands
Crisis Court
Ombuds
UW –
Wraparound
and MST
Fidelity
Donna
Obermeyer
Wraparound
& FAMH
Medical
Director
Crisis Clinic:
Information
and Referral
Community
Integration
Outreach
(CIO)
King County
Southwest
Behavioral Health
North Sound MH
Administration
NAMI
ProtoCall
Inpatient UM
ITA
Agreements
Kitsap MH
Kids ITA
Key:
PIHP: Prepaid Inpatient Health Plan
MHBG: Mental Health Block Grant
NAMI: National Alliance on Mental Illness
E&T: Evaluation & Treatment
EBP: Evidence Based Practice
WISe: Wraparound with Intense Services
HATC: Housing Authority of Thurston County
Community
Housing Support
Inpatient Services
CIO includes the
Mentally Ill
Offender (MIO)
Program provided
in Olympia, Mason,
and Thurston Jails
HATC Homeless
Veteran’s Leasing
Assistance Program
Central
Services
Medicaid
Personal
Care
Out of
Network
Outpatient
NetSmart
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5c
Kristy Lysell, Social Services Program Specialist I - Public Health and Social Services 867-2560
Mark Freedman , Social Services Division Director - Public Health and Social
Services - 867-2558
Item Title:
Outpatient Service Program Contract Amendment between Behavioral Health Resources
and Thurston County.
Action Needed: Execute Contract
Class of Item: Department
List of Exhibits
Outpatient 2014-62OP03.pdf
Adobe Acrobat Document
112 KB
2015 RSN BHR
outpatient contract
030315.pdf
Adobe Acrobat Document
579 KB
Recommended Action:
Move to approve an amendment to the Outpatient Program Service Contract for children and adult
mental health services between Thurston County and Behavioral Health Resources extending services
from January 1, 2015 through December 31, 2015, in an amount of $8,739,873 for a revised total
maximum consideration not to exceed $17,685,963, and authorize the Director of Public Health and
Social Services to execute this amendment as well as future amendments that do not change this
approved dollar amount or duration by more than 50%.
Item Description:
This request is for an amendment to the Outpatient Service Program Contract between Behavioral
Health Resources and Thurston County for mental health services. The purpose of this amendment is to
1) extend the current contract and funding for an add itional twelve (12) months, for a new end date of
December 31, 2015, and 2) add new deliverables including a staffing report and claims data report.
This amendment is consistent with the objectives and goals of the Thurston Thrives Clinical and
Emergency Care Team, including increasing access to appropriate behavioral health
treatment, residential care, and community oriented services and appropriate resource utilization.
The duration of the original contract was from January 01, 2014 through December 31, 2014. The
duration of this amendment is January 01, 2015 through December 31, 2015. This amendment
increases the contract by $8,739,873 for a revised total maximum consideration not to exceed
$17,685,963. Funding is fully supported b y Thurston Mason RSN’s Medicaid and State Funded
Contracts, Millage and Medicaid Reserves.
Thurston Mason RSN is requesting the Board of County Commissioners delegate authority to the
Director of Public Health and Social Services to execute this amendment as well as any future
amendments that do not change this approved dollar amount or duration of this amendment by more
than 50%.
Date Submitted: 2/23/2015
AMENDMENT #3
OUTPATIENT SERVICES
PROGRAM CONTRACT
Contract Number: 2014-62OP
Kristy Lysell, Provider Network Coordinator
Thurston Mason RSN Contract Manager:
Address: 412 Lilly Road NE, Olympia WA 98506
Contact Phone:
Information: 360.867.2560
Email:
[email protected]
Contractor: Behavioral Health Resources
Contact: John Masterson, CEO
Address: 3857 Martin Way E; Olympia WA 98506
Contact Phone:
Information: 360.704.7170
Email:
[email protected]
Is this contractor a Subrecipient for purposes of this contract?
ORIGINAL CONTRACT AMOUNT:
$4,524,046
Prior Contract Amount
Increase
$8,946,090
N
CFDA #:
NA
(for total duration)
Federal
Medicaid
$30,000
Amendment Start Date:
$15,808,438
January 01, 2015
B.1 - Compensation
93.150
New Contract Total
$8,739,873
Total Amount Per
Fund Source:
Exhibits:
Decrease
Y
$17,685,963
State
$1,263,675
TST
$6,000
Inter-Gov
$
Reserves
$465,600
Contract End Date:
Attachments:
Local
$112,250
December 31, 2015
Staffing Report [Excel]
This Program Services Contract Amendment, including all Exhibits and other attachments incorporated by reference, contains all of
the terms and conditions agreed upon by the parties as changes to the original contract. No other understandings and 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 Program Services 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. By their
signatures below, the parties hereto agree to this Program Services Contract Amendment and execute it in duplicate originals.
Contractor Signature:
Printed Name and Tile:
Date:
Thurston County Signature:
Printed Name and Title:
Date:
Don Sloma, Director
Contract Amendment 2014-62OP-03
Page 1 of 2
The Outpatient Program Service Contract 2014-62OP, between Thurston Mason RSN and the Contractor is
hereby amended as follows:
1. Extend the current contract for an additional 12 months for a new contract end date of December 31,
2015.
2. Add an additional 12 months of funding in the total amount of $8,739,873 for a new maximum
consideration not to exceed $17,685,963.
3. Amend Section 11.3. by replacing the current language with the following:
The Contractor shall internally monitor the timeliness of services and provide reports if requested by
TMRSN.
4. Delete Section 22.4. – 22.4.1. in its entirety with no replacement.
5. Replace Section 22.6 under Exhibit A with the following:
22.6. *Staffing Report
22.6.1. The Contractor shall submit the staffing report, provided by TMRSN as an Excel
document, per 26.1 on a quarterly basis. All columns of the report must completed or an
N/A must be entered.
6. Move and replace the deliverable table from Section 22.6 to 22.7 under Exhibit A with the following
table:
Deliverable
Submitted
Report Period Example
Report Due Date
Format
*Excluded Provider
Monthly
Active employees as of
the 1st of each month
By the 10th of each
month
Excel File
*Staff Training
Quarterly
Employees completed
training between Jan 1 –
Mar 31
May 10th
Provider List
PACT Client/Staff Report
Monthly
Jan 1 – 31
TMRSN Provided Excel
File
PACT Outcome Data
Quarterly
Nov 1 – Jan 31
Feb 1 – Apr 30
May 1 – Jul 31
Aug 1 – Oct 31
Joint Position Activity Log
Monthly
Jan 1 – 31
*Staffing Report
Quarterly
Active employees
By the 10th of each
month
02/15/15
05/15/15
08/15/15
11/15/15
By the 10th of each
month
April 10, 2015
July 10, 2015
Oct 10, 2015
January 10, 2016
Exhibit B
See Section 7
DBHR Provided Excel
File
TMRSN Provided Excel
File
TMRSN Provided Excel
File
*All staffing reports can be combined into one single report if the Contractor chooses. However, if it does become
one report, then it must be submitted on a monthly basis, not quarterly or as occurs. In addition, all required
information from each individual report must be captured in one Excel Spreadsheet.
7. Replace Exhibit B with Exhibit B.1, attached herein.
8. Delete Exhibit C in its entirety with no replacement.
Except as expressly provided by this Amendment No. 03, all other terms and conditions of the original
Outpatient Program Services Contract remain in full force and effect.
Contract Amendment 2014-62OP-03
Page 2 of 2
EXHIBIT B.1
Outpatient Program Contract
COMPENSATION
1.
COMPENSATION ........................................................................................................................................2
2.
OTHER FUNDING SOURCES....................................................................................................................4
3.
FISCAL MANAGEMENT............................................................................................................................4
4.
PRODUCTIVITY ..........................................................................................................................................5
5.
ACCOUNTING AND REPORTING REQUIREMENTS .........................................................................5
6.
BILLING PROCEDURE AND INVOICE SCHEDULE ...........................................................................5
7.
DELIVERABLES ..........................................................................................................................................6
1.
SPECIALIZED INSTRUCTIONS FOR ATTACHMENT COMPENSATION .....................................8 Exhibit B.1 – Compensation 2014-62OP
Page 1 of 8
1. COMPENSATION
1.1. Program funding is based on the services as set forth in the Program Contract. The Contractor shall
use all funds provided pursuant to this Contract, including interest earned to support only the services
as described within this Contract.
1.2. The Contractor shall bill for services, as described below, to provide Outpatient Mental Health
Services, subject to the limitations described in this Exhibit.
1.3. For Core Outpatient services – Exhibit A Statement of Work: the Contractor shall be funded based on
a fee for service (FFS) model. The FFS is based on the number of service hours provided per month
to active enrolled TMRSN authorized clients. Compensation is based on:
1.3.1. $160.20 per hour for a facility based individual service.
1.3.2. $180.00 per hour for a community based individual service.
1.3.3. $46.80 per client hour for a group service.
1.4. Compensation rate may be adjusted based on actual costs and service productivity through an
amendment.
1.5. The Contractor is required to make available all services noted in the Benefits section of this contract
as medically necessary. The Contractor remains at risk to provide all services including when the
request exceeds the capitated fee-for-service reimbursement rates.
1.6.
Funding that supports this contract may come from Mental Health Block Grant funds from the
Department of Health and Human Services (DHHS), Catalog of Federal Domestic Assistance
(CFDA) # 93.958. Mental Health Block Grant funds may not be used for:
1.6.1.
1.7.
1.8.
Services and programs that are covered under the capitation rate for Medicaid covered
services to Medicaid enrollees; Inpatient mental health services; Construction and/or
renovation; Capital assets or the accumulation of operating reserve accounts; Equipment
costs over $5,000.00; Cash payments to consumers; or State match for other federal funds.
Each month, TMRSN shall establish the total number of eligible clients seen and outpatient service
hours performed. An eligible service hour meets all of the following conditions:
1.7.1. Is provided by a registered counselor or higher credential in Washington State;
1.7.2. Meets all federal and state staff credential requirements for service provided;
1.7.3. With the exception of doctors and nurses, is supervised by an mental health professional
(MHP);
1.7.4. Is an RSN allowable service as described in Appendix E3, Service Activity Codes (SAC)
table of the TMRSN Data Dictionary or any successors, incorporated herein by reference;
1.7.5. Follows MHD reporting guidelines with respect to provision of services, reporting of
services, and Medicaid or State funding stipulations;
1.7.6. Client is defined as eligible in this Program Contract;
1.7.7. Client has a current authorization and is enrolled in services as described in the Program
Contract, or has received an allowable pre-intake service;
1.7.8. On a case-by-case basis, the RSN will review exceptions for funding of services not covered
by Medicaid for either Non-TXIX individuals or for services not covered under a pending
spenddown benefit. Please refer to TMRSN Protocol #58 for instructions. Funds paid to the
provider under this section shall come from the State Only allocation under this contract.
1.7.9. Has not exceeded the LOC authorization period. (Unless under a grievance/appeal).
Payment shall be based on the following table. It is the responsibility of the Contractor to monitor their
monthly expenses and ensure that they do not go over the annual contract lid for each fund source. In
Exhibit B.1 – Compensation 2014-62OP
Page 2 of 8
addition, any funds identified in an attachment must be used only for the service indicated and shall not be
used to supplement any other programs and/or services.
TMRSN Compensation Rate Table: Medicaid and State Outpatient Services
Payment Period: January 01, 2015 through December 31, 2015
Service Designation
Core Outpatient
Core Outpatient
Attachment 1: Children’s
Crisis MH Specialist
Rate Method
Project Code
Medicaid
41408
$6,775,296
State
41409
$72,000
Medicaid
41408
$71,556
Overnight Staffing Model for 1.6
FTE’s; payment based on actual
costs.
Community residential services
based on Individual hr: $180.00.
Medicaid
ECS
PALS
41408
41406
41422
$522,984
$37,512
$331,188
Subtotal: $891,684
Actual Cost - costs must be authorized
by TMRSN
Medicaid
Proviso
Local
41408
41419
41499
Actual Cost and rate differential for
pager of $1.25 per hr
Medicaid
State
41408
41409
Facility Based Individual hr: $160.20
Community Based Individual hr:
$180.00
Group hr: $46.80
Monthly Service Rate $5,963

Attachment 2: Community
Housing Support
Attachment 3: PACT
Attachment 3 Supplemental:
PACT Afterhours Crisis &
Pager Differential Rate
Not to Exceed
12 Month Total
Fund Source

Total Contract Lid for Above Services:
$476,256
$173,748
$232,800
Subtotal: $882,804
$40,000
$6,533
Subtotal: $46,533
$8,739,873
1.8.1.
Medicaid funding can only fund services to those clients who are Medicaid mental health
benefit eligible. All services provided or purchased for mental health benefit eligible
Medicaid enrollees must be those identified in the benefit section of this contract.
1.8.2. TMRSN shall compensate the Contractor for providing outpatient services as specified in
Program Contract, Statement of Work, for this Contract. Required services provided to
Medicaid eligible individuals that are not an allowable Medicaid benefit shall be funded
under the TMRSN State Funded Mental Health Services Contract as resources are available
per TMRSN protocols.
1.8.3. Medicaid service funding shall have a compensation lid in total and is expected to be
proportioned between Thurston and Mason counties as well as between adults and children
services. Funding may be evaluated for adjustment if the upper target is exceeded.
1.9. In addition, as noted in the table above, each program attachment shall have an upper payment target.
Utilization beyond the target in any individual month shall result in a review by TMRSN and joint
action by TMRSN and the Contractor to review cost and decide on any adjustment if indicated.
1.10. A fee-for-service event shall only be funded if:
1.10.1. There is complete and accurate data in the Contractor and TMRSN MIS databases for all
service encounters.
1.10.2. The service encounter data matches the documentation in the clinical record.
1.10.3. The service provided accurately corresponds to the level of care, medical necessity, and
treatment plan as authorized by TMRSN.
Exhibit B.1 – Compensation 2014-62OP
Page 3 of 8
1.10.4. All required reports, deliverables, and performance measures are accurate and provided in a
timely manner.
1.11. Any monitoring process, including TMRSN encounter validation audits that show encounter
invalidation shall result in corrective action and funding reconciliation. Funding shall be reconciled
if the service event data does not comply with DBHR Encounter Instructions; does not comply with
TMRSN reporting guidelines; or does not match or is missing from the clinical record.
1.11.1. Corrective action and funding reconciliation shall occur for any missing or inaccurate
encounters received from the Contractor. Reconciliation for outstanding invalid encounters
shall occur fifteen days (15) after the Contractor has received notification of errors. Within
this fifteen day period, the Contractor may resolve errors, and unresolved invalid encounters
shall then be reconciled. Overall encounter validation accuracy outcome expectation is
100% after necessary corrections.
1.12. The funds identified as “Medicaid Required – State Only” under this Exhibit B shall only be billable
for Medicaid required services delivered to Medicaid Enrollees which are not covered by
Medicaid funds. RSN allowable services as described in Appendix E4, of the TMRSN Data
Dictionary or any successors, include;
1.12.1. 215 - Intake Rehab Case Management (except in CLIP locations);
1.12.2. 270 - Medicaid Application Completed in Jail;
1.12.3. 315/6315 - Rehab Case Management (except in CLIP locations); and
1.12.4. 325 - Engagement & Outreach.
2. OTHER FUNDING SOURCES
2.1. The Contractor shall make all reasonable effort to collect from Third Party Insurers when available.
The Contractor shall report monthly the total collections of third party reimbursement. The
Contractor shall be able to show by individual, those clients eligible for third party benefits, including
which services, how much was billed by service, and how much was collected. This information
shall be provided to TMRSN on a monthly basis prior to the invoicing date for that month (see
Section 6 – Billing Procedure/Invoice Schedule).
3. FISCAL MANAGEMENT
3.1. The Contractor shall provide services in the most effective, efficient and economical manner possible
to establish a prudent financial management system. This shall include, but not be limited to:
3.1.1. Establishing a sliding fee scale per licensing requirements. The sliding fee scale schedule
shall be posted and accessible to staff and clients and may not require payment from clients
with income levels equal to or below the grant standards for the general assistance program.
3.1.2. In accordance with Federal and State regulations and statutes, ensuring Medicaid or other
RSN funds are not utilized to support administrative and/or direct services to non-Medicaid
TMRSN authorized clients.
3.2. The Contractor shall maintain records in such a manner so as to reasonably ensure that all third-party
resources available to clients are identified and pursued, in accordance with Medicaid being the payer
of last resort. This information must be reported in the Financial Statement, as stipulated in Section 5
of this exhibit. Third party revenue received by the Contractor for TMRSN funded services shall be
deducted from the RSN payment for the same services.
3.3. The Contractor shall ensure that Medicaid enrollees are not charged or held liable for any of the
following:
3.3.1. Medicaid services covered under the terms of this Contract (42CFR447.15);
3.3.2. Contractor’s debts in the event of insolvency;
Exhibit B.1 – Compensation 2014-62OP
Page 4 of 8
3.3.3.
3.3.4.
Covered services provided to the enrollee for which DSHS does not pay TMRSN;
Services for which DSHS or TMRSN does not pay the individual or health care provider
that furnishes the services under a contractual, referral or other arrangement;
3.3.5. Any service provided under contract, on referral, or other arrangement, which exceeds what
TMRSN would cover if TMRSN provided the services directly.
4. PRODUCTIVITY
4.1. The Contractor is expected to function at a productivity level based on the most current actuarial
study authorized by DSHS. Productivity levels shall meet or exceed a minimum of 50% towards
direct care services.
5. ACCOUNTING AND REPORTING REQUIREMENTS
5.1. The Contractor will submit service event encounters through the MIS system per the TMRSN Invoice and
Data Send Calendar. All data will be certified as accurate per this contract.
5.2. The Contractor shall apply the TMRSN Reporting Guidelines, as set forth in TMRSN Policy. These
guidelines are required to be utilized to determine allowable services that includes, but is not limited to
the following: applicable funding source, appropriate service modality and service, location of service,
and appropriate staff credentials. TMRSN will monitor for billing and data accuracy to these reporting
requirements.
5.3. Funding for all programs under this Contract is only to be used to provide the services, as depicted in
the Program Contract, and may not supplement any other programs or fund sources.
5.4. Compensation for programs that are based on Staffing/Cost model shall not exceed the actual costs to
provide services for the month. A cost report showing actual expenses by program must be submitted
each month by the invoice deadline.
5.5. A minimum of 90% of the available amount from primary funding to the Contractor shall be used for
direct mental health services and the Contractor shall fully cooperate to assure compliance with this
requirement.
5.6. The Contractor shall have an annual audit performed by an outside CPA firm. If the contractor
receives any federal funds indicated in the Compensation Section 1 above or from any other funding
sources, see the general terms and conditions for A133 Single Audit requirements, or any successor.
6. BILLING PROCEDURE AND INVOICE SCHEDULE
6.1. All non-service/encounter funded services, such as cost/staffing model services, must be evidenced
by a cost report of actual expenses to be submitted by the Contractor to TMRSN prior to the month’s
invoice deadline for data submission (see Manual). Billable amount is not to exceed actual expense
or monthly lid, whichever is less.
6.2. The Contractor shall certify and verify for accuracy batch submissions to TMRSN. Before any event
send, the Contractor shall perform checks to verify for accuracy. The Contractor shall use the
appropriate TMRSN Data Certification form according to TMRSN Policy IS801: Provider Data
Certification and provide a signed monthly certification form to the TMRSN MIS Coordinator via
Email or fax to certify each batch submission within the month. The Contractor shall maintain a
copy of the signed original certification form for at least one year from the end of this contracting
period.
6.3. TMRSN shall prepare an invoice each month based on encounter data entered in the RSN MIS for
services provided. Payment shall not exceed the total amount of this Contract.
6.4. The Contractor will certify and verify for accuracy each and all batch submissions to TMRSN.
Before any event send, the Contractor will perform checks to verify for accuracy. The Contractor
will use the appropriate TMRSN Data Certification form according to policy (see the Manual) and
provide a copy of the signed form to the TMRSN MIS Coordinator via Email or by fax to certify each
Exhibit B.1 – Compensation 2014-62OP
Page 5 of 8
batch submission. The Contractor will maintain a copy of the signed original certification form for at
least one year from the end of this contracting period.
6.5. TMRSN reserves the rights to amend, delete, or add to the billing or reporting forms required in this
Exhibit.
6.6. TMRSN shall not release payment until the Contractor provides required reports identified in this
Contract.
6.7. Payment for outpatient services will be made based on all claims/encounters (services) accepted by
TMRSN for a given month, per the TMRSN MCO Invoice Deadline and Payment Schedule for
CY2015, attached herein or as otherwise stated according to 100.01 TMRSN Invoice and Data Send
Calendar.
7. DELIVERABLES
7.1. The Contractor shall submit a budget vs actual report with each monthly invoice. Invoices submitted
without the report will not be processed until the report is received.
7.2. A copy of the annual audit must be submitted to the TMRSN upon receipt of the audit report by the
Contractor.
7.3. The Contractor will submit Certification that the Administrative Costs incurred by the Contractor are
no more than ten percent (10%) of the total revenue under this contract. Certification must be
submitted to the TMRSN no later than August 14, 2015.
7.4. Financial Statements that include Contractor assets, liabilities, fund balances, and third party payers
when applicable, must be submitted to the TMRSN upon the agency’s fiscal year end or annual audit,
whichever occurs first, for this contracting period. An individual financial statement for services set
forth in this contract shall be itemized. Financial Statements may be sent electronically or via mail.
7.5. The Contractor shall run and submit monthly data error reports for any services that are considered
“cost reimbursed” or services paid on “actual costs” with the monthly invoice. Reports shall include
all pended and denied claims from the previous month(s) – please reference TMRSN MCO
Instruction: 402.01 MCO Provider Reports & Instructions, Section 4 – “837 Claims Reports” for
report details on “Claims Pended or Denied for Date Range”.
If the report shows there are claims data errors, the Contractor will have 60 days to correct and
resolve all claims errors listed. If 100% of the errors are not corrected, *penalties will apply per the
table below. The Contractor shall submit all reports as described in the table below each month. This
schedule is for the entire duration of the contract, not just the dates listed below.
TMRSN reserves the right to apply Remedial Actions per Section 23.2.2 of Exhibit A in addition to
the penalties below if the Contractor does not comply with this deliverable.
Due Date
February 10th
March 10th
April 10th
Deliverables
 January Invoice
 Claims Data Error report for Jan 01-31
 February Invoice
 Claims Data Error Report for Feb 01-28
 March Invoice
 Claims Data Error Report for Mar 01-31
 Re-run Claims Data Error Report for Jan 01-31
All claims errors for January must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total April Payment.
 71-80% errors are corrected – 5% will be deducted from the total April Payment.
 70% errors or less are corrected – 10% will be deducted from the total April Payment.
NOTE – Providers will not be able to recapture these penalties.
Exhibit B.1 – Compensation 2014-62OP
Page 6 of 8
 April Invoice
 Claims Data Error Report for Apr 01-30
 Re-run Claims Data Error Report for Feb 01-28
All claims errors for February must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total May Payment.
 71-80% errors are corrected – 5% will be deducted from the total May Payment.
 70% errors or less are corrected – 10% will be deducted from the total May Payment.
NOTE – Providers will not be able to recapture these penalties.
June 10th
 May Invoice
 Claims Data Error Report for May 01-31
 Re-run Claims Data Error Report for Mar 01-31
All claims errors for March must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total June Payment.
 71-80% errors are corrected – 5% will be deducted from the total June Payment.
 70% errors or less are corrected – 10% will be deducted from the total June Payment.
 NOTE – Providers will not be able to recapture these penalties.
This formula will continue monthly with the final reports due in February 2015.
May 10th
Exhibit B.1 – Compensation 2014-62OP
Page 7 of 8
Specialized Instructions for Attachment Compensation
1. ATTACHMENT 1 – Children’s Mental Health Crisis Specialist
1.1. Program funding is based on compliance with the Program Services Statement of Work per Program
Services, Attachment 1, or any successor.
1.2. TMRSN shall reimburse the Contractor for services performed by 1.0 FTE under this attachment,
billable as a monthly service rate.
1.3. The Contractor shall submit the Service Activity Log monthly showing services provided that are not
captured in the MIS.
2. ATTACHMENT 2 – Community Housing Support
2.1. Program funding is based on the terms of the program description in Program Services Statement of
Work Attachment 2, or any successor.
2.2. TMRSN shall reimburse the Contractor for services performed under the terms of this Contract,
payable in the following manner:
2.2.1. Compensation for the 1.6 FTE is based on actual costs. Staffing is intended for overnight
coverage at The Gardens apartment complex. Staff persons shall provide per diem
supervision and mental health support services as well as individual crisis intervention
services when necessary. Any crisis service event provided by the overnight staff under this
attachment shall offset the total amount invoiced for Community Housing Support Services.
2.2.2. Compensation for services being delivered in a residential setting is based on a fee-forservice model. Each unit of service (encounter) must be appropriately documented on a
progress note and the encounter submitted to TMRSN.
2.2.2.1.
The Contractor must submit Community Housing Support services using the
“HB” modifier, as specified in the TMRSN Data Dictionary. Only services
using the “HB” modifier and allowable by TMRSN (per TMRSN Data
Dictionary) will be included for compensation under the Community Housing
Support program.
2.2.3. The Contractor shall provide a monthly cost invoice for the 1.6 FTE’s by the “MCO
Payment Cut-off” date.
2.2.4. Reimbursement for FTE’s will be deducted first from the monthly cap. Remaining funds
shall be applied towards mental health services in a residential setting based on encounter
data.
3. ATTACHMENT 3 – PACT
3.1. Program funding is based on the terms of the program description in Program Services Statement of
Work, Attachment 3, or any successor.
3.2. Only these funds provided for the provision of WA-PACT shall be used to provide the WA-PACT
services. No other funds provided in this Contract shall be used to provide these services, with the
exception of Crisis Services, ITA Evaluations, E&T Services, and Inpatient Mental Health
Hospitalization Services. Any exceptions to this requirement must be submitted in writing to
TMRSN for consideration and must be approved prior to the expenditure.
3.3. The amount shown above for fund source “Proviso” includes both Medicaid and State Only dollars.
The amount to be charged each month to these two sources shall be ascertained by the number of
encounters entered in the MIS and the pay source attributable to each.
Exhibit B.1 – Compensation 2014-62OP
Page 8 of 8
2015 Budgeted Revenue
1 PIHP/SMHC
2 Other State
Contracts (WISe)
$5.4m
m
(state & federal Medicaid)
$19.9m
3 Other Federal
Contracts (PATH/MHBG)
$361k
$6.2m
5 Dedicated
Millage
$293k
$306k
4 Treatment Sales Tax
(County)
$748k
6 Intergovernmental
/Other
$727k
7 Reserves
$2.4m
Thurston Mason RSN Provider Network
$29.8m
Budgeted expenditures and
actual subcontract
amounts may fluctuate.
Infrastructure Support
$1.7m -10.25 FTE
(1,2,4,5,7)
Includes: Administration, Management
Info Systems and Utilization
Management/Quality Assurance
amounts may vary
Outpatient Services
$16.4m
Community
Youth
Services
(1,2,4,7)
Capital
Recovery
Center
(1,3,5,7)
St. Peter
Hospital
(1,7)
Sea Mar
(1)
Catholic
Community
Services
(1,2,4,7)
Behavioral Health
Resources (BHR)
(1,6,7)
Kids MH Liaison
Multisystemic
Therapy (MST)
Mentally Ill
Juvenile
Offender
PATH
Homeless
Peer
Support
Intensive
Outpatient
Program
Wraparound
ITA Court
WISe
Kids Crisis
WISe and TAY
[Type text]
Program of
Assertive
Community
Treatment (PACT)
Professional Services
Additional Expenses
$9.1 (1,3,4,6,7)
$894k (1,2,3,4,7)
$1.7m (1,6,7)
Providence
St. Peter
Hospital
SMHC: State Mental Health Contract
DCFS: Department of Children and Family Services
FAMH: Family Alliance for Mental Health
.
ITA: Involuntary Treatment Act
UM: Utilization Management
TAY: Transition Aged Youth
PATH: Projects for Assistance to Transition from
Homelessness
TC E&T
Facility
Operated by
BHR
DSHS - WSH
Jet Computer
Grays Harbor
Timberlands
Crisis Court
Ombuds
UW –
Wraparound
and MST
Fidelity
Donna
Obermeyer
Wraparound
& FAMH
Medical
Director
Crisis Clinic:
Information
and Referral
Community
Integration
Outreach
(CIO)
King County
Southwest
Behavioral Health
North Sound MH
Administration
NAMI
ProtoCall
Inpatient UM
ITA
Agreements
Kitsap MH
Kids ITA
Key:
PIHP: Prepaid Inpatient Health Plan
MHBG: Mental Health Block Grant
NAMI: National Alliance on Mental Illness
E&T: Evaluation & Treatment
EBP: Evidence Based Practice
WISe: Wraparound with Intense Services
HATC: Housing Authority of Thurston County
Community
Housing Support
Inpatient Services
CIO includes the
Mentally Ill
Offender (MIO)
Program provided
in Olympia, Mason,
and Thurston Jails
HATC Homeless
Veteran’s Leasing
Assistance Program
Central
Services
Medicaid
Personal
Care
Out of
Network
Outpatient
NetSmart
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5d
Kristy Lysell, Social Services Program Specialist I - Public Health and Social Services 867-2560
Mark Freedman , Social Services Division Director - Public Health and Social
Services - 867-2558
Item Title:
Professional Service Contract between ProtoCall Services Inc. and Thurston County.
Action Needed: Execute Contract
Class of Item: Department
List of Exhibits
P2015-7574.docx
Microsoft Word
Document
45.4 KB
2015 RSN ProtoCall Svcs
contract 030315.pdf
Adobe Acrobat Document
579 KB
Recommended Action:
Move to approve the Professional Service Contract for inpatient utilization management services
between Thurston County and ProtoCall Services Inc. from March 01, 2015 through December 31,
2015, for a total maximum consideration not to exceed $70,000, and authorize the Director of Public
Health and Social Services to execute this contract as well as future amendments that do not change
this approved dollar amount or duration by more than 50%.
Item Description:
Thurston Mason Regional Support Network (RSN) released a Notice of Interest (NOI) in November 2014
to determine if a Request for Proposal (RFP) was going to be released for the 2015 Utilization
Management (UM) Contract. The NOI was published in the Olympian as well as distributed to all RSN
Network Providers and UM Companies under contract with other RSN ’s. The only response received was
from ProtoCall Services Inc. – no RFP was released. ProtoCall was previously awarded this contract
from an RFP in 2008 and provided this service from 2008 – 2013.
This request is for approval of the Professional Service Contract between ProtoCall Services Inc. and
Thurston County for Inpatient Utilization Management. ProtoCall will provide 24 hour a day, 7 day a
week prior authorization services for voluntary and involuntary inpatient hospitalization requests for
individuals who meet eligibility. ProtoCall is required to have Mental Health Professionals (MHP) respond
to all calls so that there is a peer-to-peer review of medical necessity and the possibility of a of less
restrictive alternative such as a crisis intervention or diversion service instead of hospitalization.
ProtoCall will defer to the RSN’s Medical Director if the MHP’s assessment of the inpatient request
should be a denial. In addition, ProtoCall will maintain call logs and all client information and enter the
data into ProviderOne which is the Department of Social and Health Services billing system.
This amendment is consistent with the proposed objectives and goals of the Thurston Thrives Clinical
and Emergency Care Team, including appropriate resource utilization, maintaining a safety net for non -
Medicaid consumers, and increasing access to appropriate medical care and behavioral health
treatment.
The duration of this contract is March 01, 2015 through December 31, 2015. Total funding for this
contract is $70,000, fully supported by Thurston Mason RSN’s Medicaid Contract.
Thurston Mason RSN is requesting the Board of County Commissioners delegate authority to the
Director of Public Health and Social Services to execute this contract as well as any future amendments
that do not change this approved dollar amount or duration of this contract by more than 50%.
Date Submitted: 2/18/2015
PROFESSIONAL SERVICES CONTRACT
THURSTON COUNTY DEPARTMENT: THURSTON MASON RSN
THIS CONTRACT is entered into in duplicate originals between THURSTON COUNTY, a municipal corporation,
with its principal offices at 412 Lilly Rd NE, Olympia, Washington 98506, hereinafter “COUNTY,” and
, with its
principal offices at
hereinafter “CONTRACTOR.”
In consideration of the mutual benefits and covenants contained herein, the parties agree as follows:
1. DURATION OF CONTRACT
The term of this Contract shall begin March 01, 2015, and shall terminate on December 31, 2015.
2. SERVICES PROVIDED BY THE CONTRACTOR
The CONTRACTOR represents that it is qualified and possesses the necessary expertise, knowledge, training,
and skills, and has the necessary licenses and/or certification to perform the services set forth in this Contract.
The CONTRACTOR shall perform the following services:

a. A detailed description of the services to be performed by the CONTRACTOR is set forth in Exhibit A,
which is attached hereto and incorporated herein by reference.
b. The CONTRACTOR agrees to provide its own labor and materials. Unless otherwise provided for in the
Contract, no material, labor, or facilities will be furnished by the COUNTY.
c. The CONTRACTOR shall perform according to standard industry practice of the work specified by this
Contract.
d. The CONTRACTOR shall complete its work in a timely manner and in accordance with the schedule
agreed to by the parties.
e. The CONTRACTOR shall, from time to time, during the progress of the work, confer with the
COUNTY. At the COUNTY’S request, the CONTRACTOR shall prepare and present status reports on
its work.
f.
A statement of the CONTRACTOR’S and the COUNTY’S responsibilities with respect to protected
health information (the “Business Associate Addendum”) is attached hereto and incorporated herein by
reference.
3. SERVICES PROVIDED BY THE COUNTY
In order to assist the CONTRACTOR in fulfilling its duties under this Contract, the COUNTY shall provide the
following:
a. Relevant information as exists to assist the CONTRACTOR with the performance of the
CONTRACTOR’S services.
b. Coordination with other County Departments or other Consultants as necessary for the performance of the
CONTRACTOR’S services.
c. Services documents, or other information identified in Exhibit A.
4. CONTRACT REPRESENTATIVES
Each party to this Contract shall have a contract representative. Each party may change its representative upon
providing written notice to the other party. The parties’ representatives are as follows:
ProtoCall P2015-7574
Page 1 of 11
a. For CONTRACTOR:
Name of Representative:
Title:
Mailing Address:
City, State and Zip Code:
Telephone Number: 800-435-297
Fax Number:
E-mail Address: [email protected]
b. For COUNTY:
Name of Representative:
Title:
Mailing Address:
City, State and Zip Code:
Telephone Number: 360.867.2561
Fax Number: 360.867.2601
E-mail Address:
5. COMPENSATION
a. For the services performed hereunder, the CONTRACTOR shall be paid based upon mutually agreed
rates contained in Exhibit B, which is attached hereto and incorporated herein by reference. The
maximum total amount payable by the COUNTY to the CONTRACTOR under this Contract shall not
exceed $70,000.00.
b. No payment shall be made for any work performed by the CONTRACTOR, except for work identified
and set forth in this Contract or supporting exhibits or attachments incorporated by reference into this
Contract.
c. The CONTRACTOR may, in accordance with Exhibit B, submit invoices to the COUNTY not more
often than once per month during the progress of the work for partial payment of work completed to date.
Invoices shall cover the time CONTRACTOR performed work for the COUNTY during the billing
period. The COUNTY shall pay the CONTRACTOR for services rendered in the month following the
actual delivery of the work and will remit payment within thirty (30) days from the date of receipt of
billing.
d. The CONTRACTOR shall not be paid for services rendered under the CONTRACT unless and until they
have been performed to the satisfaction of the COUNTY.
e. In the event the CONTRACTOR has failed to perform any substantial obligation to be performed by the
CONTRACTOR under this Contract and such failure has not been cured within ten (10) days following
notice from the COUNTY, then the COUNTY may, in its sole discretion, upon written notice to the
CONTRACTOR, withhold any and all monies due and payable to the CONTRACTOR, without penalty
until such failure to perform is cured or otherwise adjudicated. “Substantial” for purposes of this Contract
means faithfully fulfilling the terms of the contract with variances only for technical or minor omissions
or defects.
f.
Unless otherwise provided for in this Contract or any exhibits or attachments hereto, the CONTRACTOR
will not be paid for any billings or invoices presented for payment prior to the execution of the Contract
or after its termination.
ProtoCall P2015-7574
Page 2 of 11
6. SAFEGUARDING PERSONAL INFORMATION
a. Personal information collected, used or acquired in connection with this Contract shall be used solely for
the purposes of this Contract. The CONTRACTOR agrees not to release, divulge, publish, transfer, sell
or otherwise make known personal information without the express written consent of the entity or as
provided by law.
b. The CONTRACTOR agrees to implement physical, electronic and managerial safeguards to prevent
unauthorized access to personal information. The COUNTY reserves the right to monitor, audit, or
investigate the use of personal information collected, used or acquired by the CONTRACTOR through
this Contract. To the extent required by law, the CONTRACTOR shall certify the return or destruction of
all personal information upon expiration of this Contract.
c. Any breach of this Section may result in termination of the Contract and the demand for return of all
records in connection with this Contract. The CONTRACTOR agrees to indemnify and hold harmless
the COUNTY for any damages related to the CONTRACTOR’S unauthorized use or disclosure of
personal information.
d. The provisions of this Section shall be included in any CONTRACTOR’S subcontract(s) relating to the
services provide under this Contract.
e. “Personal Information” shall mean information identifiable to any person, including, but not limited to,
information that relates to a person’s name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, social security numbers, driver
license numbers, other identifying numbers, and any financial identifiers. Personal Information includes
“Protected Health Information” as set forth in 45 CFR § 160.103 as currently drafted and subsequently
amended or revised and other information that may be exempt from disclosure to the public or other
unauthorized persons under either Chapter 42.17 RCW or other federal and state statutes and regulations
including 42 CFR Part 2, Chapter 70.02 RCW, Chapter 70.24 RCW, Chapter 70.96A RCW and Chapter
71.05 RCW.
7. AMENDMENTS AND CHANGES IN WORK
a. In the event of any errors or omissions by the CONTRACTOR in the performance of any work required
under this Contract, the CONTRACTOR shall make any and all necessary corrections without additional
compensation. All work submitted by the CONTRACTOR shall be certified by the CONTRACTOR and
checked for errors and omissions. The CONTRACTOR shall be responsible for the accuracy of the work,
even if the work is accepted by the COUNTY.
b. No amendment, modification or renewal shall be made to this Contract unless set forth in a written
Contract Amendment, signed by both parties and attached to this Contract. Work under a Contract
Amendment shall not proceed until the Contract Amendment is duly executed by the COUNTY.
8. HOLD HARMLESS AND INDEMNIFICATION
a. The CONTRACTOR shall hold harmless, indemnify and defend the COUNTY, its officers, officials,
employees and agents, from and against any and all claims, actions, suits, liability, losses, expenses,
damages, and judgments of any nature whatsoever, including costs and attorneys fees in defense thereof,
for injury, sickness, disability or death to persons or damage to property or business, caused by or arising
out of the CONTRACTOR’S acts, errors or omissions or the acts, errors or omissions of its employees,
agents, subcontractors or anyone for whose acts any of them may be liable, in the performance of this
Contract. Claims shall include, but not be limited to, assertions that information supplied or used by the
CONTRACTOR or subcontractor infringes any patent, copyright, trademark, trade name, or otherwise
results in an unfair trade practice. PROVIDED HOWEVER, that the CONTRACTOR’S obligations
hereunder shall not extend to injury, sickness, death or damage caused by or arising out of the sole
negligence of the COUNTY, its officers, officials, employees or agents. PROVIDED FURTHER, that in
the event of the concurrent negligence of the parties, the CONTRACTOR’S obligations hereunder shall
ProtoCall P2015-7574
Page 3 of 11
apply only to the percentage of fault attributable to the CONTRACTOR, its employees, agents or
subcontractors.
b. In any and all claims against the COUNTY, its officers, officials, employees and agents by any employee
of the CONTRACTOR, subcontractor, anyone directly or indirectly employed by any of them, or anyone
for whose acts any of them may be liable, the indemnification obligation under this Section shall not be
limited in any way by any limitation on the amount or type of damages, compensation, or benefits
payable by or for the CONTRACTOR or subcontractor under Worker’s Compensation acts, disability
benefits acts, or other employee benefits acts, it being clearly agreed and understood by the parties hereto
that the CONTRACTOR expressly waives any immunity the CONTRACTOR might have had under Title
51 RCW. By executing the Contract, the CONTRACTOR acknowledges that the foregoing waiver has
been mutually negotiated by the parties and that the provisions of this Section shall be incorporated, as
relevant, into any contract the CONTRACTOR makes with any subcontractor or agent performing work
hereunder.
c. The CONTRACTOR’S obligations hereunder shall include, but are not limited to, investigating, adjusting
and defending all claims alleging loss from action, error or omission, or breach of any common law,
statutory or other delegated duty by the CONTRACTOR, the CONTRACTOR’S employees, agents or
subcontractors.
9. INSURANCE
a. Professional Legal Liability: The CONTRACTOR, if he is a licensed professional, shall maintain
Professional Legal Liability or Professional Errors and Omissions coverage appropriate to the
CONTRACTOR’S profession and shall be written subject to limits of not less than $1,000,000 per loss.
The coverage shall apply to liability for a professional error, act or omission arising out of the scope of
the CONTRACTOR’S services defined in this Contract. Coverage shall not exclude bodily injury or
property damage. Coverage shall not exclude hazards related to the work rendered as part of the Contract
or within the scope of the CONTRACTOR’S services as defined by this Contract including testing,
monitoring, measuring operations, or laboratory analysis where such services are rendered as part of the
Contract.
b. Workers’ Compensation (Industrial Insurance): The CONTRACTOR shall maintain workers’
compensation insurance as required by Title 51 RCW, and shall provide evidence of coverage to the
Thurston County Risk Management Division.
The CONTRACTOR shall send to Thurston County at the end of each quarter written verification that
premium has been paid to the Washington State Department of Labor and Industries for Industrial
Insurance coverage. Alternatively, the CONTRACTOR shall provide certification of approval by the
Washington State Department of Labor and Industries if self-insured for Workers Compensation.
c. Commercial General Liability: The CONTRACTOR shall maintain Commercial General Liability
coverage for bodily injury, personal injury and property damage, subject to limits of not less than
$1,000,000 per loss. The general aggregate limit shall apply separately to this Contract and be no less than
$2,000,000.
i.
The CONTRACTOR shall provide Commercial General Liability coverage which does not exclude
any activity to be performed in fulfillment of this Contract. Specialized forms specific to the industry
of the CONTRACTOR will be deemed equivalent provided coverage is no more restrictive than
would be provided under a standard Commercial General Liability policy, including contractual
liability coverage.
ii. The CONTRACTOR’S Commercial General Liability insurance shall include the COUNTY, its
officers, officials, employees and agents with respect to performance of services, and shall contain no
special limitations on the scope of protection afforded to the COUNTY as additional insured.
iii. The CONTRACTOR shall furnish the COUNTY with evidence that the additional insured provision
required above has been met. An acceptable form of evidence is the endorsement pages of the policy
showing the COUNTY as an additional insured.
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iv. If the CONTRACTOR’S liability coverage is written as a claims made policy, then the
CONTRACTOR must evidence the purchase of an extended reporting period or “tail” coverage for a
three-year period after project completion, or otherwise maintain the coverage for the three-year
period.
v. If the Contract is over $50,000 then the CONTRACTOR shall also maintain Employers Liability
Coverage with a limit of not less than $1,000,000.
d. Other Insurance Provisions:
i.
The CONTRACTOR’S liability insurance provisions shall be primary with respect to any insurance
or self-insurance programs covering the COUNTY, its elected and appointed officers, officials,
employees and agents.
ii. Any failure to comply with reporting provisions of the policies shall not affect coverage provided to
the COUNTY, its officers, officials, employees or agents.
iii. The CONTRACTOR’S insurance shall apply separately to each insured against whom claim is made
or suit is brought, except with respect to the limits of the insurer’s liability.
iv. The CONTRACTOR shall include all subcontractors as insureds under its policies or shall furnish
separate certificates and endorsements for each subcontractor. All coverage for subcontractors shall
be subject to all of the requirements stated herein.
v. The insurance limits mandated for any insurance coverage required by this Contract are not intended
to be an indication of exposure nor are they limitations on indemnification.
vi. The CONTRACTOR shall maintain all required policies in force from the time services commence
until services are completed. Certificates, policies, and endorsements expiring before completion of
services shall be promptly replaced.
e. Verification of Coverage and Acceptability of Insurers: The CONTRACTOR shall place insurance
with insurers licensed to do business in the State of Oregon and having A.M. Best Company ratings of no
less than A-, with the exception that excess and umbrella coverage used to meet the requirements for
limits of liability or gaps in coverage need not be placed with insurers or re-insurers licensed in the State
of Oregon.
i.
Certificates of Insurance shall show the Certificate Holder as Thurston County and include c/o of the
Office or Department issuing the Contract. The address of the Certificate Holder shall be shown as
the current address of the Office or Department.
ii. Written notice of cancellation or change shall be mailed to the COUNTY at the following address:
iii. The CONTRACTOR shall furnish the COUNTY with properly executed certificated of insurance or a
signed policy endorsement which shall clearly evidence all insurance required in this section prior to
commencement of services. The certificate will, at a minimum, list limits of liability and coverage.
The certificate will provide that the underlying insurance contract will not be canceled or allowed to
expire except on thirty (30) days prior written notice to the COUNTY.
iv. The CONTRACTOR or its broker shall provide a copy of any and all insurance policies specified in
this Contract upon request of the Thurston County Risk Management Division.
10. TERMINATION
a. The COUNTY may terminate this Contract for convenience in whole or in part whenever the COUNTY
determines, in its sole discretion that such termination is in the best interests of the COUNTY. The
COUNTY may terminate this Contract upon giving ten (10) days written notice by Certified Mail to the
CONTRACTOR. In that event, the COUNTY shall pay the CONTRACTOR for all costs incurred by the
CONTRACTOR in performing the Contract up to the date of such notice. Payment shall be made in
accordance with Section 5 of this Contract.
b. The CONTRACTOR may terminate this Contract for convenience in whole or in part whenever the
CONTRACTOR determines, in its sole discretion that such termination is in the best interests of the
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CONTRACTOR. The CONTRACTOR may terminate this Contract upon giving ten (10) days written
notice by Certified Mail to the COUNTY. In that event, the COUNTY shall pay the CONTRACTOR for
all costs incurred by the CONTRACTOR in performing the Contract up to the date of termination of the
contract. Payment shall be made in accordance with Section 5 of this Contract.
c. In the event that funding for this project is withdrawn, reduced or limited in any way after the effective
date of this Contract, the COUNTY may summarily terminate this Contract notwithstanding any other
termination provision of the Contract. Termination under this paragraph shall be effective upon the date
specified in the written notice of termination sent by the COUNTY to the CONTRACTOR. After the
effective date, no charges incurred under this Contract are allowable.
d. If the CONTRACTOR breaches any of its obligations hereunder, and fails to cure the breach within ten
(10) days of written notice to do so by the COUNTY, the COUNTY may terminate this Contract, in
which case the COUNTY shall pay the CONTRACTOR only for the costs of services accepted by the
COUNTY, in accordance with Section 5 of this Contract. Upon such termination, the COUNTY, at its
discretion, may obtain performance of the work elsewhere, and the CONTRACTOR shall bear all costs
and expenses incurred by the COUNTY in completing the work and all damage sustained by the
COUNTY by reason of the CONTRACTOR’S breach. If, subsequent to termination, it is determined for
any reason that (1) the CONTRACTOR was not in default, or (2) the CONTRACTOR’S failure to
perform was not its fault or its subcontractor’s fault or negligence, the termination shall be deemed to be a
termination under subsection a of this section.
11. ASSIGNMENT, DELEGATION, AND SUBCONTRACTING
a. The CONTRACTOR shall perform the terms of the Contract using only its bona fide employees or agents
who have the qualifications to perform under this Contract. The obligations and duties of the
CONTRACTOR under this Contract shall not be assigned, delegated, or subcontracted to any other
person or firm without the prior express written consent of the COUNTY.
b. The CONTRACTOR warrants that it has not paid nor has it agreed to pay any company, person,
partnership, or firm, other than a bona fide employee working exclusively for CONTRACTOR, any fee,
commission, percentage, brokerage fee, gift, or other consideration contingent upon or resulting from the
award or making of this Contract.
12. NON-WAIVER OF RIGHTS
a. The parties agree that the excuse or forgiveness of performance, or waiver of any provision(s) of this
Contract does not constitute a waiver of such provision(s) or future performance, or prejudice the right of
the waiving party to enforce any of the provisions of this Contract at a later time.
13. INDEPENDENT CONTRACTOR
a. The CONTRACTOR’S services shall be furnished by the CONTRACTOR as an Independent
CONTRACTOR and not as an agent, employee or servant of the COUNTY. The CONTRACTOR
specifically has the right to direct and control CONTRACTOR’S own activities in providing the agreed
services in accordance with the specifications set out in this Contract.
b. The CONTRACTOR acknowledges that the entire compensation for this Contract is set forth in Section 5
of this Contract, and the CONTRACTOR is not entitled to any County benefits, including, but not limited
to: vacation pay, holiday pay, sick leave pay, medical, dental, or other insurance benefits, fringe benefits,
or any other rights or privileges afforded to Thurston County employees.
c. The CONTRACTOR shall have and maintain complete responsibility and control over all of its
subcontractors, employees, agents, and representatives. No subcontractor, employee, agent or
representative of the CONTRACTOR shall be or deem to be or act or purport to act as an employee, agent
or representative of the COUNTY.
d. The CONTRACTOR shall assume full responsibility for the payment of all payroll taxes, use, sales,
income or other form of taxes, fees, licenses, excises, or payments required by any city, county, federal or
state legislation which is now or may during the term of this Contract be enacted as to all persons
employed by the CONTRACTOR and as to all duties, activities and requirements by the CONTRACTOR
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in performance of the work on this project and under this Contract and shall assume exclusive liability
therefore, and meet all requirements thereunder pursuant to any rules or regulations.
e. The CONTRACTOR agrees to immediately remove any of its employees or agents from assignment to
perform services under this Contract upon receipt of a written request to do so from the COUNTY’S
contract representative or designee for reasonable cause.
14. COMPLIANCE WITH LAWS
a. The CONTRACTOR shall comply with all applicable federal, state and local laws, rules and regulations
in performing this Contract.
b. The relationship contemplated by this Contract may implicate the Privacy Regulations under the Health
Insurance Portability and Accountability Act of 1996, Pub.L. No. 104-191, 110 Stat. 1936 (1996)
(HIPAA). The CONTRACTOR shall comply with HIPAA and applicable regulations contained in 45
CFR parts 160 and 164. The CONTRACTOR shall enter into a Business Associate Addendum with the
COUNTY if the COUNTY determines that the CONTRACTOR will be acting as Business Associate as
defined under HIPAA.
15. INSPECTION OF BOOKS AND RECORDS
a. The COUNTY may, at reasonable times, inspect the books and records of the CONTRACTOR relating to
the performance of this Contract. The CONTRACTOR shall keep all records required by this Contract for
six (6) years after termination of this Contract for audit purposes.
16. NONDISCRIMINATION
a. The CONTRACTOR, its assignees, delegatees or subcontractors shall not discriminate against any person
in the performance of any of its obligations hereunder on the basis of race, color, creed, ethnicity,
religion, national origin, age, sex, marital status, veteran or military status, sexual orientation or the
presence of any disability. Implementation of this provision shall be consistent with RCW 49.60.400.
17. OWNERSHIP OF MATERIALS/WORK PRODUCED
a. Material produced in the performance of the work under this Contract shall be “works for hire” as defined
by the U.S. Copyright Act of 1976 and shall be owned by the COUNTY. This material includes, but is
not limited to, books, computer programs, plans, specifications, documents, films, pamphlets, reports,
sound reproductions, studies, surveys, tapes, and/or training materials. Ownership includes the right to
copyright, patent, register, and the ability to transfer these rights. The COUNTY agrees that if it uses any
materials prepared by the CONTRACTOR for purposes other than those intended by this Contract, it does
so at its sole risk and it agrees to hold the CONTRACTOR harmless therefore to the extent such use is
agreed to in writing by the CONTRACTOR.
b. An electronic copy of all or a portion of material produced shall be submitted to the COUNTY upon
request or at the end of the job using the word processing program and version specified by the
COUNTY.
18. DISPUTES
a. Differences between the CONTRACTOR and the COUNTY, arising under and by virtue of this Contract,
shall be brought to the attention of the COUNTY at the earliest possible time in order that such matters
may be settled or other appropriate action promptly taken. Any dispute relating to the quality or
acceptability of performance and/or compensation due the CONTRACTOR shall be decided by the
COUNTY’S Contract representative or designee. All rulings, orders, instructions and decisions of the
COUNTY’S contract representative shall be final and conclusive, subject to the CONTRACTOR’S right
to seek judicial relief pursuant to Section 18.
19. CHOICE OF LAW, JURISDICTION AND VENUE
a. This Contract has been and shall be construed as having been made and delivered within the State of
Washington, and it is agreed by each party hereto that this Contract shall be governed by the laws of the
State of Washington, both as to its interpretation and performance.
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b. Any action at law, suit in equity, or judicial proceeding arising out of this Contract shall be instituted and
maintained only in any of the courts of competent jurisdiction in Thurston County, Washington.
20. SEVERABILITY
a. If a court of competent jurisdiction holds any part, term or provision of this Contract to be illegal, or
invalid in whole or in part, the validity of the remaining provisions shall not be affected, and the parties’
rights and obligations shall be construed and enforced as if the Contract did not contain the particular
provision held to be invalid.
b. If any provision of this Contract is in direct conflict with any statutory provision of the State of
Washington, that provision which may conflict shall be deemed inoperative and null and void insofar as it
may conflict, and shall be deemed modified to conform to such statutory provision.
c. Should the COUNTY determine that the severed portions substantially alter this Contract so that the
original intent and purpose of the Contract no longer exists, the COUNTY may, in its sole discretion,
terminate this Contract.
21. ENTIRE CONRACT
a. The parties agree that this Contract is the complete expression of its terms and conditions. Any oral or
written representations or understandings not incorporated in this Contract are specifically excluded.
22. NOTICES
a. Any notices shall be effective if personally served upon the other party or if mailed by registered or
certified mail, return receipt requested, to the addresses set out in Section 4. Notice may also be given by
facsimile with the original to follow by regular mail. Notice shall be deemed to be given three days
following the date of mailing or immediately if personally served. For service by facsimile, service shall
be effective upon receipt during working hours. If a facsimile is sent after working hours, it shall be
effective at the beginning of the next working day.
The parties hereto acknowledge that the waiver of immunity set out in Section 8.b. was mutually negotiated and
specifically agreed to by the parties herein.
Contractor’s Authorized Representative:
For the Board of Thurston County Commissioners:
Signature
Signature
DON SLOMA
Printed Name
Printed Name
DIRECTOR
Title
Title
Date
Date
Approved as to Form by the Prosecuting Attorney’s Office
Reviewed 1/5/05
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Exhibit A
SCOPE OF SERVICES
A. The services to be performed by the CONTRACTOR under this Contract, which are identified in Section 2 of the
Contract (SERVICES PROVIDED BY THE CONTRACTOR), are set forth as follows:
1. The CONTRACTOR shall provide limited Utilization Management services for Thurston Mason RSN. Services
will include;
a)
Medical necessity certification and prior-authorization services for voluntary inpatient admission requests
for eligible Medicaid and non-Medicaid individuals.
b)
Authorization services for involuntary inpatient admission (ITA) notifications for eligible Medicaid and
non-Medicaid individuals.
c)
Documentation of hospital notifications to TMRSN of hospital inpatient admissions that do not require
TMRSN prior-authorization or authorization (primarily when Medicaid is secondary to Medicare).
d)
Timely twenty four hour, seven day a week (24/7) telephone response to pre-authorization requests for
eligible individuals.
i)
Requests for voluntary prior-authorizations and involuntary authorizations must be responded to by a
credentialed Mental Health Professional (MHP), as defined in WAC 388-865-0150, promptly, but at
least within 1 hour.
2. The CONTRACTOR shall follow TMRSN’s written policies, procedures and protocols.
3. The CONTRACTOR shall be in compliance with Utilization Management requirements of the Centers for
Medicare and Medicaid Services (CMS) for Medicaid managed care as found in 42 CFR Part 438.
4. The CONTRACTOR shall;
a)
Maintain a designated toll free (800) line for calls from TMRSN Network Providers, community hospitals
providing voluntary hospitalization services, and outlying facilities (other than TMRSN’s Evaluation and
Treatment Facility) licensed to provide ITA services.
b)
Provide 24 hour per day, 7 day per week response to telephone requests for authorization of involuntary
psychiatric inpatient admissions in accordance with State of Washington’s Inpatient Hospital Psychiatric
Admissions requirements and TMRSN protocols.
c)
Provide a “live answer” to calls within 30 seconds.
d)
Provide certification of medical necessity and prior authorization of voluntary hospital admission requests
for all eligible consumers by a Mental Health Professional as defined in WAC 388-865-0150.
e)
Provide the initial prior-authorization for voluntary inpatient care once medical necessity is established and
certified as soon as possible, but at least within 12 hours of request.
f)
Contact TMRSN’s Medical Director for consultation or peer review when medical necessity for voluntary
inpatient admission or continuing stay is questionable. Only TMRSN’s Medical Director can determine a
denial for TMRSN voluntary inpatient admission or continuing stay requests.
g)
Contact TMRSN or the TMRSN Medical Director for consultation before authorizing extension of
voluntary hospitalization stay when the request seems based more on lack of discharge placement resources
than on continuing medical necessity.
h)
Obtain by phone from requesting facility demographic and clinical information relative to each request for
authorization or extension of stay.
i)
Maintain a TMRSN database system that captures Call Log details and the demographic and clinical
information relative to each request and authorization record. (TMRSN uses this database for utilization
management and as a basis for deliverables required of TMRSN.)
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j)
Enter information in Washington’s ProviderOne (P1) database to establish an authorization number and a
record of each voluntary and involuntary inpatient episode of care. (The P1 database is the official record of
all Washington RSN inpatient authorizations and the basis for the payment process to hospitals and facilities
providing inpatient care.)
k)
Provide the P1-generated authorization number to the facility requesting TMRSN prior-authorization of
voluntary admission or notifying TMRSN of involuntary admission.
l)
Collaborate with crisis services staff, case managers, emergency department staff, Designated Mental Health
Professionals (DMHPs), and other allied service providers regarding crisis intervention, diversions, inpatient
care, and available community resources when requested.
m)
Ensure denial procedures are implemented prior to any denial of certification or prior-authorization.
n)
Transmit specified screening, clinical and certification/authorization information by the next business day in
accordance with TMRSNs’ protocols.
5. The CONTRACTOR shall establish and maintain a record-keeping system to track and monitor the services
performed, and a method of data submission for the following:
a)
Screening and other data collected for medical necessity determinations and prior authorization decisions by
the next business day.
b)
Response times, utilization management services reports, and provision of other specified data to the
respective Partners upon request.
c)
Provision of any additional information regarding Utilization Management services that may be required or
requested by TMRSN, the Department of Social and Health Services (DSHS), and CMS.
6. Inpatient denials and appeals are made only by physicians and will be managed directly by TMRSN and is not part
of this contract. The responsibility of the CONTRACTOR is limited to ensuring that communication between
inpatient facilities and psychiatrists, so each is informed of the pending decision in a timely manner.
B. TMRSN reserves the right to revoke delegation, impose corrective action, or take other remedial actions if the
Contractor’s performance is not considered adequate based on the outcome of the annual review.
1. Adverse findings will be communicated in writing to the Contractor and may result in one of the following:
a)
Corrective action or other remedial actions;
b)
Contract revision and amendment;
c)
Termination of this contract.
2. The authority to perform the delegated function(s) shall be revoked with the contract expiration date.
C. The Contractor shall comply with the Excluded Providers requirements and perform monthly checks on all staff,
board members, volunteers, and interns that provide services funded under this contract.
1. The Contractor shall submit a monthly report to TMRSN showing a check was performed against the OIG
Excluded Provider Database. The Report shall be submitted electronically, by no later than the 10th of
each month to [email protected]
D. The services to be performed by the COUNTY under this Contract, which are identified in Section 3 of the Contract
(SERVICES PROVIDED BY THE COUNTY), are set forth as follows:
1. COUNTY, Thurston Mason RSN, will:
a)
Issue the authorizations for Thurston Mason RSN;
b)
Provide a designated contact person or persons;
c)
Provide written protocols, policies, and any other supporting documentation to support the inpatient
authorization process; and
d)
Perform periodic monitoring and oversight of delegated Utilization Management functions to assure
compliance with the terms of this contract, protocols, and policies.
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Exhibit B
COMPENSATION
A. The CONTRACTOR’S compensation under this Contract, which is described in Section 5 of the Contract
(COMPENSATION), is set forth as follows:
1. The COUNTY shall reimburse the CONTRACTOR for services performed under this Contract no more than
$70,000, payable in the following manner:
a) The CONTRACTOR shall bill in advance each month $3,125.00 which includes up to 25 inpatient prior
authorization requests. Additional inpatient prior authorization requests will be charged $125.00 per
inpatient prior authorization request up to 50 per month.
i. Should the volume of inpatient prior authorization requests exceed 50 per month, the COUNTY
and the CONTRACTOR shall negotiate a revised rate and amend the current contract.
b) The CONTRACTOR may use up to $7,500 of funding for interpreter services or other contract related
expenses not included in the prior authorization process.
2. The CONTRACTOR shall bill the COUNTY for services using the specified invoice form in this Exhibit. The
COUNTY reserves the right to amend, delete or add to the billing form as shown in this Exhibit.
3. Attached to this exhibit is an invoice form in Excel that must be completed for reimbursement. An original
signed invoice must be received prior to dispersal of funds. Attach any data requested prior to submitting
invoices.
a) The Contractor shall complete the budget vs actual report with each monthly invoice.
4. All invoices must have an invoice number provided which must unique and not be repeated.
5. The CONTRACTOR must submit billings to arrive at the COUNTY’S Social Services Department no later than
the tenth (10th) calendar day of the month in order to receive COUNTY reimbursement by the last working day of
the month. Billings received after the tenth calendar day shall be reimbursed no later than the last working day of
the following month. The CONTRACTOR agrees that receipt of any payment from the COUNTY is expressly
conditioned on submission to the COUNTY of any, and all required reports and documentation prior to the
COUNTY deadlines.
6. COUNTY shall not release reimbursement until the CONTRACTOR provides any reports identified in this
Contract.
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2015 Budgeted Revenue
1 PIHP/SMHC
2 Other State
Contracts (WISe)
$5.4m
m
(state & federal Medicaid)
$19.9m
3 Other Federal
Contracts (PATH/MHBG)
$361k
$6.2m
5 Dedicated
Millage
$293k
$306k
4 Treatment Sales Tax
(County)
$748k
6 Intergovernmental
/Other
$727k
7 Reserves
$2.4m
Thurston Mason RSN Provider Network
$29.8m
Budgeted expenditures and
actual subcontract
amounts may fluctuate.
Infrastructure Support
$1.7m -10.25 FTE
(1,2,4,5,7)
Includes: Administration, Management
Info Systems and Utilization
Management/Quality Assurance
amounts may vary
Outpatient Services
$16.4m
Community
Youth
Services
(1,2,4,7)
Capital
Recovery
Center
(1,3,5,7)
St. Peter
Hospital
(1,7)
Sea Mar
(1)
Catholic
Community
Services
(1,2,4,7)
Behavioral Health
Resources (BHR)
(1,6,7)
Kids MH Liaison
Multisystemic
Therapy (MST)
Mentally Ill
Juvenile
Offender
PATH
Homeless
Peer
Support
Intensive
Outpatient
Program
Wraparound
ITA Court
WISe
Kids Crisis
WISe and TAY
[Type text]
Program of
Assertive
Community
Treatment (PACT)
Professional Services
Additional Expenses
$9.1 (1,3,4,6,7)
$894k (1,2,3,4,7)
$1.7m (1,6,7)
Providence
St. Peter
Hospital
SMHC: State Mental Health Contract
DCFS: Department of Children and Family Services
FAMH: Family Alliance for Mental Health
.
ITA: Involuntary Treatment Act
UM: Utilization Management
TAY: Transition Aged Youth
PATH: Projects for Assistance to Transition from
Homelessness
TC E&T
Facility
Operated by
BHR
DSHS - WSH
Jet Computer
Grays Harbor
Timberlands
Crisis Court
Ombuds
UW –
Wraparound
and MST
Fidelity
Donna
Obermeyer
Wraparound
& FAMH
Medical
Director
Crisis Clinic:
Information
and Referral
Community
Integration
Outreach
(CIO)
King County
Southwest
Behavioral Health
North Sound MH
Administration
NAMI
ProtoCall
Inpatient UM
ITA
Agreements
Kitsap MH
Kids ITA
Key:
PIHP: Prepaid Inpatient Health Plan
MHBG: Mental Health Block Grant
NAMI: National Alliance on Mental Illness
E&T: Evaluation & Treatment
EBP: Evidence Based Practice
WISe: Wraparound with Intense Services
HATC: Housing Authority of Thurston County
Community
Housing Support
Inpatient Services
CIO includes the
Mentally Ill
Offender (MIO)
Program provided
in Olympia, Mason,
and Thurston Jails
HATC Homeless
Veteran’s Leasing
Assistance Program
Central
Services
Medicaid
Personal
Care
Out of
Network
Outpatient
NetSmart
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5ee
Kristy Lysell, Social Services Program Specialist I - Public Health and Social Services 867-2560
Mark Freedman , Social Services Division Director - Public Health and Social
Services - 867-2558
Item Title:
Mental Health Block Grant amendment between Department of Social and Health Services
and Thurston County.
Action Needed: Execute Contract
Class of Item: Department
List of Exhibits
1369-76936-02
Thurston Mason RSN.pdf
Adobe Acrobat Document
45.4 KB
1369-76936-02
Thurston Mason RSN B1 Plan for COD Pilot.pdf
Adobe Acrobat Document
34.6 KB
2015 RSN Mental Health
Block Grant Contract
030315.pdf
Adobe Acrobat Document
99.1 KB
Recommended Action:
Move to approve the amendment to the Mental Health Block Grant for the co-occurring pilot program
in a school-based setting between Thurston County and the Department of Social and Health Services
extending services from January 1, 2015 through June 30, 2015, in the amount of $99,777 for a
revised total maximum consideration not to exceed $701,681, and authorize the Director of Public
Health and Social Services to execute the amendment. Further authorize the Director to execute the
Co-Occurring Pilot Program Contract between Thurston County and ESD 113 True North from January
1, 2015 through June 30, 2015, for a total maximum consideration not to exceed $99,777.
Item Description:
This request is for an amendment to the Mental Health Block Grant (MHBG) between the Department of
Social and Health Services (DSHS) and Thurston County. These funds provide support to existing
programs to enhance or sustain services that cannot be funded through Federal Medicaid or State only
funding.
This amendment is adding a new pilot program that is aimed at building infrastructure to address
mental health and substance use disord ers, known as co-occurring disorders for students in a school based setting. This project will focus on building capacity for the assessment, case management, and
treatment to students who have been identified as having co-occurring disorders. The goal in the first
six (6) months of this pilot is to identify and serve 20 students.
In ad dition, the project will have both mental health and chemical dependency professionals working
collaboratively with the University of Washington Evidence Based Practice Institute in training school
staff in Mental Health First Aid. This Evidence-based program teaches individuals how to identify and
respond to mental health and substance use risk factors and warning signs.
The amendment from DSHS specifically states that this pilot program has been granted to ESD 113
True North – Rochester School District. DSHS chose ESD 113 for this pilot because it ’s an opportunity
to serve a rural community, Rochester already provides school b ased services and has substance use
disorder services.
This program is consistent with the objectives and goals of the Thurston Thrives Clinical and Emergency
Care Team, including increasing the use of evidence based practices, maintaining a safety net for non Medicaid consumers, and increasing access to behavioral health treatment in the community.
The duration of the original contract was from July 01, 2013 through June 30, 2015. this amendment is
from January 01, 2015 through June 30, 2015. This amendment increases the contract by $99,777, for
a revised maximum consideration not to exceed $701,681.
TMRSN is also requesting that the Board of County Commissioners delegate authority to the Director of
Public Health and Social Services to execute the contract between Thurston County and ESD 113 True
North for the Co-Occurring Pilot Program Contract. The d uration of the contract will be from January 01,
2015 through June 30, 2015, for a maximum consideration not to exceed $99,777.
The reason for the delay in executing the MHBG amendment and the contract between ESD 113 True
North and the County is due to the issuing of the amendment from the state. The amendment was just
received on February 12, 2015.
Date Submitted: 2/19/2015
CONTRACT AMENDMENT
DSHS CONTRACT NUMBER:
1369-76936
Amendment No. 02
This Contract Amendment is between the State of Washington Department of
Social and Health Services (DSHS) and the Contractor identified below.
Program Contract Number
Contractor Contract Number
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Thurston County
Thurston-Mason RSN
CONTRACTOR ADDRESS
WASHINGTON UNIFORM BUSINESS
IDENTIFIER (UBI)
DSHS INDEX NUMBER
342-007-752
1244
Public Health Social Services
412 Lilly Road NE
Olympia, WA 98506CONTRACTOR CONTACT
CONTRACTOR TELEPHONE
CONTRACTOR FAX
Mark Freedman
(360) 867-2558
(360) 867-2601
CONTRACTOR E-MAIL ADDRESS
[email protected]
DSHS ADMINISTRATION
DSHS DIVISION
DSHS CONTRACT CODE
Behavioral Health and Service Integration
Division of Behavioral Health
and Recovery
1687LS-69
DSHS CONTACT NAME AND TITLE
DSHS CONTACT ADDRESS
Thomas Gray
Mental Health Program Administrator
4500 10th Avenue SE
Lacey, WA 98503
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
(360) 725-1314
[email protected]
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT?
CFDA NUMBERS
No
93.958
AMENDMENT START DATE
CONTRACT END DATE
01/01/2015
06/30/2015
PRIOR MAXIMUM CONTRACT AMOUNT
AMOUNT OF INCREASE OR DECREASE
TOTAL MAXIMUM CONTRACT AMOUNT
$601,904.00
$99,777.00
$701,681.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT
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): Exhbit B-1
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
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 1
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1.
Amend the Total Maximum Agreement Amount, by an increase of $99,777, for a revised Total
Maximum Contract Amount of $701,681.
2.
Amend the Agreement by adding a new Exhibit B-1, 2015 MHBG Plan (attached).
3.
Amend the Agreement’s Special Terms and Conditions, Section 3. Statement of Work, subsection b, to
read as follows:
3. Statement of Work.
b. The Contractor shall provide services in alignment with the Contractor’s submitted MHBG Plan
(Exhibit A; not attached, remains in original contract), and 2015 MHBG Plan (Exhibit B not
attached, remain in amendment 1) and Exhibit B-1, attached.
4.
Amend the Agreement’s Special Terms and Conditions, Section 7. Consideration, subsection a, to read
as follows:
7. Consideration.
a.
Total Maximum Consideration payable to the Contractor for satisfactory performance of the
work under this Agreement is $701,681 and is for two (2) distinct and separate serviceprovided time periods.
i.
Total allowable consideration payable to Contractor for satisfactory performance of the
work under this Agreement for SFY 2014 is a maximum of $300,952, including any and
all expenses and shall be based on maximum cost amounts as depicted within Exhibit A
Contractor’s Submitted Project Plan for SFY 2014.
ii. Total allowable consideration payable to Contractor for satisfactory performance of the
work under this Agreement for SFY 2015 is a maximum of $300,952, including any and
all expenses and shall be based on maximum cost amounts as depicted within Exhibit B
Contractor’s Submitted Project Plan for SFY 2015.
iii. Total allowable consideration payable to Contractor for satisfactory performance of the
work under this Agreement for SFY 2015 is a maximum of $99,777, including any and all
expenses and shall be based on maximum cost amounts as depicted within Exhibit B-1
Contractor’s Submitted Project Plan for SFY 2015.
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 2
March 18, 2014 Distributed Version
Mental Health Block Grant Special Project Plan
Regional Support Network (RSN) Project Plan
SFY 2015 (1/1/15 – 6/30/15)
Introduction
Washington State’s Mental Health strategies to further the goals of the 2014 – 2015 Combined Federal Block Grant will rely on service delivery through RSNs.
Contracts with RSNs continue to support flexibility to meet the needs of populations based on local planning efforts and goals as identified in this Project Plan. Our
collective overarching “Goal” is to ensure effective services are provided across populations with measurable outcomes and performance indicators.
Instructions:
Please complete this document and submit electronically to Tom Gray and Amy Martin ([email protected] and [email protected]) . DBHR will contact
the RSN Contact Person identified below if there are any questions.
Note:
This Plan is for the 2nd year of Your Current Contract (SFY 2015). All Mental Health Block Grant funds contractually allocated for services provided in SFY
2014, but not expended for services actually provided by June 30, 2014, may not be used or carried forward into SFY 2015.
RSN:
Current Date:
RSN Contact Person:
Phone Number:
E-mail:
Total SFY 2015 Contract Amount: $99,777
Section 1
Local Board Involvement
Instructions:
Please attach a copy of a letter of support from the local RSN Advisory Board Chair for the RSN’s Project Plan. In addition, provide a short narrative that describes
how consumers and their families participated in planning the proposed RSN services and programs.
Consumer and Family Participation Narrative (no more than 2 paragraphs):
RSN MHBG Project Plan: SFY 2015
Page 2 of 6
Section 2
Project Summary List
Instructions:
• Do not modify or delete parts of this Template.
• New Federal REQUIREMENT for SFY 2015 – A minimum of 5% of allocated funding must be expended on Evidence Based Practices
noted within the Template below as (Qualifies as EBP); EBPs for SFY 2015 do not have to be provided at the level of Fidelity (Fidelity
Reviews are not required).
•
Insert Contractual Amount Allocated by Category under column “Proposed Category Allocation Amount.” The Total at bottom of column must equal
total contract amount for SFY 2015. Do not include RSN’s specific amounts being allocated by Sub Category.
• The Project Names can be very short; please include short descriptions of anticipated range of services.
• Insert the projected number of Adults and Children anticipated to be served during SFY 2015.
• The column “Proposed # Other Non-Direct Services” is to allow RSNs to list anticipated projects; and, to count numbers served indirectly. This is to
help document projects that do not easily “fit” into projects serving adults with SMI and/or Children with SED.
• In the space labeled “Narrative” provided on the left at the bottom of each Category, provide a short, clear summary how services noted within the
Category support adults, older adults (65 and over), youth (10 -17) , and transitional age youth (18-21); and, are in alignment with the State’s Behavioral
Health Priority Outcomes noted as follows:
o Improve health status and wellness.
o Increase meaningful activities, including employment and education.
o Reduce involvement with criminal justice systems, including jails and prisons.
o Reduce avoidable costs in hospitals, emergency rooms, crisis services, and jails/prisons.
o Increase stable housing in the community.
o Improve satisfaction with quality of life, including measures of recovery and resilience.
o Decrease population-level disparities.
o Enhance safety and access to treatment for forensic patients.
Note: Only complete Categories/Sub Categories that align with local plans. There is no requirement to provide services in each Category.
Category/Sub
Category
Insert Project Names & Description (2-4
short sentences, per project); may include
more than 1 project per Sub Category.
Proposed
# Adults
with SMI
Served
Proposed
# Children
with SED
Served
Proposed
# "Other"
Non-Direct
Services
(Add short
narrative in
"Notes”)
Proposed
Category
Allocation
Amount
Notes
Other Services
$99,777
Special Projects
ESD 113 True North Student Assistance
Co-Occurring Disorder (COD) School
Based Project:
ESD 113 True North Student Assistance will
Master’s Level Mental Health Professional
(MHP) to provide Mental Health Services.
20
•
Required staff education, competencies
RSN MHBG Project Plan: SFY 2015
Page 3 of 6
work collaboratively with existing Chemical
Dependency Professional (CDP) or CDP
Trainee for Co-Occurring Disorder services;
including:
Screening and Assessment
CANS (Child and Adolescent Needs and
Strengths) is an assessment strategy that is
designed to be used for decision support and
outcomes management. Its primary purpose is
to allow a system to remain focused on the
shared vision of serving children and families,
by representing children at all levels of the
system.
CANS will be the tool used to assist in
screening/identification, on-going progress
monitoring every 90 days and upon discharge
or transition to a lower level of care.
The CANS will be completed in collaboration
with the referent and ancillary resources as
needed.
When available to the COD School Based
Project, the CANS assessment will be entered
into the Behavioral Health Assessment System
(BHAS) as the CANS information database.
Until the BHAS system is the system of
record, paper forms will be completed and
retained to be entered in at a later date.
Individual administering the CANS will be
certified via the on-line training platform
provided by the PRAED Foundation. User
will remain certified per the protocol set out
by the PRAED system.
Utilize the CANS tool to refer to Wraparound
with Intensive Services (WISe), when
appropriate. WISe is designed to provide
comprehensive behavioral health services and
supports to Medicaid-eligible individuals, up
to 21 years of age, with complex behavioral
needs and to their families.
An assessment will be provided that meets
and qualifications:
•
Minimum of master’s degree in social
work or closely-related field to provide
direct services, in the area of mental
health and substance use disorder
(SUD)
•
MHP shall meet the requirements in
WAC 388-877A-0110
•
Successful background checks
•
Understanding of the SUD and MH
delivery systems and community and
alternative support systems
•
Knowledge of child/youth SUD and
MH
•
Collaboration, coordination and
negotiation skills that are required to
work with children/families and
families/systems
•
Motivational engagement skills
•
Understanding of child/youth
development
•
Knowledge of current community
resources and how to access them on
behalf of clients
•
CANS certification (and knowledge) to
utilize screening tool
•
Understanding of suicide
awareness/prevention
•
Knowledge of WISe
Mental Health Professional requires staff
RSN MHBG Project Plan: SFY 2015
Page 4 of 6
standards outlined in WAC 388-877A-0130.
Case-related Mental Health Services
The MHP shall provide individual treatment
consistent with WAC 388-877A-0135. The
treatment services are conducted with the
individual and any natural supports as
identified by the individual.
Brief Intervention Treatment services are
solution-focused and outcome-oriented
cognitive and behavioral interventions,
intended to resolve situation disturbances.
Services shall be consistent with WAC 388877A-0140
Group treatment services are provided to an
individual in a group setting to assist the
individual in attaining the goals described in
the individual service plan and must meet
standards in WAC 388-877A-0150
Case Management services are services that
meet the ongoing assessment, facilitation, care
coordination and advocacy for options and
services to meet an individual’s needs through
communication and available resources, to
promote quality and effective outcomes.
Services shall be consistent with language
outlined in WAC 388-877A-0170
Other Activities
•
•
•
Review of current EBP’s in cooccurring disorders treatment.
Review and select promotion and
prevention curriculums with district
partners.
Train staff member in
Comprehensive School Based service
delivery.
supervision by a Licensed Mental Health
Counselor (LMHC) and CDP
RSN MHBG Project Plan: SFY 2015
Page 5 of 6
•
•
•
•
•
•
•
•
Establish a calendar of behavioral
health promotion events to occur
within the school.
Train staff in assessment tool and
selected elements of the EBP.
Outreach to community behavioral
health partners to establish systems
for coordination of care.
Create Student Support Team at the
school building consisting of key
administration and staff.
Create a referral process to identify
and prioritize students in need of
services.
Provide an overview of the project at
all staff meeting at school building.
Establish a process to prioritize
students at risk of dropping out of
school.
County and Project Staff shall
participate in quarterly meetings with
DBHR staff.
Progress Reports
With the billing, submit a progress report with
the following information – include the date
range of the collected data:
Number of:
• Mental Health assessments
• CANS screens and full
• Individual sessions
• Group sessions
• Brief intervention and
treatment sessions
• Medicaid and non-Medicaid
youth
• Title and description of any
other activities related to the
project (trainings, all staff
meeting presentations, etc.).
Evaluation
Submit to Contract Manager the evaluation
RSN MHBG Project Plan: SFY 2015
Page 6 of 6
Narrative
design for approval not later than May 31,
2015.
This project is aimed at building infrastructure to address co-occurring disorders for students in a school-based setting. This project will focus on building
capacity for the assessment, case management and treatment to students with co-occurring disorders. This project will enlist a Mental Health Professional,
under the direct clinical supervision of a dually licensed Chemical Dependency and Mental Health Professional, to serve a minimum of 20 youth with cooccurring needs. The direct services will be best practices identified by the University of Washington Evidence Based Practice Institute. An integral
component of this project is training school staff in Mental Health First Aid. This Evidence-based program teaches individuals how to identify and respond to
mental health and substance use risk factors and warning signs.
Section 3
Age, Cultural and Linguistic Competence
Instructions:
Please provide a short narrative summarizing how cultural competence, overall, is incorporated within proposed projects. Identify what anticipated efforts will be taken
to measure progress.
Please Note: It is not necessary for each project to focus specifically on cultural competence. However, there should be a clear statement within each of the RSN’s
implemented subcontracts that one of the goals is to provide services in alignment with multiple factors, such as language, culture, emerging populations and age.
Cultural Competence Definition: “Cultural Competence” means a set of congruent behaviors, attitudes and policies that come together in a system, or
agency, and enables that system or agency to work effectively in cross-cultural situations. A culturally competent system of care acknowledges and
incorporates at all levels the importance of language and culture, assessment of cross-cultural relations, knowledge and acceptance of dynamics of
cultural differences, and expansion of cultural knowledge and adaptation of services, to meet culturally unique needs.
Cultural Competence Narrative (no more than 4 paragraphs):
2015 Budgeted Revenue
1 PIHP/SMHC
2 Other State
Contracts (WISe)
$5.4m
(state & federal Medicaid)
$19.9m
3 Other Federal
Contracts (PATH/MHBG)
$361k
Infrastructure Support
$1.7m -10.25 FTE
(1,2,4,5,7)
Outpatient Services
$16.4m
Multisystemic
Therapy (MST)
Mentally Ill
Juvenile
Offender
Capital
Recovery
Center
(1,3,5,7)
PATH
Homeless
Peer
Support
St. Peter
Hospital
(1,7)
Intensive
Outpatient
Program
ITA Court
Sea Mar
(1)
Catholic
Community
Services
(1,2,4,7)
ESD
113
True
North
(3)
Kids Crisis
WISe
$2.4m
Inpatient Services
Professional Services
Additional Expenses
$9.1 (1,3,4,6,7)
$894k (1,2,3,4,7)
$1.7m (1,6,7)
Providence
St. Peter
Hospital
Kids MH Liaison
ITA
Agreements
Community
Housing Support
Program of
Assertive
Community
Treatment (PACT)
Grays Harbor
Timberlands
SMHC: State Mental Health Contract
DCFS: Department of Children and Family Services
FAMH: Family Alliance for Mental Health
.
ITA: Involuntary Treatment Act
UM: Utilization Management
TAY: Transition Aged Youth
PATH: Projects for Assistance to Transition from
Homelessness
TC E&T
Facility
Operated by
BHR
DSHS - WSH
Jet Computer
Southwest
Behavioral Health
North Sound MH
Administration
NAMI
Crisis Court
ProtoCall
Inpatient UM
Community
Integration
Outreach
(CIO)
King County
Kitsap MH
Kids ITA
Key:
[Type text]
7 Reserves
Includes: Administration, Management
Info Systems and Utilization
Management/Quality Assurance
Behavioral Health
Resources (BHR)
(1,6,7)
Wraparound
WISe and TAY
PIHP: Prepaid Inpatient Health Plan
MHBG: Mental Health Block Grant
NAMI: National Alliance on Mental Illness
E&T: Evaluation & Treatment
EBP: Evidence Based Practice
WISe: Wraparound with Intense Services
HATC: Housing Authority of Thurston County
6 Intergovernmental
/Other
$727k
Thurston Mason RSN Provider Network
$29.8m
Budgeted expenditures and
actual subcontract
amounts may fluctuate.
Community
Youth
Services
(1,2,4,7)
5 Dedicated
Millage
$293k
4 Treatment Sales Tax
(County)
$748k
CIO includes the
Mentally Ill
Offender (MIO)
Program provided
in Olympia, Mason,
and Thurston Jails
UW –
Wraparound
and MST
Fidelity
Medical
Director
Ombuds
Donna
Obermeyer
Wraparound
& FAMH
Crisis Clinic:
Information
and Referral
HATC Homeless
Veteran’s Leasing
Assistance Program
Central
Services
Medicaid
Personal
Care
Out of
Network
Outpatient
NetSmart
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/18/2015
Agenda Item #: 5f
Kristy Lysell, Social Services Program Specialist I - Public Health and Social Services 867-2560
Mark Freedman , Social Services Division Director - Public Health and Social
Services - 867-2558
Item Title:
Evaluation and Treatment Program Contract between Behavioral Health Resources and
Thurston County.
Action Needed: Execute Contract
Class of Item: Department
List of Exhibits
2015-62ET.pdf
Adobe Acrobat Document
429 KB
2015 RSN BHR Eval and
treatment contract
030315.pdf
Adobe Acrobat Document
579 KB
Recommended Action:
Move to approve the Evaluation & Treatment Program Contract for voluntary/involuntary inpatient
services, crisis stabilization, community based crisis services which includes supportive housing
paired with “rapid re-housing” between Thurston County and Behavioral Health Resources from
January 1, 2015 through December 31, 2015, for a maximum consideration not to exceed
$7,995,738, and authorize the Director of Public Health and Social Services to execute the contract
as well as future amendments that do not change this approved dollar amount or duration by more
than 50%.
Item Description:
This request is for the renewal of the Evaluation and Treatment Program Contract between Thurston
County and Behavioral Health Resources (BHR). Thurston Mason RSN contracts with Behavioral Health
Resources to operate the Thurston County Evaluation and Treatment Facility to provide crisis and acute
mental health services for both Thurston and Mason Counties. BHR is currently the only local agency
licensed to provide Freestanding Evaluation and Treatment services. Services provided by the
Evaluation and Treatment facility include; crisis stab ilization, involuntary treatment evaluation and
commitment services, ITA mental health court, 15 bed psychiatric inpatient services, and community
outreach. These services provide for clients experiencing acute symptoms of mental illness. Services
are available 24 hours a day, 7 days a week in a safe, supervised environment.
This contract also includes the Community Integration Outreach (CIO) Program, which provides
intensive case management services for the homeless or near homeless in the jails, shelters, and other
community settings. The RSN partners with Housing & Community Renewal to utilize rapid re-housing
funding as part of this program. Another responsibility of the CIO Program is to p rovide the Mentally Ill
Offender (MIO) services in Thurston County Jail. TMRSN released a Request for Proposal for the MIO
services in December 2015 and Behavioral Health Resources was determined as the successful bidder
by a panel of community stakeholders which included two (2) Correctional Officers. MIO service
requirements are incorporated into the CIO statement of work attachment.
This contract is consistent with the objectives and goals of the Thurston Thrives Clinical and Emergency
Care Team, including increasing patient and day hospital treatment for behavioral health, increasing
capacity of and access to behavioral health service in the community including the criminal justice
system and homeless, and maintaining a safety net for non-Medicaid consumers.
This program contract falls under the Thurston Mason RSN Contract on General Terms & Conditions
umbrella dated January 1, 2012. The duration of this contract is January 01, 2015 through December
31, 2015. Total funding for this contract is $7,995,738, fully supported by Thurston Mason RSN’s
Medicaid and State Funded Contracts and Mental Health Block Grant.
Thurston Mason RSN is requesting the Board of County Commissioners delegate authority to the
Director of Public Health and Social Services to execute this contract as well as any future amendments
that do not change this approved dollar amount or duration of this contract by more than 50%.
Date Submitted: 2/19/2015
EVALUATION & TREATMENT
PROGRAM CONTRACT
Program Contract Number: 2015-62ET
This Program Contract is between the Thurston Mason Regional Support Network (TMRSN) and the Contractor identified below. This Program Contract,
exhibits, and attachment(s) are valid only when the Contractor and the TMRSN have executed the Contract on General Terms and Conditions. The
Contract on General Terms and Conditions is incorporated herein by reference as if fully set forth herein. The Contract on General Terms and Conditions,
Program Contract, and all exhibits, attachment(s) and other documents attached or incorporated by reference contain all of the terms and conditions agreed
to by the parties.
Kristy Lysell, Provider Network Coordinator
Thurston Mason RSN Contract Manager:
Address: 412 Lilly Road NE, Olympia WA 98506
Contact Phone:
Information: 360.867.2560
Email:
[email protected]
Contractor: Behavioral Health Resources
Contact: John Masterson, CEO
Address: 3857 Martin Way East Olympia WA 98506
Contact Phone:
Information: 360.704.7170
Email:
[email protected]
Is this contractor a Subrecipient for purposes of this contract?
TOTAL FUNDING DURING CONTRACT PERIOD:
Fund Source:
Amount:
Federal
$45,738
Contract Start Date:
Medicaid
$4,645,029
State
N
CFDA #:
93.958
$7,995,738
TST
$2,561,643
January 01, 2015
Y
$83,640
Inter-Gov
$16,140
Contract End Date:
Proviso
$207,552
Reserves
$435,996
December 31, 2015
A: Statement of Work
1: Community Integration Outreach
Attachments:
B: Compensation
2: Maintenance Responsibilities
C: Performance Measures
Invoices – E&T and CIO [Excel]
D: Data Security
Specialized Service Activity Log [Excel]
E: Modality Definitions
Quarterly Staffing Report [Excel]
F: Access to Care Standards
This Program Contract, including all Exhibits and other documents incorporated by reference, contains all of the terms and
conditions agreed upon by the parties. No other understandings and representations, oral or otherwise, regarding the subject matter of
this Contract shall be deemed to exist or bind the parties. The parties signing below warrant that they have read and understand this
Contract, and have authority to enter into this Program Contract. By their signatures below, the parties hereto agree to this Program
Contract and execute it in duplicate originals.
Contractor Signature:
Printed Name and Tile:
Date:
Exhibits:
Thurston County Signature:
Printed Name and Title:
Date:
Don Sloma, Director
Evaluation & Treatment Contract 2015-62ET
Page 1 of 47
EXHIBIT A
Evaluation and Treatment Facility
STATEMENT OF WORK
1.
PURPOSE OF CONTRACT ........................................................................................................................3
2.
DEFINITIONS ...............................................................................................................................................3
3.
PROGRAM OBJECTIVES ..........................................................................................................................7
4.
FACILITY REQUIREMENTS ....................................................................................................................8
5.
PROGRAM OPERATIONS .........................................................................................................................8
6.
SERVICES....................................................................................................................................................10
7.
ACCESS, ELIGIBILITY AND CLINICAL SERVICES ........................................................................12
8.
CRISIS OUTREACH SERVICES .............................................................................................................14
9.
CRISIS STABILIZATION AND TANSITION UNIT (CSTU) ...............................................................15
10. INPATIENT SERVICES ............................................................................................................................16
11. ADDITIONAL ACCESS CONDITIONS ..................................................................................................20
12. ITA FUNCTIONS AND SUPERIOR COURT .........................................................................................21
13. CLINICAL PRACTICE ..............................................................................................................................22
14. INCIDENT REPORTING ..........................................................................................................................23
15. INFORMATION REQUIREMENTS ........................................................................................................25
16. QUALITY MANAGEMENT ......................................................................................................................27
17. CLIENT RIGHTS AND PROTECTIONS ................................................................................................29
18. MANAGEMENT INFORMATION SYSTEM .........................................................................................35
19. PERSONNEL AND STAFF TRAINING ..................................................................................................40
20. GRIEVANCE SYSTEM ..............................................................................................................................41
21. COMMUNITY COORDINATION ............................................................................................................42
22. TRIBAL RELATIONSHIPS ......................................................................................................................44
23. REMEDIAL ACTIONS ..............................................................................................................................45
24. CONTRACT DELIVERABLES ................................................................................................................46
Evaluation & Treatment Contract 2015-62ET
Page 2 of 47
1. PURPOSE OF CONTRACT
1.1. Operate the Evaluation and Treatment Facility to provide Crisis Stabilization, Inpatient, and ITA
services to individuals experiencing acute symptoms of a mental illness or disorder within the
Thurston Mason RSN service area. Services provided shall be age, linguistic and culturally
competent, and be medically necessary and clinically appropriate and relevant pursuant to:
1.1.1. Federal 1915 (b) Mental Health Waiver and the Medicaid State plan or any successors;
1.1.2. Thurston Mason RSN’s Contract on General Terms and Conditions;
1.1.3. Thurston Mason RSN’s policies, procedures, protocols, guidelines, and instructions
provided or referenced herein, and any successors, amended or replaced;
1.1.4. CFR 42 Part(s) 438, 206, 207 or any successors;
1.1.5. RCW 38.52, 70.02, 71.05, 71.24, and 71.34, or any successors;
1.1.6. WAC Chapter 388-865, 388-877, and 388-877A, or any successors; and
1.1.7. Other applicable state and federal laws and regulation, administrative policies, or any
successors.
2. DEFINITIONS
2.1. Access to Care Standards are a set of standards published by DBHR that defines the eligibility
requirements for initial authorization of outpatient services for Medicaid and Non-Medicaid adults,
older adults, and children. The guidelines define the minimum eligibility criteria that can be applied,
and are not intended to be applied as continuing stay criteria. The Standards provide guidelines on
the goals and periods of authorization, a list of covered diagnoses, identifying functional impairments
within life domains, supports and environment, and a minimum modality set for treatment services
identified at two levels - brief intervention and community support. The most current Access to Care
Standards is dated January 01, 2006.
2.2. Action in the context of PIHP services means
2.2.1. the denial or limited authorization of a requested service, including the type or level of
service.
2.2.2. the reduction, suspension, or termination of a previously authorized service.
2.2.3. the denial, in whole or in part, of payment for a service.
2.2.4. the failure to provide services in a timely manner, as defined by the state.
2.2.5. the failure of a PIHP to act within the timeframes provided in section 42 CFR 408(b).
2.3. Administrative Cost means costs for the administration of this Contract for the general operation of
the public mental health system. These activities cannot be identified with a specific direct services or
direct services support function as defined in the BARS supplemental instructions and must be
limited to no more than 10%.
2.4. Advance Directive A written instruction, such as a living shall or durable power of attorney for
health care, recognized under State law (whether statutory or as recognized by the courts of the
State), relating to the provision of health care (including mental health care) when the individual is
incapacitated.
2.5. Annual Revenue means all revenue received by the Contractor pursuant to the Contract for July of
any year through June of the next year.
2.6. Appeal means a request for review of an action as “action” is defined above.
2.7. Available Resources means funds appropriated for the purpose of providing community MH
programs: federal funds, except those provided according to Title XIX of the Social Security Act, and
state funds appropriated under RCW 71.24 or RCW 71.05 by the legislature during any biennium for
the purpose of providing residential services, resource management services, community support
Evaluation & Treatment Contract 2015-62ET
Page 3 of 47
2.8.
2.9.
2.10.
2.11.
2.12.
2.13.
2.14.
2.15.
2.16.
2.17.
2.18.
2.19.
2.20.
2.21.
2.22.
2.23.
services, and other MH services. This does not include funds appropriated for the purpose of
operating and administering the state psychiatric hospitals.
Clinical Management Team A team of clinical professionals that includes the Evaluation and
Treatment Facility Medical Director, Program Manager, and a Psychiatric Registered Nurse.
Community Mental Health Agency (“CMHA”) means a Community Mental Health Agency that is
licensed by the State of Washington to provide mental health services and Subcontracted to provide
services covered under this Contract.
Consumer means a person and/or Enrollee who has applied for, is eligible for, or who has received
mental health services.
Cultural Competence means a set of congruent behaviors, attitudes, and policies that come together
in a system or agency and enable that system or agency to work effectively in cross-cultural
situations. A culturally competent system of care acknowledges and incorporates at all levels the
importance of language and culture, assessment of cross-cultural relations, knowledge and acceptance
of dynamics of cultural differences, expansion of cultural knowledge and adaptation of services to
meet culturally unique needs.
Day for purposes of this Contract means calendar days unless otherwise indicated in the Contract.
Deliverable means items that are required for submission to TMRSN to satisfy the work
requirements of this Contract and that are due by a particular date or on a regularly occurring
schedule.
Denial means the decision by a Pre-paid Inpatient Health Plan (PIHP), or their formal designee, not
to authorize a covered Medicaid mental health services that have been requested by a provider on
behalf of an eligible Medicaid Client.
2.14.1. It is also a denial if an intake is not provided upon request by a Medicaid Enrollee.
Designated Mental Health Professional (DMHP) means a mental health professional designated by
the appropriate Regional Support Network to perform the duties of the Involuntary Treatment Acts.
RCW 71.05.020(11) and RCW 71.34.020(4)
Elective Inpatient Admission A clinically appropriate voluntary preplanned admission occurring
prior to the need for an emergent admission.
Emergent Care means services provided for a person, that, if not provided, would likely result in the
need for crisis intervention or hospital evaluation due to concerns of potential danger to self, others,
or grave disability according to RCW 71.05.
Emergent Inpatient Admission A voluntary admission to inpatient psychiatric care when an
individual meets the criteria of the Involuntary Treatment Act (RCW 71.05 or RCW 71.34) agree to
care, or who have eligible diagnosis, and whose health and bodily functions are in serious and
imminent jeopardy due to medication or chemical reactions.
Emerging Best Practice or Promising Practice means a practice that presents, based on preliminary
information, potential for becoming a research-based or consensus-based practice.
Enrollee means a Medicaid recipient who is enrolled in an RSN.
Evidence Based Practice means a program or practice that has had multiple site random controlled
trials across heterogeneous populations demonstrating that the program or practice is effective for the
population.
Fair Hearing means a hearing before the Washington State Office of Administrative Hearings
(OAH).
Family means:
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2.24.
2.25.
2.26.
2.27.
2.28.
2.29.
2.30.
2.23.1. For adult Clients, family means those the Client defines as family or those
appointed/assigned (e.g., guardians, siblings, caregivers, and significant others) to the Client.
2.23.2. For children, family means a child's biological parents, adoptive parents, foster parents,
guardian, legal custodian authorized pursuant to Title 26 RCW, a relative with whom a child
has been placed by the department of social and health services, or a tribe.
Grievance means an expression of dissatisfaction about any matter other than an action. Possible
subjects for Grievances include, but are not limited to, the quality of care or services provided, and
aspects of interpersonal relationships such as rudeness of a provider or employee, or failure to respect
the Client’s rights (42 CFR 438.400(b)).
“High Risk”
2.25.1. Persons who are not Medicaid eligible but are determined to meet the criteria for "state
priority populations" as defined in RCW 71.05, 71.24. 71.34 or any successors,
2.25.2. Who meet the Federal Poverty Level, with special attention to children, older adults and
minorities shall be served based on available state only funding.
2.25.3. The level of need, risk for inpatient and jail (due to mental illness) and severity of illness
shall determine the order of precedence for utilizing available resources for serving those
without Medicaid.
2.25.4. Those with the highest priority shall be at imminent risk of psychiatric hospitalization or jail
due to their disorder or just released
2.25.5. Those individuals who are on a “spenddown”, who can achieve Medicaid Client status
within the first month of their spend down period, shall be served based on available
resources through State Only funding to assist the individual prior to achieving their
spenddown level.
Indirect Costs Costs incurred for activities other than those that qualify as direct costs. Indirect costs
include, but are not limited to: activities, staff, tools, depreciation and equipment, transportation,
education or training related to financial, facilities, or data management, quality management,
resource management (except for direct costs incurred pursuant to RCW 71.24.025), and RSN/PIHP
or subcontractor administration. Indirect costs do not include capital items or unexpended reserves.
Involuntary Admission An admission that occurs for initial detention and/or involuntary
commitment in accordance with RCW 71.34 or RCW 71.05.
Involuntary Treatment Act was intended by the legislature to prevent inappropriate, indefinite
commitment of mentally ill persons and to eliminate legal disabilities that arise from such
commitment, provide prompt evaluation and timely treatment, to safeguard individual rights, protect
public safety, and encourages stewardship when delivering services.
Medicaid Funds means funds provided by CMS Authority under Title XIX of the Social Security
Act.
Medical Necessity or Medically Necessary means a requested service which is reasonably
calculated to prevent, diagnose, correct, cure, alleviate or prevent the worsening of conditions in the
recipient that endanger life, or cause suffering or pain, or result in illness or infirmity, or threaten to
cause or aggravate a handicap, or cause physical deformity or malfunction, and there is no other
equally effective, more conservative or substantially less costly course of treatment available or
suitable for the person requesting service. “Course of treatment” may include mere observation or,
where appropriate no treatment at all.
Additionally, the individual must be determined to have a mental illness covered by Washington State
for public mental health services. The individual’s impairment(s) and corresponding need(s) must be
the result of a mental illness. The intervention is deemed to be reasonably necessary to improve,
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2.31.
2.32.
2.33.
2.34.
2.35.
2.36.
2.37.
2.38.
2.39.
stabilize or prevent deterioration of functioning resulting from the presence of a mental illness. The
individual is expected to benefit from the intervention. Any other formal or informal system or
support cannot address the individual’s unmet need.
Mental Health Care Provider (“MHCP”) means the individual with primary responsibility for
implementing an individualized plan for mental health rehabilitation services. Minimum
qualifications are B.A. level or related field or A.A. level with two years experience in the mental
health related fields.
Mental Health Professional means:
2.32.1. A psychiatrist, psychologist, psychiatric nurse or social worker as defined in chapters 71.05
and 71.34 RCW.
2.32.2. A person with a master’s degree or further advanced degree in counseling or one of the
social sciences from an accredited college or university. Such person shall have, in addition,
at least two years of experience in direct treatment of persons with mental illness or
emotional disturbance, such experience gained under the supervision of a mental health
professional.
2.32.3. A person who meets the waiver criteria of RCW 71.24.260, which was granted prior to
1986.
2.32.4. A person who had an approved waiver to perform the duties of a mental health professional
that was requested by the regional support network and granted by the DSHS prior to July 1,
2001; or
2.32.5. A person who has been granted a time-limited exception of the minimum requirements of a
mental health professional by the DBHR consistent with WAC 388-865-0265.
Network Provider means a Community Mental Health Agency, Professional Service, or other
identified service that is contracted directly with Thurston Mason RSN for the delivery, or support of
delivery, of mental health services in the Provider Network.
Patient Days of Care includes all voluntary patients and involuntarily committed patients under
Chapter 71.05 RCW, regardless of where in the State Hospital they reside. Patients who are
committed to the State Hospital under 10.77 RCW are not included in the Patient Days of Care.
Patients who are committed under Chapter Ch. 375, Laws of 2007 (ESSB 5533), Section 5
(misdemeanor procedure) by municipal or district courts after failed competency restoration and
dismissal of misdemeanor charges are not counted in the Patient Days of Care until a petition for 90
days of civil commitment under Chapter 71.05 RCW has been filed in court. Patients who are
committed under Chapter Ch. 375, Laws of 2007 (ESSB 5533), Section 4 (felony procedure) by a
superior court after failed competency restoration and dismissal of felony charges are not counted in
the Patient Days of Care until the patient is civilly committed under Chapter 71.05 RCW.
Provider Network means all Thurston Mason RSN contracted Network Providers within the
Thurston Mason service area.
Provider One means the Departments Medicaid Management Information Payment Processing
System.
Quality Assurance means a focus on compliance to minimum requirements (e.g. rules, regulations,
and Contract terms) as well as reasonably expected levels of performance, quality, and practice.
Quality Improvement means a focus on activities to improve performance above minimum
standards/reasonably expected levels of performance, quality, and practice.
Quality Strategy means an overarching system and/or process whereby quality assurance and quality
improvement activities are incorporated and infused into all aspects of an organization’s or system’s
operations
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2.40. Recovery means the process in which people are able to live, work, learn, and participate fully in
their communities.
2.41. Regional Support Network (“RSN”) means a county authority or group of county authorities or
other entity recognized by the secretary of DSHS to administer mental health services in a defined
region.
2.42. Resilience means the personal and community qualities that enable individuals to rebound from
adversity, trauma, tragedy, threats, or other stresses, and to live productive lives.
2.43. Service Area means the geographic area covered by this Contract for which the Contractor is
responsible.
2.44. Urgent Care means a service to be provided to persons approaching a mental health crisis. If
services are not received within 24 hours of the request, the person’s situation is likely to deteriorate
to the point that emergent care is necessary
3. PROGRAM OBJECTIVES
3.1. This Contract is designed to prescribe specific functions and to define expected outcomes. These are
considered minimum requirements.
3.2. The Contractor shall provide the following program services in Thurston and Mason Counties or for
Thurston and Mason County residents:
3.2.1. Telephone / Face-to-Face Screening. Determine appropriate level of, and location for, full
continuum of care as available through the TMRSN mental health system of care. Facilitate
an intake for outpatient services as necessary.
3.2.2. Crisis Resolution Services. Evaluate mental health condition, both on-site and in the
community, to determine acuity and level of care needed and take initial steps to stabilize.
Provide crisis intervention services both on-site and in the community. These services shall
be provided in concert with the Crisis Stabilization and Transitional Unit. These are not
discreet and separate programs but rather extensions of program services. Services include
the facilitation of intakes for outpatient services as necessary. These services may be
provided under Medicaid or State funding. Crisis services include co-occurring screening
per Section 7.3.
3.2.3. Involuntary Treatment Act Services (ITA). Provide all necessary services, administrative
and court functions required for the evaluation for involuntary detention or involuntary
treatment determination. These services are always provided under state funding. Clinical
services are primarily those provided by Designated Mental Health Professionals in the
evaluation and commitment process.
3.2.4. Crisis Stabilization Services. Alleviate acute symptoms and avert decompensation or reescalation on site or in the community. Provide a least restrictive, step-down from or
alternative to inpatient care that includes a range of integrated treatment modalities,
primarily group therapy and psycho-education. These services shall include respite care, jail
diversion, hospital diversion, and state hospital (WSH) step-down services to be a
continuum of care.
3.2.5. Freestanding Evaluation and Treatment Services. Provide evaluation and inpatient level
treatment to individuals who would otherwise meet psychiatric hospital admission criteria.
Maintain Involuntary Treatment Act certified treatment beds to meet the statutory
requirements of RCW 71.24.300(6)(c).
3.2.6. Transition/Residential Services. When stabilization services extend beyond 14 days,
Transition/Residential services to further stabilize and supervise the client shall be provided.
These services are utilized for WSH or other inpatient setting step down, PACT program, or
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diversion prior to or from community based and jail based services.
4. FACILITY REQUIREMENTS
4.1. The Contractor shall:
4.1.1. Maintain policies and procedures designed to direct personnel in the care and protection of
buildings, furnishings, appliances and equipment used in the provision of services described
herein.
4.1.2. Report any and all building or County-owned equipment damage, breach of grounds
integrity, infrastructure systems failures or any safety issue to TMRSN or as appropriate to
Central Services for Thurston County immediately, or, if non-emergent, by the next business
day.
4.1.3. Provide for janitorial / custodial and light maintenance services. Attachment 1, describes
Thurston County maintenance responsibilities.
4.1.4. Provide connectivity, installation, and maintenance of telephone, and computer systems.
4.1.5. Provide and replace necessary office furnishings and equipment.
4.1.6. Ensure that the building, equipment and furnishings are safe, sanitary, and maintained in
good repair.
4.1.7. Per Attachment 1, ensure that the building structure, exterior grounds and component parts
are safe, clean, and maintained in good repair. This also includes safety during inclement
weather, including snow and ice, by clearing and/or de-icing the parking lot, sidewalks, and
building entrances if the service is not provided by Thurston County.
4.1.8. Ensure laundry facilities and equipment is clean, in good repair and adequate to meet the
needs of clients.
5. PROGRAM OPERATIONS
5.1. The Contractor shall maintain an organizational structure that includes, who the Contractor’s legal
responsible authority is, clear lines of authority for management and clinical supervision, as
evidenced by a single, non-duplicated line of authority for overall program management and
operations. A printed organizational chart illustrating this structure shall be submitted to TMRSN
within thirty (30) days upon execution of this contract and then as revised.
5.2. The Contractor shall maintain written policies and procedures that shall implement all applicable
rules. Such policies and procedures are to be reviewed by the legally responsible authority or
designed, kept current, located together, are made available at all times to all personnel who are
responsible to carry out these policies, and are in compliance with WAC 246-337, 388-865, and 388877.
5.3. The Contractor shall adopt, periodically review and update written policies, written procedures and
written position descriptions that include, at a minimum:
5.3.1. Program description and scope of services, including population served.
5.3.2. Description of resources that are provided to meet client needs as per WAC 246-337-045.
5.3.3. Description of essential functions and credentials required for specific jobs.
5.3.4. Plan for communication and conflict resolution for clients and employees as per WAC 246337-045.
5.3.5. Medical and nursing procedures.
5.3.6. Policy regarding possession of weapons in Evaluation & Treatment Facility.
5.3.7. Procedures for assessment, admission, discharge, and transfer of clients, both voluntary and
involuntary.
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5.4.
5.5.
5.3.8. Description of treatment modalities utilized.
5.3.9. Plan for addressing needs of children, adolescents, and elders (when applicable).
5.3.10. Procedures and training plan for managing disruptive, violent, suicidal and self-destructive
behaviors.
5.3.11. Policy regarding smoking.
5.3.12. Plan for responding to emergency situations.
The Contractor must have policies and procedures for crisis and ITA services that implement the
following requirements:
5.4.1. No DMHP or crisis intervention worker shall be required to respond to a private home or
other private location to stabilize or treat a person in crisis, or to evaluate a person for
potential detention under the state's involuntary treatment act unless a second trained
individual accompanies them.
5.4.2. The clinical team supervisor, on-call supervisor, or the individual professional acting alone
based on a risk assessment for potential violence shall determine the need for a second
individual to accompany them.
5.4.3. The second individual may be a law enforcement officer, a mental health professional, a
mental health paraprofessional who has received training as described in RCW 49.19.030, or
other first responder, such as fire or ambulance personnel.
5.4.4. No retaliation may be taken against individual who, following consultation with the clinical
team or supervisor refuses to go to a private home or other private location alone.
5.4.5. The Contractor must provide training, mental health staff back-up, information sharing, and
communication for crisis outreach staff who respond to private homes or other private
locations.
5.4.6. Every DMHP, mental health professional, or crisis worker that is dispatched on a crisis visit,
as described above, shall have access to all information through the MIS including any
history of dangerousness or potential dangerousness on the client 24/7 they are being sent to
evaluate that is documented in crisis plans or commitment records and is available without
unduly delaying a crisis response.
5.4.7. Every mental health professional including DMHP’s and crisis outreach workers, who
engage in home visits to Clients or potential Clients shall have access to the use of a cellular
telephone or comparable devise provided by the Contractor for the purpose of emergency
communication.
Seclusion and restraint. The Contractor shall protect client rights and safety with regard to the use
of seclusion and restraint, and shall comply with all requirements of WAC 246-337-110, WAC 388865-0545 and 0546 and shall:
5.5.1. Maintain a written policy that meets all applicable state and federal laws, rules and
regulations pertaining to seclusion and restraint.
5.5.2. Ensure that restraint or seclusion is performed in a manner that is safe, proportionate and
appropriate to the severity of the behavior, the client’s chronological and developmental age,
size, gender, physical, medical and psychiatric condition and personal history.
5.5.3. Only use seclusion and restraint in case of emergency when treatment methods have failed.
5.5.4. Collect and keep data and provide reports regarding use of seclusion and restraint, and
efforts to reduce use.
5.5.5. Demonstrate efforts to keep staff current with national trends in use of physically restrictive
containment methods.
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5.5.6.
The Contractor shall maintain working relationships with local law enforcement, 911
services, and emergency medical transportation systems.
5.5.7. The Contractor shall maintain service relationships with local hospitals, emergency rooms,
and outpatient mental health providers.
5.5.8. The Contractor shall develop service relationships for the purpose of coordinated care plans
with any County that has an established Contract or contract with TMRSN for ITA services.
5.6.
Food and Nutrition Services. The Contractor shall have a policy and procedure per WAC 246337-090 to ensure that nutritionally adequate and appetizing meals that meet the client needs are
acquired, stored, prepared and served in accordance with chapter 246-215 WAC, or any successor.
5.7.
Infection Control. Contractor shall have written policies and procedures per WAC 246-337-060
to ensure client’s care is provided in an environment that prevents the transmission of
communicable diseases among clients, staff, and visitors.
5.8.
Medication Management. Contractor shall be responsible for the control and use of all
medications used by clients within the Evaluation & Treatment Facility whether administered or
self-administered. The Contractor shall have written policies and procedures for medication
acquisition, storage, administration and documentation that are developed, approved, and reviewed
by medical and nursing staff, administration and pharmacist (as needed) per WAC 246-337-105
and WAC 388-865-0570.
5.9.
Medical Records. Contractor shall have a policy and procedure per WAC 246-337-095 to ensure
medical records that document the client’s psychiatric care are maintained.
5.10. Plan of Care/Treatment. The Contractor shall have a policy and procedure per WAC 246-337100 and WAC 388-865-0547 that ensures an individual plan of care/treatment is developed and
implemented for each client based on assessment of the client’s health care needs upon admission
and updated as additional needs are identified during treatment.
5.11. Health and Safety. The Contractor shall have a policy and procedures per WAC 246-337-065 that
protect the client’s health and safety.
6. SERVICES
6.1. Required Services. The Contractor is required to provide all of the following services as described
in the Crisis Mental Health and Inpatient sections, unless otherwise specified in this Contract. These
services must be prioritized for the use of funds provided under this Contract. The Contractor shall
ensure access to and availability of mental health services for any individual with acute or emergent
mental health needs in any geographic area of Thurston and Mason Counties, residents of any County
that has an ITA Contract or contract with TMRSN, and any other state residents in accordance with
State law, rules, and regulations.
6.1.1. Crisis Mental Health Services. The Contractor must provide 24-hour, 7 day a week crisis
mental health services to individuals who are within the Contractor’s service area and report
they are experiencing a mental health crisis. There must be sufficient staff available,
including Designated Mental Health Professionals, to respond to requests for crisis services.
Crisis services must be provided regardless of the individual’s ability to pay. Crisis services
provided at the E&T are not a replacement or substitute for crisis services provided in an
outpatient setting. Crisis mental health services must include each of the following:
6.1.1.1.
Crisis Services. Evaluation and treatment of mental health crisis to all
individuals experiencing a crisis. A mental health crisis is defined as a turning
point in the course of anything decisive or critical, a time, a stage, or an event
or a time of great danger or trouble, the outcome of which decides whether
possible bad consequences shall follow. Crisis services must be available on a
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6.1.1.2.
6.1.1.3.
6.1.1.4.
6.1.1.5.
24-hour basis. Crisis Services are intended to stabilize the person in crisis,
prevent further deterioration and provide immediate treatment and intervention
in a location best suited to meet the needs of the individual and in the least
restrictive environment available. Crisis services may be provided prior to
completion of an intake evaluation. Services must be provided by or under the
supervision of a mental health professional.
Stabilization Services. Services provided to individuals who are experiencing
a mental health crisis. These services are to be provided in the person's own
home, or another home-like setting, or a setting which provides safety for the
individual and the mental health professional. Stabilization services shall
include short-term (less than two weeks per episode) face-to-face assistance
with life skills training, and understanding of medication effects. This service
includes: a) follow up to crisis services; and b) other individuals determined by
a mental health professional to need additional stabilization services.
Stabilization services may be provided prior to an intake evaluation for mental
health services. This service may include cost for room and board (as allocated
through State Only funds).
Involuntary Treatment Act Services. Includes all services and administrative
functions required for the evaluation for involuntary detention or involuntary
treatment of individuals in accordance with RCW 71.05 RCW 71.24. 300 and
RCW 71.34. This includes all clinical services, costs related to court processes
and transportation. Crisis Services become Involuntary Treatment Act
Services when a Designated Mental Health Professional (DMHP) determines
an individual must be evaluated for involuntary treatment. The decision
making authority of the DMHP must be independent of the RSN
administration. ITA services continue until the end of the involuntary
commitment.
Ancillary Crisis Services. Includes costs associated with providing medically
necessary crisis services not included in the Medicaid State Plan. Costs
include but are not limited to the cost of room and board in hospital diversion
settings or in freestanding Evaluation and Treatment facilities (per State Only
Funding).
Freestanding Evaluation and Treatment Services. Provided in freestanding
inpatient residential (non-hospital) facilities licensed by the Department of
Health and certified by DBHR to provide medically necessary evaluation and
treatment to the individual who would otherwise meet hospital admission
criteria. These are not-for-profit organizations. At a minimum, services
include evaluation, stabilization and treatment provided by or under the
direction of licensed psychiatrists, nurses and other mental health
professionals, and discharge planning involving the individual, family,
significant others so as to ensure continuity of mental health care. Nursing
care includes but is not limited to performing routine blood draws, monitoring
vital signs, providing injections, administering medications, observing
behaviors and presentation of symptoms of mental illness. Treatment
modalities may include individual and family therapy, milieu therapy, psychoeducational groups and pharmacology. The individual is discharged as soon as
a less-restrictive plan for treatment can be safely implemented.
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6.1.2.
Crisis mental health services may be provided prior to an intake evaluation or screening
process. The Contractor must provide:
6.1.2.1.
Emergent care within 2-hours of the request received from any source for crisis
mental health services.
6.1.2.2.
Urgent care within 24-hours of the request received from any source for crisis
mental health services.
6.1.3. The Contractor must provide access to all components of the Involuntary Treatment Act to
persons who have mental disorders in accordance with State law (RCW 71.05 and RCW
71.34) and without regard to ability to pay.
6.1.4. The Contractor must incorporate and train all Designated Mental Health Professionals
(DMHP) on the most current statewide DMHP Protocols. The protocols can be accessed on
the DBHR internet website and copies can be provided upon request.
6.1.4.1.
DMHP’s will be credentialed per TMRSN Policy SD231 Designated Mental
Health Professional.
6.1.5. Maintain Involuntary Treatment Act (ITA) certified treatment beds to meet the statutory
requirements of RCW 71.24.
6.2. Mental Health Services provided in Residential Settings. A specialized form of rehabilitation
service (non hospital/non IMD) that offers a sub-acute psychiatric management environment.
Medicaid-enrolled individuals receiving this service present with severe impairment in psychosocial
functioning or have apparent mental illness symptoms with an unclear etiology due to their mental
illness. Treatment for these individuals cannot be safely provided in a less restrictive environment
and they do not meet hospital admission criteria. Individuals in this service require a different level
of service than High Intensity Treatment. The Mental Health Care Provider is sited at the residential
location (e.g., boarding homes, supported housing, cluster housing, SRO apartments) for extended
hours (minimum of 8 hours per day, 7 days per week) to provide direct mental health care to a
Medicaid Client. Therapeutic interventions both in individual and group format may include
medication management and monitoring, stabilization, and cognitive and behavioral interventions
designed with the intent to stabilize the individual and return him/her to more independent and less
restrictive treatment. The treatment is not for the purpose of providing custodial care or respite for
the family, nor is it for the sole purpose of increasing social activity or used as a substitute for other
community-based resources. This service is billable on a daily rate. In order to bill the daily rate for
associated costs for these services, a minimum of 8 hours of service must be provided. This service
does not include the costs for room and board, custodial care, and medical services, and differs from
other services in the terms of location and duration.
7. ACCESS, ELIGIBILITY AND CLINICAL SERVICES
7.1. Telephone Screening and Crisis Intervention
7.1.1. Evaluation & Treatment Facility personnel shall accept phone calls from any person
directly. Initial telephone calls shall be answered within 30 seconds or five (5) rings.
7.1.2. If caller is currently enrolled in public mental health services, assistance of the case manager
may be requested.
7.1.3. Callers with non-urgent requests for service shall be routed to or scheduled with an
outpatient provider.
7.1.4. A mental health crisis worker shall speak with an individual requesting care for symptoms
of a mental illness within 15 minutes.
7.1.5. Screening includes nature of request, demographic data, financial data, eligibility
determination and direction toward appropriate services.
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7.2.
7.3.
Face to face crisis assessment and initial crisis intervention
7.2.1. Initial services shall be made available to the community for emergent and urgent care.
There shall be a seamless flow of services between Crisis Resolution Services (CRS), Crisis
Stabilization and Transitional Unit (CSTU) and the Evaluation and Treatment Unit (ETU).
Assessment is intended for initial crisis response and determine of other services that may be
needed.
7.2.2. Eligibility for mental health assessment includes adults or children who:
7.2.2.1.
Believe they are having a mental health crisis.
7.2.2.2.
Are reported by others to have acute symptoms of a mental disorder that may
lead to deterioration in function if there is no intervention.
7.2.3. Unless there is an apparent major medical problem, individuals who are referred or
requesting crisis services shall not be diverted to a hospital Emergency Room prior to being
seen. Services shall be coordinated with hospital emergency departments and medical
centers.
7.2.4. Initial face to face assessment and crisis intervention may include, depending on individual
need and location:
7.2.4.1.
Mental health assessment.
7.2.4.2.
Nursing Health screen;
7.2.4.3.
Consultation with psychiatrist or psychiatric ARNP;
7.2.4.4.
Admission, transfer or referral to appropriate care;
7.2.4.5.
Arrangement of suitable transportation; and
7.2.4.6.
Specialists available for evaluation and consultation as indicated, e.g., children,
elders, physically or sensory disabled, non-English speaking or any other
specialist required for adequate evaluation.
7.2.4.7.
Stabilization of symptoms
7.2.4.8.
Crisis Intervention
7.2.4.9.
ITA Evaluation
Co-Occurring Disorder Screening and Assessment: The Contractor must maintain the
implementation of the integrated, comprehensive screening and assessment process for chemical
dependency and mental disorders as required by RCW 70.96C. Failure to maintain the Screening and
Assessment process shall result in remedial actions up to and including financial penalties as
described in Section 23, Remedial Actions, of this Contract.
7.3.1. Contractor must attempt to screen all individuals aged 13 and above through the use of
DBHR provided Global Appraisal of Individual Needs – Short Screener (GAIN-SS) during:
7.3.1.1.
New intakes, as applicable.
7.3.1.2.
The provision of each crisis episode of care including ITA investigation
services, except when:
7.3.1.2.1.
The service results in a referral for an intake assessment.
7.3.1.2.2.
The service results in an involuntary detention under RCW
71.05, 71.34 or RCW 70.96B.
7.3.1.2.3.
The contact is by telephone only.
7.3.1.2.4.
The professional conducting the crisis intervention or ITA
investigation has information that the individual completed a
GAIN-SS screening within the previous 12 months.
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7.3.2.
The GAIN-SS screening must be completed as self report by the individual and signed by
that individual on DBHR-GAIN-SS form. If the individual refuses to complete the GAIN-SS
screening or if the clinician determines the individual is unable to complete the screening for
any reason this must be documented on DBHR-GAIN-SS form.
7.3.3. The results of the GAIN-SS screening, including refusals and unable-to-completes, must be
reported to TMRSN through the MIS system.
7.3.4. Staff utilizing the tool must attend ongoing DBHR trainings on the use of the screening and
assessment process that includes use of the tool and quadrant placement.
7.3.5. The Contractor must complete a co-occurring mental health and chemical dependency
disorder assessment, consistent with training provided by DBHR and outlined in the
SAMHSA Treatment Protocol 42, to determine a quadrant placement for the individual when
the individual scores a 2 or higher on either of the first two scales (ID Screen & ED Screen)
and a 2 or higher on the third (SD Screen).
7.3.6. The HRSA-GAIN-SS screening form, along with the quadrant score, must be placed within
the Enrollee’s clinical chart even if the Enrollee refused or was unable to complete it.
7.3.7. The assessment is required during the next outpatient treatment planning review following
the screening and as part of the initial evaluation at free-standing, non-hospital, evaluation
and treatment facilities. The assessment is not required during crisis interventions or ITA
investigations. The quadrant placements are defined as:
7.3.7.1.
Less severe mental health disorder/less severe substance disorder.
7.3.7.2.
More severe mental health disorder/less severe substance disorder.
7.3.7.3.
Less severe mental health disorder/more severe substance disorder.
7.3.7.4.
More severe mental health disorder/more severe substance disorder.
7.3.8. The quadrant placement must be reported to TMRSN through the MIS system.
8. CRISIS OUTREACH SERVICES
8.1. Eligibility shall include adults youth and children regardless of ability to pay or enrollment who:
8.1.1. Believe they are experiencing a mental health crisis, or
8.1.2. Demonstrate acute symptoms of a mental disorder; or
8.1.3. Have had an initial screen, assessment, or are directly routed to a mental health professional.
8.2. Crisis Services shall be provided per the following:
8.2.1. Off-site crisis outreach or on-site crisis intervention available 24 hours a day, 7 days a week.
8.2.2. The region of services is defined as Thurston and Mason Counties. The Contractor shall
responds to requests for services throughout the service region.
8.2.3. Community intervention services provided within two (2) hours of initial contact. Any
exceptions are clearly documented and are subject to review.
8.2.3.1.
The mental health professional determines whether law enforcement, backup
staff, or evaluation for involuntary treatment is needed per Section 5.4.
8.2.4. Crisis outreach services shall be provided at the level of intensity and duration necessary
until the crisis is mitigated.
8.2.5. The mental health professional determines whether conditions are safe for outreach
activities. If considered unsafe, arrangements may be made to have the client transported to
a facility capable of containment or responded to with additional clinical staff or police.
8.2.6. Outreach requests for mental health assessment and crisis intervention from the following
shall not be declined:
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8.2.6.1.
Law enforcement;
8.2.6.2.
Jail / juvenile court or detention staff;
8.2.6.3.
Hospital emergency staff;
8.2.6.4.
Attending physician for a person in a medical unit at a local hospital;
8.2.6.5.
Residential providers; and
8.2.6.6.
Schools.
8.2.7. Requests from Police or other law enforcement for crisis intervention shall be responded to,
whether or not an ITA evaluation is requested.
8.2.8. Mental health professionals shall have access to crisis plans 24 hours a day, 7 days a week.
8.2.9. Mutual development of a plan with the client that supports client stability and safety.
8.2.9.1.
Involvement of client’s natural support system.
8.2.9.2.
Assistance with appropriate referral, including next business day appointments.
8.2.10. Crisis intervention or initial brief treatment shall be available 24 hours a day, 7 days a week,
and may occur in the field or on-site.
8.2.11. Follow up brief treatment up to five (5) sessions by appointment.
8.2.12. Staffing assistance with voluntary admission to hospital, Crisis Stabilization Transition Unit
(CSTU) or Evaluation and Treatment Unit (ETU), as needed.
8.2.13. Linkage to natural and professional supports.
8.2.14. Evaluation for involuntary treatment according to chapter 71.05 RCW by DMHP if initial
intervention is unsuccessful in providing safety and client refuses services.
8.2.15. Evaluations for involuntary treatment occur within the boundaries of Thurston and Mason
Counties.
8.2.16. Coordination of client transportation to the Evaluation & Treatment Facility and Providence
St. Peter Hospital as necessary.
8.2.17. If a crisis may be resolved by providing food, transportation, medication, or lodging, the
Contractor may provide these on a short-term basis, as resources are available. This may be
provided ONLY for those who are experiencing acute mental health symptoms exacerbated
by lack of food, medication, or shelter and who are not enrolled in TMRSN mental health
services.
8.2.18. The Contractor shall provide direct monitoring for non-enrolled individuals discharged to
Thurston or Mason counties who are on a Least Restrictive Alternative (LRA) or
Conditional Release (CR).
9. CRISIS STABILIZATION AND TANSITION UNIT (CSTU)
9.1. CSTU services shall be seamless in providing continuum of care with Crisis Resolution Services and
the ETU. CSTU is intended to provide a setting to monitor a client, even for an hour as part of their
initial crisis response. CSTU services are designed to allow any crisis client a chance to stabilize
when an initial crisis intervention in the community is insufficient.
9.2. The CSTU is also intended as a diversion and step down program from inpatient and jail. In
particular, the CSTU is to be utilized for moving clients out of WSH prior to placement in the
community. The CSTU shall work with outpatient programs, especially the Program for
Assertiveness Community Treatment (PACT), to facilitate community placement.
9.3. Eligibility for admission includes:
9.3.1. Client has acute symptoms of a mental illness or mental disorder;
9.3.2. Client requires additional crisis services on a short term basis to stabilize;
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9.3.2.1.
CSTU “beds” may be utilized for brief periods to provide an individual time to
stabilize. Procedures such as extensive medical clearance should not present
as a barrier to providing these short term crisis services.
9.3.3. Client presents risk or imminent risk of danger to self or others, or an inability to care for
basic needs as a result of symptoms;
9.3.4. Community resources and outpatient services are insufficient to provide client safety or
stabilization;
9.3.5. It is likely that services offered shall be beneficial;
9.3.6. Client is voluntary or on a Lesser Restricted Order or Conditional Release Order from WSH;
9.3.7. Clients are residents of Thurston or Mason Counties, or, if out of county, admission is by
prior TMRSN authorization;
9.3.8. Client is need of transition treatment services from WSH, or other Inpatient or Jail settings;
9.3.9. Client is in need of stabilization and transition to divert from inpatient care or jail due to a
mental illness.
9.4. Initial authorization for stabilization admission shall be retrospective based on Access to Care
Standards and WAC definition of acuity. If the length of stay is less than 23 hours then this service
shall constitute a crisis intervention and requires no authorization. If the stay is 24 hours or more up
to 14 days, then the service is Crisis Stabilization and shall be authorized retrospectively by the RSN.
If the length of stay is more than 14 days, then the service is residential, requires prior authorization
for Outpatient Level of Care, Residential Treatment and enrollment into outpatient services. This
residential service is only available for individuals who have Medicaid.
9.5. Any denial of access to CSTU shall be documented and reported to TMRSN with 24 business hours.
9.6. The need for medication shall not be a reason for denial of admittance to CSTU.
9.7. Crisis stabilization in the CSTU is provided in a short-term, professionally staffed residential
environment that includes:
9.7.1. Individually assigned room within a secure environment, supervision, protection of privacy,
and behavior monitoring.
9.7.2. Meals and food service in accordance with WAC 246-337-090.
9.7.3. Provision of basic health needs that may include, though is not limited to, a combination of
rest, sleep, hygiene, nutrition, activity, personal privacy, social contact, fresh air, education
and recreation as needed.
9.7.4. Individualized plan of care in accordance with WAC 246-337-100 and WAC 388-865-0547.
9.7.5. Coordination with Outpatient Services for Medication assessment, administration, education
and monitoring when necessary. Mental health-related laboratory services.
9.7.6. Routine medical services within the limits of medical resources available.
9.7.7. Facilitation of ongoing support post discharge including post discharge phone consult based
on written discharge instructions. Discharge instructions shall be available to consult staff
for 90 days.
9.8. The Contractor shall ensure entry and submission of MIS reporting at minimum; billing or
stabilization services, other services when appropriate, admission transaction data, demographic data,
utilization data, discharge data and other data requirements as set forth in this Contract.
9.9. Crisis Stabilization shall include Respite Care and function as a step down and diversion for Western
State Hospital.
10. INPATIENT SERVICES
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10.1. Evaluation and Treatment Unit (ETU)
10.1.1. Eligibility for admission includes, for clients detained or committed in accordance with
chapters 71.05 or 71.34 RCW:
10.1.1.1.
Thurston County DMHP or other Washington DMHP has performed probable
cause evaluation; and
10.1.1.2.
Detention is for adolescents age 13 to17 and adults age 18 and older detained
for a 72 hour evaluation period; or
10.1.1.3.
Adolescents age 13 to 17 and adults age 18 and older committed by Thurston
County Superior Court for a 14 - day evaluation and treatment period; or
10.1.1.4.
Adolescents age 13 to 17 and adults age 18 and older, whose least restrictive
Court Order has been revoked.
10.1.2. Eligibility for voluntary admission to the ETU includes, at a minimum:
10.1.2.1.
Client has acute symptoms of a mental illness or mental disorder;
10.1.2.2.
Client presents risk or imminent risk of danger to self or others, or an inability
to care for basic needs as a result of acute symptoms as defined under RCW
71.05;
10.1.2.3.
Community resources and outpatient services are insufficient to provide client
safety;
10.1.2.4.
There is a likelihood that services offered shall be beneficial; and
10.1.2.5.
Clients are residents of Thurston or Mason Counties, or, if out of county,
admission is by prior authorization by TMRSN.
10.1.3. The TMRSN Medical Director shall review determination of clinical appropriateness for
clients if denied a request for inpatient admission.
10.2. Inpatient services are made available through 15 Evaluation & Treatment Facility certified treatment
beds in a professionally staffed, short-term residential setting and shall include but are not limited to:
10.2.1. Individually assigned room within a secure environment with a locked perimeter,
supervision, protection of privacy, and behavior monitoring.
10.2.2. Meals and food service in accordance with WAC 246-337-090.
10.2.3. Provision of basic health needs that may include, though is not limited to a combination of:
rest, sleep, hygiene, nutrition, activity, personal privacy, social contact, fresh air, education
and recreation as needed.
10.2.4. Daily monitoring of vital signs.
10.2.5. Comprehensive evaluation including physical examination, psychosocial assessment and
mental status examination within 24-hours of initial contact.
10.2.6. A structured daily program of activities and services to include:
10.2.6.1.
Basic health care as described in Exhibit E: Modalities;
10.2.6.1.1. Individual therapy;
10.2.6.1.2. Group therapies;
10.2.6.1.3. When appropriate, family therapy;
10.2.6.1.4. Medication assessment, administration, education and
monitoring.
10.2.6.2.
Flexible structure to accommodate and/or closely match individual client’s
acuity and home activity schedule.
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10.2.6.3.
10.2.6.4.
10.2.6.5.
Mental health-related laboratory services.
Routine medical services within the limits of medical resources available.
Individualized plan of care in accordance with WAC 246-337-100 and WAC
388-865-0547.
10.2.6.6.
Arrangement for appropriate transportation at discharge.
10.2.6.7.
Facilitation of ongoing support post discharge including post discharge phone
consult by Evaluation & Treatment Facility staff. Consult shall be available
for 90 days post discharge.
10.2.7. The Contractor shall ensure entry and submission of MIS reporting including but not limited
to; bed days, individual services when appropriate, admission transaction data, demographic
data, utilization data, discharge data and other data requirements as set forth in Section 18
for voluntary and involuntary services.
10.2.8. Request for voluntary admission requires pre-authorization through TMRSN inpatient
authorization process.
10.2.8.1.
First phase of authorization shall be for initial admission to the Evaluation &
Treatment Facility. Initial authorization shall include number of bed days to be
authorized.
10.2.8.2.
Second phase of authorization shall be for continued stay if requested. Second
phase authorization shall require same written request to be faxed to TMRSN
prior to approval. Response from TMRSN shall include number of additional
bed days to be authorized.
10.3. Hospital Liaison
10.3.1. The Contractor shall identify and designate 1 FTE as a Hospital Liaison to provide
Rehabilitation Case Management services conducted in or with an inpatient facility for the
direct benefit of an individual in or eligible for TMRSN mental health services.
10.3.2. The Liaison shall provide case management services at WSH to include monitoring of client
status, regular documentation and updates, collaboration with WSH staff, and discharge
planning and residential placement for all TMRSN eligible clients.
10.3.2.1.
The hospital liaison shall be responsible for providing services to the total
number of TMRSN allocated Western State Hospital beds. Current number of
beds is 30.
10.3.2.2.
The Hospital Liaison shall provide direct services to a minimum of twenty (20)
clients per month to be eligible for full MHBG funding per Exhibit B.
10.3.2.2.1. To be eligible for full funding, the Contractor must also satisfy
the 1 FTE requirement in section 10.3.1. Should the FTE be less
than 1, the funding amount will be reduced per Exhibit B.
10.3.2.3.
The Contractor shall submit a monthly deliverable report to include:
10.3.2.3.1. Staff name
10.3.2.3.2. Portion of the 1 FTE each staff represents, if more than one staff
equates the 1 FTE.
10.3.2.3.3. Number of clients (each) staff has served in the month.
10.3.3. Contractors’ WSH Hospital Liaison shall co-facilitate a monthly meeting with TMRSN Care
Management staff; the PACT designated care coordinator, the Contractor’s Housing
Coordinator, and identified case managers as needed for care coordination and planning.
10.3.4. The TMRSN WSH Liaison shall facilitate all discharge planning, residential placement and
linkages to services for all WSH clients considered TMRSN responsibility, regardless of
enrollment status. The WSH Liaison shall obtain client information as necessary from other
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10.3.5.
10.3.6.
10.3.7.
10.3.8.
10.3.9.
Network Providers in order to coordinate discharge planning and placement activities for
clients enrolled with providers other than BHR.
Rehabilitation Case Management activities include assessment for discharge or admission to
community mental health care, integrated mental health treatment planning, resource
identification and linkage to mental health rehabilitative services and primary care, and
collaborative development of individualized services that promote continuity of care.
Services are provided by or under the supervision of a Mental Health Professional.
The Contractor shall ensure that contact with the inpatient facility occurs within three (3)
working days of an authorized voluntary or involuntary admission. The Contractor’s liaison
must participate throughout the admission in treatment and discharge planning with the
inpatient treatment team.
The Contractor shall provide to the inpatient unit any available information regarding the
individual’s treatment history at the time of admission. The Contractor or its designee must
provide all available information related to payment resources and coverage.
The Hospital Liaison shall collaborate with outpatient providers to facilitate transition of an
enrollee from the inpatient level of care to less restrictive and alternative services once the
client is stabilized. Continuity of care must be provided to maintain the stability gained by
the provision of services at the higher level of care.
The Contractor’s Hospital Liaison shall facilitate appropriate and timely discharge for
Medicaid eligible individuals regardless of enrollment status. This may include providing
assistance with developing treatment plans, facilitating benefit applications or reinstatement
of benefits, coordinating with H&CS for CARE assessments and residential placement,
negotiating residential rates, and requesting TMRSN authorization for residential
placement/Pathway.
10.3.9.1.
The Contractor shall coordinate with TMRSN and the HCS regional office to
support the placement of persons discharged or diverted from state hospitals
into HCS placements. In order to accomplish this, the Contractor will,
whenever possible, prior to referring a person with a diagnosis of dementia for
a 90 day commitment to a state hospital:
10.3.9.1.1. Ensure that a request for a CARE assessment is made as soon as
possible after admission to a hospital psychiatric unit or
Evaluation and Treatment facility in order to initiate placement
activities for all persons who might be eligible for long- term
care services. HCS has agreed to prioritize requests for CARE
assessments for individuals who have been detained to an E&T
or in another setting.
10.3.9.1.2. Request and coordinate with HCS, a scheduled CARE
assessment for such persons. If the assessment indicates
functional and financial eligibility for long- term care services,
coordinate efforts with HCS to attempt a community placement
prior to referral to the state hospital.
10.3.9.1.3. For individuals (both those being discharged and those being
diverted) whose CARE assessments indicate likely functional
and financial eligibility for long-term care services:
 The Contractor will coordinate with HCS placement
activities with one entity designated as being responsible
for those activities. This designation will be documented in
writing and agreed upon by TMRSN, the Contractor, and
HCS. Where such designation is not made the
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responsibility shall be the Contractor’s.
 The responsible entity will establish and coordinate a
placement or discharge planning team that includes
Contractor staff, HCS assessors, and other community
partners, as necessary, to develop a plan of action for
finding a safe, sustainable placement.
 The Contractor will ensure coordination and
communication will occur between those participants
involved in placement activities as identified by the
discharge planning team.
10.3.9.1.4. If a placement has not been found for an individual referred for
long-term care services within 30 days, the designated entity will
convene a meeting to review the plan and to make adjustments
as necessary. Such review meetings will occur at least every 30
days until a placement is affected.
10.3.9.1.5. When individuals being discharged or diverted from state
hospitals are placed in a long-term care setting, the Contractor
will:
 Coordinate with HCS and any residential provider to
develop a crisis plan to support the placement.
 When the individual meets access to care criteria,
coordinate with HCS and any residential provider in the
development of a treatment plan that supports the viability
of the HCS placement
10.3.10. The Contractor must provide or arrange for, a follow–up outpatient service within at least
seven (7) calendar days from discharge for Medicaid eligible individuals who have been
authorized for a voluntary or involuntary inpatient admission. If the individual is not
Medicaid eligible, they may be referred to the E&T CRS for a follow-up visit as needed,
including monitoring of LRA’s.
10.3.11. Upon TMRSN request, the Hospital Liaison shall participate with TMRSN Care Managers
in case reviews for high utilizers of inpatient and Emergency Department services, to
develop team strategies for alternative treatments and less restrictive and costly levels of
care.
11. ADDITIONAL ACCESS CONDITIONS
11.1. The Contractor shall maintain policies that address physical, developmental, and medical conditions.
Regarding the Crisis Stabilization and Transitional Unit and the Evaluation and Treatment Unit:
11.1.1. Clients with physical disabilities must have the disability stabilized prior to admission.
11.1.2. Clients with serious or complex medical conditions shall require medical clearance prior to
admission.
11.1.3. Clients demonstrating substance abuse may be treated with the following exceptions:
11.1.3.1.
Clients demonstrating acute substance abuse symptoms without symptoms of a
mental disorder shall be referred to a chemical dependency program.
11.1.3.2.
Clients demonstrating acute toxicity or acute withdrawal from alcohol or other
substances shall be transferred to a hospital or other facility equipped to
medically monitor or medically manage the client depending on the level of
the disorder.
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11.1.4. For those individuals with a pending (not dismissed or otherwise disposed) felony charge,
the Contractor shall develop procedures for evaluating admission on a case- by- case basis.
11.2. The Contractor shall maintain policies for serving sexual predators detained pursuant to chapter 71.09
RCW or high-risk sex offenders as classified by law enforcement:
11.2.1. Level III sex offenders (highest risk) shall be excluded from admission to the Evaluation &
Treatment Facility.
11.2.2. Level II individuals may be considered on a case-by-case basis prior to admission.
11.3. The Contractor shall maintain policies for evaluation and referral of individuals whose level of
violence and/or destructive behaviors cannot be contained within the Evaluation & Treatment
Facility. The decision to exclude an individual based solely on violent behavior shall be made by the
clinical management team.
11.4. The Contractor shall arrange for the appropriate level of transportation to and from the Evaluation &
Treatment Facility, as clinically appropriate, to facilitate client and family access. The Contractor
shall assure that Medical Administration Assistance (MAA) is billed for the transportation costs when
an enrolled individual is transported to the Evaluation & Treatment Facility and when appropriate,
away from the Evaluation & Treatment Facility.
11.5. Aside from the limitations above, the Evaluation & Treatment Facility shall have a “no decline”
policy for referrals within the TMRSN service area provided the individual meets admission criteria
described herein.
11.6. The Contractor shall admit clients to voluntary inpatient care after hours based on pre-authorization
criteria established by TMRSN. Authorization and denial procedures shall follow the same “Hospital
Instructions” as for community inpatient care. The TMRSN designated Inpatient Care Coordinator,
Community Network for Behavioral Healthcare, Inc. (CommCare), can be contacted 24 hours a day,
7 days a week for authorization at (877) 468-9313.
12. ITA FUNCTIONS AND SUPERIOR COURT
12.1. Superior court judicial proceedings shall occur at the Evaluation & Treatment Facility; these
proceedings shall have priority over all other uses of the Court Conference/Hearing room in the
Evaluation & Treatment Facility.
12.2. With regard to ITA court functions Contractor shall:
12.2.1. Provide coordination of involved parties;
12.2.2. Notify parties of hearing dates, times and locations;
12.2.3. Adhere to timelines as determined by Washington State Law;
12.2.4. Arrange client transportation to Western State Hospital;
12.2.5. Recommend conditions for least restrictive alternatives (LRAs) in conjunction with case
manager of record or DMHP;
12.2.6. Ensure that DMHPs are available for testimony when required;
12.2.7. Provide all necessary paperwork including but not limited to chapters 71.05 and 71.34
RCW.
12.3. With regard to ITA Court Hearings the Contractor shall:
12.3.1. Ensure court testimony by professional staff at probable cause hearings or trials;
12.3.2. Provide reports of client history, circumstances of admission and course of treatment;
12.3.3. Accompany and provide care of clients during court proceedings within and away from the
Evaluation & Treatment Facility;
12.3.4. Monitor court process;
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12.3.5. Assess court milieu for safety and intervene when there are disruptions;
12.3.6. Provide support to the County Prosecutor’s office, Assigned Counsel office and State
Attorney General’s office in the form of consultation, live and telephonic testimony, records
and reports, where required, at ITA proceedings for specific individuals;
12.3.7. Provide or arrange for expert witness testimony by a licensed physician, psychiatrist or
licensed psychologist.
12.4. With regard to education the Contractor shall:
12.4.1. Assess learning needs of patient and family and provide information regarding ITA status
and process;
12.4.2. Provide education and training regarding ITA and Court functions to the community,
including but not limited to: emergency transportation services, hospitals and clinics,
emergency departments and law enforcement.
12.5. With regard to documentation the Contractor shall:
12.5.1. Provide legal documents pertaining to the involuntary detention of persons at the Evaluation
& Treatment Facility as required by the Thurston County Superior Court;
12.5.2. Ensure completion and filing of all ITA related court orders or accompanied documents
including but not limited to Least Restrictive Orders and involuntary detention orders;
12.5.3. When necessary for judicial proceedings, Contractor shall promptly supply a certified copy
of all medical and psychological records and make available, if necessary, a records
custodian capable of testifying;
12.5.4. The Contractor shall ensure entry and submission of ITA investigations, detentions,
revocations and hearing events and data as set forth in Section 18 of this Contract.
13. CLINICAL PRACTICE
13.1. The Contractor shall provide the necessary number of staff with the appropriate professional
backgrounds and licensure needed to assure compliance with state and federal laws, rules and
regulations and the terms set forth in this Contract.
13.1.1. A Medical Director, responsible for decisions regarding client care, quality management,
safety issues, review of critical incidents and policy.
13.1.2. A Registered Nurse, an Advanced Registered Nurse Practitioner (ARNP) or Physician
Assistant (PA) shall perform healthcare assessments.
13.1.3. Comprehensive psychiatric evaluations shall be performed by a psychiatric ARNP, board
certified or board eligible psychiatrist.
13.1.4. An ARNP, physician, or licensed Physician’s Assistant (PA) shall perform comprehensive
physical examinations.
13.1.5. A Registered Nurse with psychiatric experience shall perform medication administration,
education, and monitoring. The Contractor shall ensure that a Registered Nurse certified, or
meeting the certification competencies, as established by American Nurses Association
Psychiatric or Mental Health Nurse, or greater credential, shall be on site at all times.
Licensed Practical Nurses (LPN’s) may perform some of these functions within their
credentials.
13.1.6. Mental health assessments shall be performed a staff person who meets at minimum mental
health professional (MHP) credentials.
13.1.7. Crisis / brief services shall be performed by mental health professionals with training and
experience in crisis intervention.
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13.1.8. A DMHP shall perform all evaluations for involuntary treatment pursuant to chapters 71.05
and 71.34 RCW and the DBHR DMHP Protocols.
13.1.9. Support for activities of daily living, basic health activities and vital signs measurement may
be provided by any mental health clinician demonstrating competence and delegated by a
Registered Nurse.
13.1.10. Clients with special needs shall have access to appropriately trained professionals for
evaluation and consultation, e.g., children, elders, physically or sensory disabled, foreign
language speaking, culturally relevant or any specialist required for adequate evaluation.
13.1.11. Sufficient numbers of clinical staff and professional mix shall be available at all times to
ensure safety, quality of care, and regulatory requirements.
13.1.12. Employees trained in cardiopulmonary resuscitation and emergency first-aid shall be present
in client treatment areas at all times.
14. INCIDENT REPORTING
14.1. The Contractor must maintain policies and procedures regarding mandatory incident reporting and
referrals consistent with all applicable state and federal laws. The policies must address the
Contractor’s oversight and review of the requirements in this section.
14.1.1. The Contractor must have a designated incident manager responsible for meeting the
requirements under this section.
14.1.2. The Contractor must report and follow-up on all incidents involving Enrollees, listed below.
14.1.3. The Contractor must report incidents to TMRSN by phone, fax, or an approved electronic
incident reporting system. The report must contain:
14.1.3.1.
A description of the incident;
14.1.3.2.
The date and time of the incident;
14.1.3.3.
Incident location;
14.1.3.4.
Incident type;
14.1.3.5.
Names and ages, if known, of all individuals involved in the incident;
14.1.3.6.
The nature of each individual’s involvement in the incident;
14.1.3.7.
The service history with the Contractor, if any, of individuals involved;
14.1.3.8.
Steps taken by the Contractor to minimize harm; and
14.1.3.9.
Any legally required notifications made by the Contractor.
14.1.4. The Contractor must report and follow-up on the following incidents. In addition, the
Contractor shall use professional judgment in reporting incidents not listed herein.
14.1.4.1.
Category One Incidents: the Contractor must report and also notify the
TMRSN Incident Manager by telephone or email immediately upon becoming
aware of the occurrence of any of the following Category One incidents
involving any individual that was served within 365 days of the incident.
14.1.4.1.1. Death or serious injury of patients, clients, staff, or public
citizens at a facility that DSHS licenses, contracts with, or
certifies.
14.1.4.1.2. Unauthorized leave of a mentally ill offender or a sexual violent
offender from a mental health facility or a Secure Community
Transition Facility. This includes ETU, CSTU, and Triage
Facilities that accept involuntary clients.
14.1.4.1.3. Any violent act to include rape or sexual assault, as defined in
RCW 71.05.020 and RCW 9.94A.030, or any homicide or
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attempted homicide committed by a client.
14.1.4.1.4. Any event involving an individual or staff that has attracted
media attention.
14.1.4.2.
Category Two Incidents: the Contractor must report within one (1) working
day of becoming aware that any of the following Category Two Incidents has
occurred, involving an Enrollee:
14.1.4.2.1. Alleged client abuse or client neglect of a serious or emergent
nature by an employee, volunteer, licensee, Contractor, or
another client.
14.1.4.2.2. A substantial threat to facility operation or client safety resulting
from a natural disaster (to include earthquake, volcanic eruption,
tsunami, fire, flood, an outbreak of communicable disease, etc.).
14.1.4.2.3. Any breach or loss of client data in any form that is considered
as reportable in accordance with the Health Information
Technology for Economic and Clinical Health (HITECH) Act
and that would allow for the unauthorized use of client personal
information. In addition to the standard elements of an incident
report, the Contractor shall document and/or attach: 1) the Police
report, 2) any equipment that was lost, and 3) specifics of the
client information.
14.1.4.2.4. Any allegation of financial exploitation as defined in RCW
74.34.020.
14.1.4.2.5. Any attempted suicide that requires medical care that occurs at a
facility that DSHS licenses, contracts with, and/or certifies.
14.1.4.2.6. Any event involving a client or staff, likely to attract media
attention in the professional judgment of the Incident Manager.
14.1.4.2.7. Any event involving: a credible threat towards a staff member
that occurs at a facility that DSHS licenses, contracts with, or
certifies; or a similar event that occurs within the community. A
credible threat towards staff is defined as “A communicated
intent (veiled or direct) in either words or actions of intent to
cause bodily harm and/or personal property damage to a staff
member or a staff member’s family, which resulted in a report to
Law Enforcement, a Restraining/Protection order, or a
workplace safety/personal protection plan.
14.1.4.2.8. Any incident that was referred to the Medicaid Fraud Control
Unit by the Contractor or its Subcontractor.
14.1.4.2.9. A life safety event that requires an evacuation or that is a
substantial disruption to the facility.
14.2. Comprehensive Review: TMRSN or DSHS may require the Contractor to initiate a comprehensive
review of an incident.
14.2.1. The Contractor will fully cooperate with any investigation initiated by TMRSN/DSHS and
provide any information requested by TMRSN/DSHS within the timeframes specified within
the request.
14.2.2. If the Contractor does not respond according to the timeframe in the request, TMRSN/DSHS
may obtain information directly from any involved party and request their assistance in the
investigation.
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14.2.3. DSHS may request medication management information.
14.2.4. DSHS may also review or may require the Contractor to review incidents that involve clients
who have received services from the Contractor more than 365 days prior to the incident.
14.3. Incident Review and Follow-up: the Contractor will review and follow-up on all incidents reported.
The Contractor will provide sufficient information, review, and follow-up to take the process and
report to its completion. An incident will not be categorized as complete until the following
information is provided:
14.3.1. A summary of any incident debriefings or review process dispositions;
14.3.2. Whether the person is in custody (jail), in the hospital, or in the community, and if in the
community whether the person is receiving services. If the client cannot be located, the
Contractor will document in the Incident reporting system the steps that the Contractor took
to attempt to locate the client by using available local resources;
14.3.3. Documentation of whether the client is receiving or not receiving mental health services
from the Contractor at the time the incident is being closed.
14.3.4. In the case of a death of the client, the Contractor must provide either a telephonic
verification from an official source or via a death certificate.
14.3.5. In the case of a telephonic verification, the Contractor will document the date of the contact
and both the name and official duty title of the person verifying the information.
14.3.6. If this information is unavailable, the attempt to retrieve it will be documented.
15. INFORMATION REQUIREMENTS
15.1. The Contractor must provide information to enrollees that complies with the requirements of 42 CFR
§438.100, §438.10, §438.6(i)(3) or any successor.
15.2. The Contractor shall maintain written policy and procedures addressing all information requirements,
and shall;
15.2.1. Ensure equal access to mental health services for enrollees with communication barriers
or sensory impairments.
15.2.2. Ensure that Mental Health Professionals and MHCPs have an effective mechanism to
communicate with Enrollees with sensory impairments.
15.2.3. Provide interpreter services if necessary for enrollees with a primary language other than
English for all interactions between the enrollee and the Contractor including, but not
limited to, customer service, all appointments for any covered service, crisis services, and all
steps necessary to file a concern or grievance.
15.2.3.1.
The Contractor and affiliated service providers must maintain a log of all
enrollee requests for interpreter services, or translated written material.
15.2.3.2.
Provide written translations of generally available materials including, at
minimum, applications for services, consent forms and Benefits Booklets, in
each of the DSHS prevalent languages that are spoken by five percent (5%) or
more of the population of the State of Washington based on the most recent US
census. Currently, Spanish is the language requiring written translations.
15.2.3.3.
The other DSHS Prevalent languages are Cambodian, Chinese, Korean,
Laotian, Russian, Somali, Spanish and Vietnamese. The Mental Health
Benefits booklet which includes client rights has been provided to the
Contractor by DBHR. The expectation is that this material is readily available
to enrollees at all times from the Contractor.
15.2.3.4.
These materials may be provided in English if the enrollee’s primary language
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is other than English but the enrollee can understand English and is willing to
receive the materials in English. The enrollee’s consent to receiving
information and materials in English must be documented in the enrollee’s
chart.
15.2.3.5.
For enrollees whose primary language is not identified above and translated,
the requirement may be met by providing the information through audio or
video recording in the enrollee’s primary language, having an interpreter read
the materials in the enrollee’s primary language or providing materials in an
alternative format that is acceptable to the enrollee. If one of these methods is
used it must be documented in the enrollee’s chart.
15.2.3.6.
The Contractor and affiliated service providers shall post a multilingual notice
in each of the DSHS prevalent languages, which advises consumers that
information is available in other languages and how to access this information.
15.2.3.7.
The Contractor and affiliated service providers shall post a translated copy of
the consumer rights as listed in the Mental Health Benefits Booklet in each of
the DSHS prevalent languages.
15.3. Upon an enrollee’s request, the Contractor shall make available and provide:
15.3.1. Oral interpretation service free of charge to the enrollee;
15.3.2. Information regarding benefits and authorization requirements;
15.3.3. Identification of individual Mental Health Care Providers (MHCP) who are accepting new
enrollees;
15.3.4. Community Mental Health Agency (CMHA) licensure, certification and accreditation status;
and
15.3.5. Information that includes but is not limited to, education, licensure, and Board certification
and/or re-certification of mental health professionals and MHCPs.
15.4. The Contractor shall use the Mental Health Benefits Booklet published by DBHR as the mechanism
by which Enrollees are notified of their benefits, rights, and responsibilities.
15.4.1. The Contractor shall inform every Enrollee at the time of an intake evaluation that the
Benefits Booklet produced by DBHR and the Benefits Booklet produced by TMRSN are
available anytime upon request. Booklets may be downloaded from:
http://www.co.thurston.wa.us/health/ssrsn and
http://www1.dshs.wa.gov/Mentalhealth/benefits.shtml.
15.4.2. The Contractor shall provide interpreter services for Enrollee’s who speak a primary
language other than English and shall use a DSHS authorized vendor, which may include
CTS Language link; http://hca.ctslanguagelink.com/.
15.4.2.1.
The Contractor shall maintain a log of all requests for interpreter services or
written translated materials. Logs must be made available to TMRSN upon
request.
15.5. Customer Service
15.5.1. The Contractor shall provide Customer Service that is customer friendly, flexible, proactive,
and responsive to Consumers, families, and stakeholders. The Contractor shall provide a
local calling area telephone number and a toll free number.
15.5.2. At a minimum, Customer Services shall include:
15.5.2.1.
Prompt answering of telephone calls with minimum wait time, from
Consumers, family members and stakeholders from 8 a.m. until 5:00 p.m.
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Monday through Friday, holidays excluded.
15.5.2.2.
Maintenance of an after hours and holiday telephone answering system that
informs callers of hours of operation, scheduled closings, and options for
reaching on call staff after hours.
15.5.2.3.
Responding to Consumers, family members and stakeholders in a manner that
resolves their inquiry. Staff must have the ability to respond to those with
limited English proficiency or hearing loss.
15.5.2.4.
Staff that is trained to route calls to the appropriate staff or department with
minimal redialing.
16. QUALITY MANAGEMENT
16.1. All performance measures, reviews, and audits included under this contract shall meet the minimum
standard of 90% to be considered compliant. For any measure that has a varying percentage, TMRSN
will identify that measure separately. Measures that fall below 90% are subject to corrective and/or
remedial actions per Section 23.
16.2. The Contractor shall maintain an ongoing, planned and systematic organization-wide quality
management process to measure, asses, analyze and improve its performance. At minimum, the
Contractor shall monitor their internal quality management systems and provide monitoring
results/outcomes to TMRSN upon request. Monitoring shall include;
16.2.1. Bed utilization of the ETU and CSTU targeted at 95% occupancy.
16.2.2. Quality Improvement activities including Performance Improvement Projects.
16.2.3. Implementation of Practice Guidelines and Evidence Based Practices.
16.2.4. Staff productivity which is driven by the most current actuarial performed by DSHS.
Productivity levels shall meet or exceed a minimum of 50% towards direct care services.
16.2.5. Staff training requirements per Section 19.
16.2.6. Data accuracy, integrity, and encounter validation
16.2.7. Coordination efforts with primary medical care.
16.3. The Contractor shall monitor and provide quarterly reports per Section 24 on the following
performance measures:
16.3.1. Data for each seclusion and restraint event, including;
16.3.1.1.
Causes of seclusion/restraint use;
16.3.1.2.
Alternatives attempted;
16.3.1.3.
Frequency and duration of use;
16.3.1.4.
Regulatory compliance;
16.3.1.5.
Documentation;
16.3.1.6.
Results and/or adverse outcomes;
16.3.1.7.
Staff training;
16.3.1.8.
Seclusion and restraint reduction measures.
16.4. The Contractor shall conduct internal chart reviews and submit results to TMRSN upon request.
Review shall include the quality and timeliness of clinical record requirements, including, but not
limited to;
16.4.1. Individualized Service/Treatment Plans;
16.4.2. Consumer Rights;
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16.4.3. Efforts to create and support mental health services that are driven by and incorporate the
voice of the Client and those they identify as family;
16.4.4. The degree to which mental health services delivered are age, culturally and linguistically
competent;
16.4.5. Efforts to create and support services that promote Enrollee recovery and resiliency;
16.4.6. Monitoring activities to ensure that services are offered and provided in the most appropriate
and least restrictive environment.
16.4.7. Efforts to provide services that are integrated and coordinated with other formal/informal
allied service delivery systems.
16.5. The Contractor shall also monitor additional quality activities and submit results to TMRSN upon
request. Activities shall include;
16.5.1. Service utilization, with particular attention to outliers (over and under utilization of
services).
16.5.2. Cumulative responses to Enrollee surveys and how they are included into overall quality
improvement.
16.5.2.1.
Surveys included may be those solicited by the Contractor, DSHS, and
TMRSN QRT.
16.5.3. Enrollee Concerns and Grievances and how they are included into overall quality
improvement.
16.5.4. The Contractor shall provide quality improvement feedback to staff and other interested
parties. The Contractor shall maintain documentation of the activities and provide the
documentation to TMRSN upon request.
16.6. Quality Review Activities
16.6.1. Thurston Mason RSN will engage in ongoing quality improvement activities throughout the
year. This includes conducting clinical, program, and utilization reviews. Ongoing quality
improvement reviews are announced and the Contractor is expected to participate by:
16.6.1.1.
Ensuring that clinical records are available for review;
16.6.1.2.
Ensuring that staff are present for interviews during program reviews;
16.6.1.3.
Creating Program Improvement Plans (PIPs) in response to any TMRSN
findings as a result of the quality improvement review; and
16.6.1.4.
Enacting recommended programmatic and clinical changes once the PIP has
become finalized.
16.6.2. Thurston Mason RSN and Thurston County or any of their duly-authorized representatives,
may conduct announced and unannounced:
16.6.2.1.
Surveys, audits and reviews of compliance with licensing and certification
requirements and the terms of this Contract;
16.6.2.2.
Contract, chart, and data quality compliance;
16.6.2.3.
Reviews regarding the quality, appropriateness, and timeliness of mental health
services provided under this Contract; and
16.6.2.4.
Inspections and/or audits of financial records.
16.6.3. The Contractor shall notify TMRSN when an entity other than TMRSN performs any audit
or review described above related to any activity contained in this Contract.
16.6.4. The Contractor shall submit to working with TMRSN annually for the EQRO monitoring
review and schedule a time for the monitoring review that works for both parties.
16.6.5. The Contractor shall participate with TMRSN and DSHS in completing the annual Mental
Health Statistics Improvement Project (MHSIP) surveys. Participation must include at a
minimum:
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16.6.5.1.
16.6.5.2.
Provision of accurate enrollee contact information to TMRSN.
Involvement in the analysis of results and development of system
improvements based on that analysis on a statewide basis.
16.6.5.3.
Incorporation of the results into specific quality improvement activities.
16.7. Agency Licensing and Credentialing
16.7.1. Maintain DSHS and Department of Health (DOH) licensure and certification necessary as
“Residential Treatment Facility”, “Mental Health Adult Residential Treatment Facility” for
the whole facility, and “Mental Health Inpatient Evaluation and Treatment Facility” for the
services and space where Evaluation and Treatment Services voluntary and involuntary are
to be provided.
16.7.2. Maintain certification as “Inpatient Evaluation and Treatment Facility” and “Community
Support Service Provider” in accordance with chapter 388-865 WAC.
16.7.3. Maintain certification as an “Inpatient Evaluation and Treatment Facility” in accordance
with Chapter 388-865 WAC and its revisions for the facility space and Evaluation and
treatment services to be provided. Maintain all other necessary certifications per WAC 388865 for the facility space and all other program services.
16.7.4. The Contractor shall meet licensing requirements for a community mental health agency as
defined in WAC 388-877 and 388-877A, as they now exist or are hereinafter amended. The
Contractor shall ensure that appropriately licensed and certified staff is employed when
required by State and Federal regulations and statutes.
16.7.5. All services to adults, older adults, children, and special populations shall include those
requirements as described in State WACs 388-865 and 388-877 and any successor. The
Contractor shall submit copies to TMRSN of agency licenses, certifications, and proof of
insurance annually when renewed.
16.7.6. The Contractor must participate in an agency credentialing process at least every two years.
Type of credentialing application, either a complete or recredential, as well as the date of the
application process, shall be determined by TMRSN.
16.7.7. The Contractor shall notify TMRSN immediately if there is any change in licensing status or
in the event a license or certification is revoked or not renewed.
16.7.8. The Contractor shall submit copies of agency licenses and DSHS and DOH certifications
annually when renewed.
17. CLIENT RIGHTS AND PROTECTIONS
17.1. The Contractor and affiliated service providers shall comply with any applicable Federal and State
laws that pertain to enrollee rights and ensure that its staff takes those rights into account when
furnishing services to enrollees. Any changes to applicable law must be implemented with 90 days of
the effective date of change.
17.2. The Contractor shall maintain written policies and procedures addressing all requirements under this
section. Polices must comply with all regulations, laws, contract, and documents as listed under
Section 1 of this contract.
17.3. The Contractor must ensure that each enrollee is free to exercise his or her rights, and that the
exercising of those rights does not adversely affect the way the Contractor and its providers treat the
enrollee.
17.4. The Contractor shall require that mental health professionals and MHCPs, acting within the lawful
scope of mental health practice, are not prohibited or restricted from advising or advocating on behalf
of an enrollee with respect to:
17.4.1. The enrollee’s mental health status;
17.4.2. Receiving all information regarding mental health treatment options including any
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alternative or self-administered treatment, in a culturally-competent manner;
17.4.3. Any information the enrollee needs in order to decide among all relevant mental health
treatment options;
17.4.4. The risks, benefits, and consequences of mental health treatment (including the option of no
mental health treatment);
17.4.5. The enrollee’s right to participate in decisions regarding his or her mental health care,
including the right to refuse mental health treatment and to express preferences about future
treatment decisions;
17.4.6. The enrollee’s right to be treated with respect and with due consideration for his or her
dignity and privacy;
17.4.7. The enrollee’s right to be free from any form of restraint or seclusion used as a means of
coercion, discipline, convenience, or retaliation;
17.4.8. The enrollee’s right to request and receive a copy of his or her medical records, and to
request that they be amended or corrected, as specified in 45 CFR part 164.
17.5. Enrollee’s Rights
17.5.1. The Contractor shall ensure enrollee’s, prospective enrollee’s and legally responsible others
are informed, in prevalent non-English languages as described in under this section, of their
rights per 42 CFR Part 438.100 and WAC 388-877-0600 or any successors.
17.5.2. Post a written statement of enrollee rights in public areas with a copy available to enrollees
on request.
17.5.3. Ensure the statement of enrollee rights incorporates DBHR enrollee’s rights listed in the
DBHR Handbook.
17.5.4. The Contractor shall ensure that all enrollees on LRAs are informed as to their rights
pertaining to Chapter 71.05 RCW, or any successor, and provided all applicable services.
17.6. Additional Rights for Consumers on Less Restrictive Alternative:
17.6.1. To have access to an attorney, the court and other legal redress
17.6.2. To be told statements the consumer makes may be used in the involuntary proceedings
17.6.3. To be advised of rights if detained or committed under RCW 71.05 including, but not
limited to:
17.6.3.1.
To wear his or her own clothes and to keep and use his or her own personal
possessions, except when deprivation of same is essential to protect the safety
of the resident or other person;
17.6.3.2.
To keep and be allowed to spend a reasonable sum of his or her money for
canteen expenses and small purchases;
17.6.3.3.
To have access to individual storage space for his or her private use;
17.6.3.4.
To have visitors at reasonable times;
17.6.3.5.
To have reasonable access to a telephone, both to make and receive
confidential calls;
17.6.3.6.
To have ready access to letter writing materials, including stamps, and to send
and receive uncensored correspondence through the mail;
17.6.3.7.
Not to consent to the administration of antipsychotic medications beyond the
hearing conducted pursuant to RCW 71.05.320(2) or the performance of
electro-convulsant therapy or surgery, except emergency life-saving surgery,
unless ordered by a court of competent jurisdiction pursuant to the standards
and procedures;
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17.6.3.8.
To dispose of property and sign contracts unless such person has been
adjudicated an incompetent in a court proceeding directed to that particular
issue;
17.6.3.9.
Not to have psychosurgery performed on him or her under any circumstances;
17.6.3.10. Be presumed competent and not lose any civil rights as a consequence of
receiving evaluation and treatment for a mental disorder;
17.6.4. Any person who leaves a public or private agency following evaluation or treatment for
mental disorder shall be given a written statement setting forth the substance of Section 450
of RCW 71.05 and WAC 388-865-0566.
17.6.5. To have the DMHP or Peace Officer take reasonable precautions to safeguard personal
property, including locking the home or other property as soon as possible after being
detained.
17.7. Additional Rights for Consumers in Long-term Care Facilities:
17.7.1. To receive appropriate services
17.7.2. To be treated with courtesy
17.7.3. To continue to enjoy their basic rights
17.7.4. To have the opportunity to exercise reasonable control over life decisions, including but not
limited to:
17.7.4.1.
Choice, participation, privacy, and the opportunity to engage in religious,
political, civic, recreational, and other social activities foster a sense of selfworth and enhance the quality of life for long-term care residents.
17.7.4.2.
To receive care in a manner and in an environment that promotes maintenance
or enhancement of each resident's quality of life, including but not limited to:
17.7.4.2.1. A safe, clean, comfortable, and homelike environment, allowing
the resident to use his or her personal belongings to the extent
possible.
17.7.4.2.2. The right to personal privacy and confidentiality of his or her
personal and clinical records. Personal privacy includes, but is
not limited to:
 Accommodations, medical treatment, written and telephone
communications, personal care, visits, and meetings of
family and resident groups.
17.8. Enrollee Voice in Treatment and Decision Making
17.8.1. The Contractor shall ensure informed consent to treatment and enrollee access to his or her
medical records in accordance with WAC 388-877-0650 or any successor.
17.8.2. For enrollee’s under the age of 13 or adults with a legal guardian, appropriate documentation
of the informed consent of the guardian must be in the enrollee’s medical record chart.
17.8.3. Every enrollee, and their family, and/or other natural supports, if appropriate and authorized
by the enrollee, have a voice in the ongoing process of treatment planning and decisionmaking. Enrollee voice shall be demonstrated through:
17.8.3.1.
Enrollee signature, if age 13 or older;
17.8.3.2.
Enrollee’s parent or guardian or legal representative, if age 12 or under;
17.8.3.3.
Enrollee quotes and input on treatment plans and 180-treatment plan reviews.
17.8.4. Enrollee quotes and input during the discharge planning process, to include the discharge
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summary.
17.8.5. Every enrollee has a choice of contracted CMHA (if more than one is available) within
his/her county of residence from which to receive mental health services.
17.8.6. An enrollee may change providers and/or direct service staff based on need and fit of
service.
17.9. Individual Service Plans must be developed in compliance with WAC 388-877-0620 and 388-877A0135.
17.9.1. In addition, the Contractor shall require that enrollees are actively included in the
development of their individualized service plans, periodic (every 180 days) service plan
reviews, advance directives for psychiatric care, and crisis plans (Section 17.10).
17.9.1.1.
This shall include but not be limited to children and their families (e.g.
caregivers and significant others, parents, foster parents, assigned/appointed
guardians, siblings).
17.9.2. At a minimum, individual service plans must include:
17.9.2.1.
A problem or needs statement that is in the words of the enrollee to be best
extent possible;
17.9.2.2.
Services mutually agreed upon by both the individual and provider for this
treatment episode;
17.9.2.3.
At least one goal that is in the words of the enrollee to the best extent possible,
and that directly relates to the problem or needs statement, and to identified
needs from the intake assessment;
17.9.2.4.
Measurable outcomes and strategies. These are measurable steps the enrollee
agrees to attempt in order to meet his/her overarching goal. These are
sometimes referred to as objectives or benchmarks;
17.9.2.5.
Service modalities; and
17.9.2.6.
Discharge criteria, agreed upon between the Contractor and the enrollee, that
clearly specifies when the treatment goal has been reached and the enrollee can
either be discharged, or a new service plan developed.
17.9.3. Individualized service plans must be reviewed upon re-authorization requests, per the
TMRSN LOC Guidelines, or at a minimum every six (6) months, and must include the
following elements:
17.9.3.1.
An evaluation of service modality effectiveness towards treatment progress;
17.9.3.2.
A review of unmet treatment goals and needs;
17.9.3.3.
The enrollee’s voice in describing personal progress towards their stated goals
and measurable outcomes; and
17.9.3.4.
A method of determining if the enrollee has met discharge criteria or if further
treatment is warranted.
17.9.4. The Individual Service Plan shall address the overall identified needs of the enrollee,
including those that may be best met by another service delivery system, such as education,
primary medical care, child welfare, drug and alcohol, developmental disabilities, aging and
adult services, corrections and juvenile justice as appropriate. If the treatment plan identifies
one of those services, the Contractor shall ensure coordination with the other service
delivery systems that shall be responsible for meeting those identified needs.
17.9.5. An individual peer support plan may be incorporated into the Individual Service Plan.
17.10. Risk Assessment and Crisis Plans
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17.10.1. The Contractor shall adopt a standardized risk assessment instrument that will assist the
mental health professional (MHP) in determining future crisis prevention services.
17.10.2. The Contractor shall perform a risk assessment when it is clinically indicated and in the best
interest of the enrollee.
17.10.2.1. At the time of the initial intake assessment the enrollee presents with current
and significant risk of harm to self or others.
17.10.2.2. At the time of the initial intake assessment the enrollee presents with a history
of significant self-injurious or suicidal behaviors within the past six (6) months
from the date of the intake.
17.10.2.3. Any time during the episode of care the enrollee presents with self-injurious or
suicidal behaviors, or presents a risk to others.
17.10.3. The Contractor shall utilize the risk assessment tool as a guide to evaluate the level of risk of
the enrollee and to determine if the level of risk requires a crisis plan. If it is determined a
crisis plan is required, the plan:
17.10.3.1. Shall be written with the enrollee and other natural supports, as available.
17.10.3.2. Can be written in the form of an advance directive.
17.10.3.3. Shall be entered into the MIS within thirty (30) days.
17.10.3.4. Shall include the following elements:
17.10.3.4.1. Date completed;
17.10.3.4.2. Dependent record , to include information on persons and pets;
17.10.3.4.3. Prescriber name;
17.10.3.4.4. Prescriber phone number;
17.10.3.4.5. Current substance abuse/chemical dependency issues;
17.10.3.4.6. High risk and de-compensation patterns; and
17.10.3.4.7. Plan for care providers, emergency personnel and others who
might be responding to the actual crisis.
17.10.4. The Contractor shall ensure that the enrollee is provided with a copy of their crisis plan upon
completion.
17.10.5. The Contractor shall re-evaluate the enrollee’s risk to self or others as determined by the risk
assessment score and will complete a new risk assessment at every treatment plan review,
per TMRSN’s Level of Care Guidelines, until the risk assessment score is at an acceptable
level (less than 4). An updated crisis plan shall be developed at six (6) months if necessary.
17.11. Choice of Mental Health Care Provider (MHCP)
17.11.1. The Contractor shall offer each enrollee a choice of an open MHCP accepting new client’s
within the Contractor’s agency. If the enrollee does not make a choice, the Contractor or its
designee must assign an MHCP no later than 14 calendar days following the request for
mental health services. The enrollee may change MHCPs during the first 90 calendar days of
enrollment and once during a twelve-month period for any reason. Any additional change of
an MHCP requested by an enrollee during a twelve-month period may be approved at the
Contractor’s discretion, provided that justification for the change is documented.
17.11.2. For continuity of care, the Contractor shall encourage the subcontractor(s) to assign
enrollees to clinicians who are anticipated to provide services to the enrollee throughout the
authorization period.
17.12. Second Opinions
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17.12.1. The Contractor shall provide, upon request, a second opinion from another Network
Provider within the Service Area. If an additional Provider is not currently available within
the network, the Contractor must provide or pay for a second opinion provided by a
Network Provider outside the network at no cost to the enrollee. The Provider providing the
second opinion must hold a contract with a RSN to provide mental health services to
Medicaid enrollees. The appointment for a second opinion must occur within 30 calendar
days of the request. Only the enrollee may request to postpone the second opinion to a date
later than 30 calendar days.
17.13. Enrollees Non-Liability
17.13.1. The Contractor shall ensure enrollees are not held liable for any of the following covered
metal health services:
17.13.1.1. Provided by insolvent community psychiatric hospitals with which the
Contractor has directly contracted.
17.13.1.2. Including those purchased on behalf of the enrollee.
17.13.1.3. For which the State does not pay the Contractor.
17.13.1.4. Provided to the enrollee, for which the State or TMRSN does not pay the
Contractor that furnishes the services under a contractual, referral, or other
arrangement.
17.13.1.5. Payments for covered services furnished under a Contract, referral, or other
arrangement, to the extent that those payments are in excess of the amount that
the enrollee would owe if the Contractor provided the services directly.
17.13.1.6. Provided by insolvent federally funded RSNs.
17.14. Thurston Mason RSN Mental Health Ombuds Services
17.14.1. The Contractor shall:
17.14.1.1. Provide information to enrollees regarding the availability of Ombuds’ services
for assistance in resolving a specific enrollee’s concern or grievance.
17.14.1.2. Respond to the Ombuds’ requests or inquiries within 24 hours of the initial
contact by the Ombuds’.
17.14.1.3. Provide the Ombuds with reasonable access to enrollees, service sites, and
records relating to the enrollee, with written consent, for the purpose of
outreach and resolving concerns and grievances.
17.14.1.4. Take no measure or action that might threaten, intimidate, or otherwise
diminish the ability of the Ombuds to fairly and independently execute her
duties, and assure there will be no retaliation against the enrollee/grievant.
17.14.1.5. Respond in writing to recommendations of the Ombuds regarding possible
changes in the delivery of services to meet enrollee needs within 30 calendar
days of any recommendation from the Ombuds.
17.14.1.6. Comply with WAC 388-865-0250 or any successor.
17.14.1.7. Continue to serve the enrollee while addressing the issue contained in a
concern or grievance.
17.14.1.8. Work with the enrollee and Ombuds towards an agreeable resolution in the
best interest of the enrollee.
17.14.1.8.1. If the Contractor and the Ombuds do not agree on a suggested
resolution, the Contractor and the Ombuds shall contact the
TMRSN Grievance Coordinator for assistance.
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17.14.1.9.
Identify the staff that is responsible for coordinating the agency’s information
and response regarding the resolution of any concern or grievance.
17.15. Advance Directives
17.15.1. The Contractor shall maintain a written Advance Directive policy and procedure that
respects enrollees' Advance Directives for psychiatric care and medical Advance Directives.
If State law changes, TMRSN shall send notice to the Contractor who must then ensure the
provision of notice to enrollees within 90 days of the change.
17.15.2. The Contractor shall inquire whether Enrollees have active Medical Advance Directives, and
shall provide those who express an interest in developing and maintaining Medical Advance
Directives with information about how to initiate a Medical Advance Directive.
17.15.3. The Contractor shall inform all Enrollees of their right to a Mental Health Advance
Directive, and shall provide technical assistance to those who express an interest in
developing and maintaining a Mental Health Advance Directive.
17.15.4. The Contractor shall inform enrollees that complaints concerning noncompliance with the
Advance Directive for psychiatric care requirements may be filed with HRSA by contacting
the Compliance section at (360) 236-2620.
17.15.5. The Contractor shall attend trainings on Advance Directives through DBHR, TMRSN, or
Ombuds and disseminate information to enrollees and family members of enrollees.
17.15.6. Inform enrollees in writing about an Advance Directive in anticipation of clinical situations
where enrollees are unable to advocate or provide clear information for him or herself.
17.15.7. Assist and/or refer the enrollee to the Ombuds for assistance in developing and
implementing Advance Directives for psychiatric care.
17.15.8. Inform the enrollee in writing that he/she has the right to choose whether or not to have an
Advance Directive. A record of the enrollees signed statement of their choice shall be
maintained in the enrollee’s record per 42 CFR 438.10 (g) or any successor.
17.15.9. Advance Directives shall be used as ancillary assistance to any concurrent psychiatric
assessment or community based needs assessment for an acute episode, provided that the
directive is clinically appropriate to the enrollee's needs and condition at the time.
17.15.10. Make available as part of, or in lieu of the crisis plan, an advanced directive, if the
enrollee so chooses.
17.15.11. Assist the enrollee in making their Advance Directive available to those individuals
identified in the plan.
17.15.12. Provide access and support to all TMRSN identified individuals including but not limited
to the Ombuds, to provide training and support to enrollees interested in developing an
Advance Directive, on site, at the Contractor’s facility.
18. MANAGEMENT INFORMATION SYSTEM
18.1. Data Submission and Error Correction
18.1.1. The Contractor shall provide TMRSN with all data and encounters described in the TMRSN
Data Dictionary that includes the Reporting Guidelines for programs and services, the
TMRSN HIPAA and Native Transaction Companion Guides, and the TMRSN File and Data
Submission Guide, or, any successors, incorporated herein by reference.
18.1.2. The Contractor shall have in place policies, procedures and/or instructions that address all
requirements under Section 18 of the contract.
18.1.3. The Contractor shall electronically submit to or enter encounters directly into the TMRSN
Managed Care Organization (MCO) Management Information System (MIS) within 45
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18.1.4.
18.1.5.
18.1.6.
18.1.7.
18.1.8.
calendar days from the date of service.
18.1.3.1.
Accurate encounters accepted by TMRSN will be included for payment
according to Exhibit B, the Compensation section of this contract, including
any amendments to Exhibit B. The cut-off dates for service submission and
payment is the Friday before “Date Invoice for Review by Thurston County &
Providers” as listed in Exhibit B.
18.1.3.2.
No submitted encounter shall be accepted for initial entry/submission or data
correction after one year from the date of service, unless by special exception.
The Contractor shall submit or enter all other required staff data, client data, and electronic
documentation within ten (10) calendar days from the date of collection or receipt, as this
data is required for encounter submissions/entries to be processed and accepted.
18.1.4.1.
Periodic Review data shall be submitted or entered upon admission, at change,
and at discharge for enrolled clients. At a minimum, the primary case manager
of record shall review the entire periodic review record for accuracy and
submit changes for entry into the Contractor MIS at least every six (6) months.
18.1.4.2.
If a crisis plan is necessary, the Contractor must submit an electronic file of the
client’s crisis plan to the RSN MCO MIS within 30 days of admit or when it is
determined a crisis plan is needed, per Section 17.10.
Upon receipt of Contractor data and encounters, TMRSN will generate error reports. The
Contractor shall have in place documented procedures to ensure that data submitted/entered
and pended/denied due to provider errors or incompleteness are corrected and resubmitted
within 30 calendar days of initial submission to TMRSN.
18.1.5.1.
Pended or denied encounters that are not corrected, resubmitted, and accepted
within the 45-day requirement for encounter submission timeliness will not be
considered timely.
18.1.5.2.
In addition, the Contractor shall have in place documented procedures to
ensure that Contractor data submitted by TMRSN that is rejected by DBHR
and/or ProviderOne due to Contractor errors is corrected and resubmitted
within ten (10) calendar days of notification by TMRSN.
The Contractor shall incur all costs including, but not limited to, hardware, equipment
maintenance, software, and connection costs necessary to transmit data and transactions to
the TMRSN MCO MIS and/or access the TMRSN MIS/MCO MIS, the DBHR Enrollee
Information System (DBHR-CIS), and the HRSA ProviderOne system.
The Contractor shall participate in regularly scheduled TMRSN MIS System Operator
(SysOp) Committee meetings. TMRSN and the Contractor’s designated SysOp member(s)
shall work together to respond to inquiries or to assist in TMRSN decisions regarding data
requirements and compliance. Meetings may include changes to data collection and
information systems to meet the terms of this and other contracts, implementation of data
collection requirements, monitoring of MIS access and security, error correction, incomplete
or invalid data issues, and data timeliness.
The Contractor shall implement data-related changes and requirements as directed by and in
coordination with TMRSN Contracts and/or Protocols.
18.1.8.1.
Changes shall be implemented within 90 days from the date of published
changes or as otherwise specified by TMRSN and/or by DBHR. These
changes may be the result of an update to DBHR requirements in the DBHR
Service Encounter Reporting Instructions for RSNs (SERI), the DBHR-CIS
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Data, and/or the ProviderOne Encounter Data Reporting Guide for MCOs and
RSNs, or any of their successors, incorporated herein by reference.
18.1.8.2.
The Contractor shall send at least one test batch of data containing the required
changes no later than 15 days prior to the implementation date.
18.1.8.2.1. The test batch must include a sample of all Programs / Project
codes, Service Activity Codes, and/or other data elements
affected by the change in requirement.
18.1.8.2.2. The processed test batch must result in at least 90% successfully
posted transactions or an additional test batch is required.
18.1.9. For data/information not covered by the TMRSN or DBHR-CIS Data Dictionaries or the
DBHR Service Encounter Reporting Instructions, the Contractor shall ensure that TMRSN
receives requested information in a manner that shall allow for a timely response to requests
or inquiries from TMRSN, Centers for Medicaid Services (CMS), the State Legislature,
DBHR/DSHS, and other parties.
18.2. Contractor and Subcontractor Data Quality Verification
18.2.1. The Contractor shall have in place mechanisms to verify the health information collected
and submitted by the Contractor to TMRSN, as well as all data received from any
Subcontractors. Mechanisms shall include the following:
18.2.1.1.
Verifying the accuracy of Contractor and Subcontractor data by a review of
DBHR, TMRSN, or Contractor error reports, error resolution reports and/or
timeliness reports;
18.2.1.2.
Screening and performing data quality monitoring on all data for accuracy,
completeness, logic, consistency, and timeliness of submission. This includes,
but is not limited to ensuring appropriate services are provided by allowable
staff, that only allowable services are provided within programs, and that all
data requirements and guidelines have been adhered to according to the
TMRSN and DBHR-CIS Data Dictionaries and the DBHR Service Encounter
Reporting Instructions (SERI) for RSNs.
18.2.1.3.
Verifying that duplicative or overlapping services are not submitted to
TMRSN.
18.2.1.4.
In addition, the following is information that is required, at a minimum, for
reporting an encounter to a consumer, documenting that encounter in a
progress note, and submitting that encounter to TMRSN and DBHR:
18.2.1.4.1. Be of sufficient duration to accomplish the therapeutic intent;
18.2.1.4.2. The record must be legible to someone other than the writer;
18.2.1.4.3. Each printed page (front and back if two-sided) of the record
must contain the consumer’s name and agency record number;
18.2.1.4.4. Clinical entries must include the Author identification, which
may be a handwritten signature or unique electronic identifier,
but must be clearly identifiable as to whom the rendering
clinician/staff is;
18.2.1.4.5. Date of the service;
18.2.1.4.6. Time of the service.
 For providers that are unable to submit time of day for the
service in their 837P electronic transaction, this information
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must be provided within 7 days of the initial service
submission date to the RSN in a format that can be
imported into the MCO MIS.
18.2.1.4.7. Location of the service;
18.2.1.4.8. Provider credentials, which must be appropriate to the service
(e.g., medication management can only be done by a prescriber);
18.2.1.4.9. Length of time/service duration;
18.2.1.4.10. Narrative description of the service provided as evidenced by
sufficient documentation that can be translated to a service
description title or code number (this may be standard
CPT/HCPCS or local nomenclature with a RSN approved
crosswalk) and describes therapeutic content;
18.2.1.4.11. The service addresses an issue on the care plan or issue
addressed is added to the care plan; and
18.2.1.4.12. The service is specific to the consumer; e.g., group therapy
progress note is specific to the consumer.
18.2.2. The Contractor shall submit to an administrative and/or on-site MIS audit and Encounter
Data Validation chart audits by TMRSN during this contract period. The audits shall be ISand/or IT-related and shall include, but not be limited to, the review of data, encounters and
data/encounter documentation, internal IS and IT policies and procedures, MIS data
accuracy, timeliness, completeness, and consistency practices, and MIS training practices.
18.3. Data Certification
18.3.1. The Contractor shall provide certification of data and encounters required by this Contract
and submitted to TMRSN. The data and encounters shall be certified by one of the
following:
18.3.1.1.
The Contractor’s Chief Executive Officer (CEO);
18.3.1.2.
The Contractor’s Chief Financial Officer (CFO);
18.3.1.3.
An individual who has delegated authority to sign for and who reports directly
to the CEO or CFO.
18.3.2. The certification shall attest, based on best knowledge, information, and belief, to the
accuracy, completeness, and truthfulness of the data and encounters submitted to TMRSN
according to the following:
18.3.2.1.
For Contractors using TMRSN’s Direct Data Entry (DDE) process to submit
data/encounters, a certification must be provided to TMRSN for each month of
the contract period for all data and encounters submitted within the given
month.
18.3.2.2.
For Contractors submitting electronic transactions/files, a certification must be
provided to TMRSN for each month of the contract period for the batches/files
submitted within the given month.
18.3.2.3.
Data and encounters that contain errors shall not be considered certified until
corrections for all errors are successfully received and processed by TMRSN.
18.3.3. The Contractor shall use only the TMRSN-supplied certification form as provided in
TMRSN Policy IS801: Provider Data Certification.
18.3.3.1.
The Contractor shall submit a signed certification form in either electronic
format or by mail within 60 calendar days from the end of each month in the
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contract period. The Contractor shall ensure that each certification contains an
original signature of the signing authority.
18.4. Information System Security and Protection of Confidential Information
18.4.1. The Contractor shall comply with applicable provisions of the Health Insurance Portability
and Accountability Act (HIPAA) of 1996, codified in 42 USC §1320(d) et.seq. and CFR
parts 160, 162 and 164.
18.4.2. The Contractor shall ensure that confidential information provided through or obtained by
way of this Contract or services provided is protected in accordance with the Data Security
Requirements contained in Exhibit D.
18.4.3. The Contractor shall maintain a statement on file for each employee and all Subcontractor
employees that have access to the Contractor’s electronic health record database or the RSN
MIS/MCO database (such as RSN Look) that is signed by the individual and attested to by a
witness’s signature acknowledging that the individual understands and agrees to follow all
regulations on confidentiality.
18.4.3.1.
Contractor staff requiring access to the TMRSN database must be granted
access based on “need-to-know” or role-based security standards in accordance
with HIPAA Security Rule guidelines, TMRSN policies and procedures, the
Business Associate Agreement Addendum, and TMRSN MIS Instructions.
18.4.3.2.
The Contractor shall provide the appropriate confidentiality and security
training to personnel that have access to client confidential data (Protected
Health Information or PHI).
18.4.4. The Contractor shall take appropriate action if a Contractor or Subcontractor employee
wrongly or willfully releases confidential information according to HIPAA requirements
and applicable TMRSN Policy and Procedures.
18.5. Business Continuity and Disaster Recovery
18.5.1. The Contractor shall demonstrate a primary and backup system for electronic submission of
data required or requested by TMRSN and DBHR. This must include the use of the InterGovernmental Network (IGN), Information Systems Services Division (ISSD), Thurston
County approved secured Virtual Private Network (VPN), or other approved dial-up. In the
event these methods of transmission are unavailable and immediate data transmission is
necessary, an alternate method of submission shall be considered based on TMRSN and/or
DBHR approval.
18.5.2. The Contractor shall create and maintain a business continuity and disaster recovery plan
that ensures timely reinstitution of their connectivity and access to the MIS following a total
loss of primary connection or a substantial loss of functionality. The plan must be in written
format, have an identified update process (at least annually), and a copy must be stored off
site.
18.5.3. The Contractor must require a business continuity and disaster recovery plan for all
Subcontractors that are required to submit data and/or encounters either electronically or by
other means such as a Service Activity Log (SAL), an MIS Demographic or Short Form, or
a copy of a Subcontractor’s invoice if TMRSN-required data is entered and submitted to
TMRSN from these documents.
18.5.4. The Contractor must submit an annual certification statement indicating there is a business
continuity disaster plan in place for both the Contractor and Subcontractors. The
certification must be submitted by January 1 of each year of this Agreement. The
certification must indicate that the plans are up to date, the system and data backup and
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recovery procedures have been tested, and copies of the Contractor and Subcontractor plans
are available for TMRSN, DBHR, and or the contracted EQRO to review and audit. The
business continuity and disaster recovery plan must address the following:
18.5.4.1.
A mission or scope statement;
18.5.4.2.
An appointed Information Services Disaster Recovery Team;
18.5.4.3.
Provisions for Backup of Key personnel; Identified Emergency Procedures;
Visibly listed emergency telephone numbers
18.5.4.4.
Procedures for allowing effective communication; Applications Inventory and
Business Recovery priority; Hardware and software vendor list;
18.5.4.5.
Confirmation of updated system and operations documentation; Process for
frequent backup of systems and data;
18.5.4.6.
Off-site storage of system and data backups; Ability to recover data and
systems from back-up files;
18.5.4.7.
Designated recovery options, which may include use of a hot or cold site; and
18.5.4.8.
Evidence that disaster recovery tests (data recovery from a back-up file) or
drills have been performed.
19. PERSONNEL AND STAFF TRAINING
19.1. The Contractor, through delegation, shall verify all staff credentials, education, and competency prior
to initiating work with clients.
19.1.1. Ensure Mental Health Professionals, Designated Mental Health Professionals, and Mental
Health Specialists are credentialed in accordance with TMRSN Policy SD230 Credentialing
of Mental Health Professionals and Specialists and TMRSN Policy SD231 Designated
Mental Health Professionals.
19.2. The Contractor shall conduct upon hire and at every annual employee review a criminal background
check and an excluded provider check through the Office of Inspector General (OIG).
19.2.1. Any staff to be found on the OIG Excluded Provider Lists or to have committed a crime
listed on the DSHS Secretary Lists of Crimes and Negative Actions (available at
http://dshs.wa.gov/bccu/bccucrimeslist.shtml), must immediately stop providing any
services under this contract or any other contract between TMRSN and the Contractor.
19.3. Document that staff, clinical supervisors, and management staff are qualified, as set forth in WAC
388-865-0551, for the positions they hold and have the education, experience, or skills to perform job
functions.
19.4. Assign, orient, supervise, monitor and perform regularly scheduled performance review sessions for
all staff positions.
19.5. The Contractor shall conduct or make available formal training for all staff pertinent to their position.
An individualized annual training plan must be implemented for each direct service staff person and
supervisor, to include at a minimum:
19.5.1. The skills he or she needs for his/her job description and the population served;
19.5.2. Least restrictive alternative options available in the community and how to access them;
19.5.3. Managing assaultive/aggressive behavior, including proper use of seclusion and/or restraint
procedures;
19.5.4. Safety and violence prevention per RCW 49.19.030;
19.5.5. Confidentiality of records and client information;
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19.5.6. Quality assurance and process improvement;
19.5.7. Emergency / Disaster Response;
19.5.8. Consumer’s Rights;
19.5.9. TMRSN Grievance System;
19.5.10. Professional Ethics and Fraud and Abuse;
19.5.11. Suicidal risk identification and intervention;
19.5.12. Cultural diversity and sensitivity training;
19.5.13. Strategies for treatment-resistant Consumers and discharge planning;
19.5.14. Utilizing natural supports, building on Consumer strengths, and recovery and resiliency;
19.5.15. Basic Life Support (CPR and first aid);
19.5.16. Infection control, including HIV / AIDS;
19.5.17. Customer Service with Behaviorally Challenged Consumers; and
19.5.18. Psychotropic medications (if applicable).
19.6. Ensure all Registered Nurses shall have training in the following topics annually:
19.6.1. Invasive nursing procedures;
19.6.2. High risk / low frequency nursing procedures;
19.6.3. Psychotropic medication update;
19.6.4. Laws and trends related to the use of seclusion and restraint; and
19.6.5. Delegation of tasks.
19.7. The Contractor shall maintain a central record of all trainings provided and who attended, as well as
document in staff personnel files completion of trainings, and other educational pursuits, and whether
staff attended in person or training was obtained through electronic media.
19.8. Ensure all trainings are provided as required by federal or state laws, rules and regulations, and in
accordance with professional standards of practice and the terms of this Contract, including
provisions for annual training and staff development under individualized staff training plans.
20. GRIEVANCE SYSTEM
20.1. The Contractor is required to have a Grievance system that complies with the requirements of
TMRSN Policy QM603: Grievances and TMRSN AP1101: Grievance Plan, as well as the
requirements of this Contract.
20.2. The Contractor must provide information about the Grievance System to all Enrollee’s.
20.3. The Contractor shall have policies and procedures addressing the grievance system, which comply
with the requirements of this Contract.
20.4. The Contractor shall provide enrollees with any assistance necessary to complete forms and other
procedural steps for Grievances. Assistance may be provided by the Ombuds serving the Contractors
geographic area, the Enrollee’s provider, the Contractor, or any other person of the enrollee’s choice.
20.5. An Enrollee or their authorized representative may file a Grievance either orally or in writing with
the Contractor or its providers.
20.6. Recordkeeping and Reporting Requirements:
20.6.1. If an Enrollee expresses a concern that can be categorized into one of the topics below, it
shall be considered a grievance and shall be reported to TMRSN. The Contractor shall report
all Grievances to the TMRSN Quality Manager on the Provider Grievance Notification
Form attached herein. Topics include:
20.6.1.1.
Access to Outpatient
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20.6.1.2.
Dignity and Respect
20.6.1.3.
Quality/Appropriateness
20.6.1.4.
Phone Call Not Returned
20.6.1.5.
Service: Intensity, Not Available, Coordination
20.6.1.6.
Consumer Rights
20.6.1.7.
Physicians and Medications
20.6.1.8.
Financial and Admin Services
20.6.1.9.
Transportation
20.6.1.10. Emergency Services
20.6.1.11. Violation of Confidentiality
20.6.1.12. Access to Inpatient Services
20.6.2. The Contractor shall complete the report form located on the TMRSN website at
https://ftp.co.thurston.wa.us/tmrsn-report/index.aspx for each concern or grievance received
by the Contractor.
20.6.3. The Quality Manager will review the concern/grievance and determine the appropriate
action, which may include follow-up by the Ombuds, TMRSN, or the Contractor.
20.6.4. The Contractor’s grievance system must maintain records of all concerns and Grievances
originating at the Contractor.
20.6.5. The Contractor shall incorporate the results of concerns and grievances, appeals and fair
hearings into its quality management plan and address any trends in a quality improvement
plan.
20.7. Fair Hearings – This function is only available to Medicaid Funded enrollees
20.7.1. Enrollees may request a Fair Hearing conducted by independent state agency in accordance
with WAC 388-02 and provisions of mental health services per WAC 388-865 and 388-877.
20.7.2. The parties to a Fair Hearing include TMRSN, the Contractor as well as the enrollee and his
or her representative or the legal representative of a deceased enrollee’s estate.
20.7.3. A Fair Hearing may be requested from the State of Washing Office of Administrative
Hearings when:
20.7.3.1.
An enrollee believes there has been a violation of DSHS rule.
20.7.3.2.
The Contractor does not provide a written response to a grievance within the
required timeframes.
20.7.3.3.
An enrollee receives an adverse ruling by the Contractor or its agent to a
grievance.
20.7.3.4.
If the enrollee elects to request a Fair hearing, the request must be filed within
20 calendar days from the date of notice of adverse ruling.
20.7.4. TMRSN and/or DBHR will notify the Contractor of hearing determinations. The Contractor
will be bound by the hearing determination, whether or not the hearing determination
upholds the Contractor’s decision.
21. COMMUNITY COORDINATION
21.1. Disaster Response
21.1.1. The Contractor must participate in all disaster preparedness activities and respond to
emergency/disaster events (e.g., natural disasters, acts of terrorism) when requested by
TMRSN and/or DBHR. The Contractor shall:
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21.1.1.1.
Attend TMRSN and DBHR-sponsored training regarding the role of the public
mental health system in disaster preparedness and response.
21.1.1.2.
Participate in local emergency/disaster planning activities when county
Emergency Operation Centers and local public health jurisdictions request
collaboration.
21.1.1.3.
Provide Disaster Outreach in Contractor’s Service Area in the event of a
disaster/emergency; “Disaster Outreach” means contacting person’s in their
place of residence or in non-traditional settings for the purpose of assessing
their mental health and social functioning following a disaster or increasing the
utilization of human services and resources.
21.1.1.4.
There are two basic approaches to outreach: mobile (going to person to person)
and community settings (e.g. temporary shelters, disaster assistance sites,
disaster information forums). The Outreach Process must include the
following:
21.1.1.4.1. Locating persons in need of disaster relief services.
21.1.1.4.2. Assessing their needs.
21.1.1.4.3. Engaging or linking persons to an appropriate level of support or
disaster relief services.
21.1.1.4.4. Providing follow-up mental health services when clinically
indicated.
21.1.1.5.
Disaster Outreach can be performed by trained volunteers, peers and/or
persons hired under a federal Crisis Counseling Grant. These persons should
be trained in disaster crisis outreach which is different than traditional mental
health crisis intervention.
21.1.1.6.
Conduct post-disaster outreach to determine the need for disaster related crisis
counseling and assess the availability of local resources in meeting those
needs.
21.1.1.7.
Provide the name and contact information to TMRSN for person(s)
coordinating the Contractor’s disaster/emergency preparedness and response
upon request.
21.1.1.8.
Provide information and preliminary disaster response plans to TMRSN within
seven days following a disaster/emergency or upon request.
21.1.1.9.
Partner in disaster preparedness and response activities with TMRSN, DBHR
and other DSHS entities, the State Emergency Management Division, FEMA,
the American Red Cross and other volunteer organizations. This must include:
21.1.1.9.1. Participation when requested in local and regional disaster
planning and preparedness activities.
21.1.1.9.2. Coordination of disaster outreach activities following an event.
21.1.2. For EXTERNAL emergency or disaster situations where there may be a change in structural
or functional integrity, a need for evacuation of clients, a sudden influx of clients or
community-wide effects the Contractor shall:
21.1.2.1.
Maintain mutual agreements with local facilities for temporary emergency
shelter;
21.1.2.2.
Identify how the premises shall be evacuated, if necessary, and the meeting
location after evacuation;
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21.1.2.3.
21.1.2.4.
Identify actions the staff shall take if clients cannot return to the building;
Identify methods to address care of clients with special needs during and after
the emergency;
21.1.2.5.
Identify how family contacts shall be facilitated;
21.1.2.6.
Have mechanisms in place to provide for post-disaster counseling;
21.1.2.7.
Provide for disaster outreach as defined in Exhibit A for the Contractor’s
community at large in the event of a disaster;
21.1.2.8.
Ensure provisions for clients including but not limited to emergency
medications, food, water, clothing, shelter, heat and power.
21.1.2.9.
Ensure protection of client records.
21.1.3. For INTERNAL emergency situations where the care of current clients and safety of others
in the Evaluation & Treatment Facility are in jeopardy, such as medical emergency,
elopement, stalking or violent behaviors, the Contractor shall:
21.1.3.1.
Ensure emergency phone numbers are adjacent to phones;
21.1.3.2.
Ensure proper function of duress alarm and paging systems;
21.1.3.3.
Ensure staff competency in response to violent behaviors, including, but not
limited to the safe and appropriate use of seclusion and restraint;
21.1.3.4.
Ensure staff competency in basic life support and first aid procedures.
21.1.3.5.
Develop and maintain protocols for client supervision, movement and
transfers, in specific emergencies, in collaboration with law enforcement, local
emergency departments, and other professionals.
22. TRIBAL RELATIONSHIPS
22.1. The Contractor shall attempt to build relationships as well as support the efforts of TMRSN to
develop Coordination Implementation Plans with each Tribe and any Recognized American Indian
Organization (RAIO) identified in the Thurston Mason service area.
22.1.1. If an Enrollee is a Tribal Member and is referred to or presents for non-crisis services and
the Enrollee or their legal representative consents, efforts must be made to notify the Tribal
Authority or RAIO to assist in treatment planning and service provision for the Enrollee.
22.1.2. Supporting efforts may consist of taking part in plan development, having a role in the
process and outcome of the plan, and/or providing training about the mental health system
and how to access outpatient services provided by the Contractor to Tribes and RAIO’s.
22.1.3. The Tribes or RAIOs listed below have service areas within the contracted Service Area of
the RSN which are defined in the following documents:
22.1.3.1.
The Indian Health Services map that represents Contract Health Service
Delivery areas as published in the Federal Register;
22.1.3.2.
The Bureau of Indian Affairs Service Area map; and
22.1.3.3.
The DSHS 7.01 Policy, which identifies the Recognized American Indian
Organizations (RAIOs).
Chehalis, Cowlitz, Nisqually, Puyallup, Skokomish, Squaxin
Island, Suquamish.
22.1.4. Any Subcontracts with Tribes and RAIOs must be consistent with the laws and regulations
that are applicable to the Tribe or RAIO. The Contractor must work with each Tribe to
identify those areas that place legal requirements on the Tribe that do not apply and refrain
from passing these requirements on to Tribes.
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22.1.5. The Contractor shall have a policy and procedure that requires efforts to recruit and maintain
Ethnic Minority Mental Health Specialists – Native American from each Tribe or RAIO
listed as listed above for use in specialists consults whenever possible.
23. REMEDIAL ACTIONS
23.1. TMRSN may initiate remedial action if it is determined that any of the following situations exist:
23.1.1. A problem exists that negatively impacts individuals receiving services.
23.1.2. The Contractor has failed to perform any of the mental health services required in this
Contract.
23.1.3. The Contractor has failed to develop, produce, and/or deliver to TMRSN any of the
statements, reports, data, data corrections, accountings, claims, and/or documentation
described herein, in compliance with all the provisions of this Contract.
23.1.4. The Contractor has failed to perform any administrative function required under this
Contract. For the purposes of this section, “administrative function” is defined as any
obligation other than the actual provision of mental health services.
23.1.5. The Contractor has failed to implement corrective action required by TMRSN and within
prescribed timeframes.
23.2. TMRSN may impose any one or more of the following remedial actions in any order:
23.2.1. Require the Contractor to develop and execute a corrective action plan. Corrective action
plans developed by the Contractor must be submitted for approval to TMRSN within 30
calendar days of notification. Corrective action plans may require modification of any
policies or procedures by the Contractor relating to the fulfillment of its obligations pursuant
to this Contract. TMRSN may extend or reduce the time allowed for corrective action
depending upon the nature of the situation.
23.2.1.1.
Corrective action plans must include:
23.2.1.1.1. A brief description of the situation requiring corrective action.
23.2.1.1.2. The specific actions to be taken to remedy the situation.
23.2.1.1.3. A timetable for completion of the actions.
23.2.1.1.4. Identification of individuals responsible for implementation of
the plan.
23.2.1.2.
Corrective action plans are subject to approval by TMRSN, which may:
23.2.1.2.1. Accept the plan as submitted.
23.2.1.2.2. Accept the plan with specified modifications.
23.2.1.2.3. Request a modified plan.
23.2.1.2.4. Reject the plan.
23.2.1.3.
Any corrective action plan that was in place as part of a previous Contract shall
be applied to this Contract in those areas where the Contract requirements are
substantially similar.
23.2.2. Withhold up to five percent of the next monthly payment and each monthly payment
thereafter until the situation has been resolved. TMRSN, at its sole discretion, may return a
portion or all of any payments withheld once satisfactory resolution has been achieved.
23.2.2.1.
Increase withholdings identified above by up to an additional three percent for
each successive month during which the remedial situation has not been
resolved.
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23.2.3. Deny any incentive payment to which the Contractor might otherwise have been entitled
under this Contract or any other arrangement by which TMRSN provides incentives.
23.2.4. Terminate for Default as described in the General Terms and Conditions; this may include
releasing a Request for Proposals to re-procure the services provided under this Contract.
23.2.4.1.
If the Contract is terminated for default the Contractor may not respond to the
released Request for Proposal as described above unless authorized by
TMRSN.
24. CONTRACT DELIVERABLES
24.1. The Contractor is responsible for submitting all deliverables described in this section and throughout
the Contract in a timely manner. Deliverables shall be submitted in the format that is identified or
provided by TMRSN and shall be submitted through one of the following mechanisms; the SFTP
site, email, fax, or hard copy mail. All deliverables shall be submitted to Kristy Lysell. If a
deliverable is submitted through the SFTP site, a notification shall be emailed to
[email protected] indicating a deliverable is available.
24.2. If this Contract requires a report or other deliverable that contains information that is duplicative or
overlaps a requirement of another Contract between the parties the Contractor may provide one (1)
report or deliverable that contains the information required by both Contracts.
24.3. *Excluded Providers
24.3.1. The Contractor shall submit an Employee Roster for the purpose of monitoring excluded
providers, which must include employees first name, last name, and date of birth. The
Report shall be submitted electronically, in an Excel spreadsheet, by no later than the 10th of
each month.
24.3.2. The Roster shall include any individuals/entities with a direct or indirect ownership or
control interest of 5% or more, including, but not limited to;
24.3.2.1.
Providers that furnish mental health services, to include supervisory employees
even if they don’t provide direct service;
24.3.2.2.
Individuals directly or indirectly conducting day-to-day operations;
24.3.2.3.
Employees who exercise operational or managerial control (e.g. CEO, general
manager, business manager, accountant, claims processor, utilization reviewer,
administrator or director);
24.3.2.4.
Any other employee, consultant or subcontractor that provides items or
services significant or material to entity’s obligations under the contract with
TMRSN; and
24.3.2.5.
Board members, Interns, and Volunteers.
24.3.3. TMRSN may require the Contractor to submit additional employee information if there is a
possible name match between the Employee Roster and the OIG Excluded Provider
database. Additional information may include; middle names, address, and type of license
and/or specialty.
24.4. Quality Management Reports
24.4.1. Seclusion & Restraint per Section 16.3.
24.4.1.1.
The Contractor shall submit the seclusion and restraint deliverable quarterly by
the 10th of month per the table below.
24.5. *Staff Training
24.5.1. The Contractor shall submit on a quarterly basis, a roster of all employees who attended the
training identified in Section 19.5.4 of this Contract.
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24.6. *Staffing Report
24.6.1. The Contractor shall submit the staffing report, provided by TMRSN as an Excel document,
per 24.1 on a quarterly basis. All columns of the report must completed or an N/A must be
entered.
24.7. Hospital Liaison FTE Report
24.7.1. The Contractor shall submit a monthly report with the monthly invoice per section 10.3.2.3
that includes the total FTE and total number of clients seen.
24.8. Deliverable Table
Deliverable
Submitted
*Excluded Provider
Monthly
Seclusion & Restraint
Quarterly
*Staff Training
As provided
*Staffing Report
Quarterly
Report Period
Example
Active employees as of
the 1st of each month
Jan 1 – March 31
Employees in
attendance at each
training
Active employees
Report Due Date
Format
By the 10th of each
month
May 10th
Excel File
After each training
Provider List
April 10, 2015
July 10, 2015
Oct 10, 2015
January 10, 2016
By the 10th of each
month
Excel File
TMRSN Provided
Excel File
Hospital Liaison
Monthly
Jan 01 – Jan 31
Provider Report
Report
Exhibit B
Section 6
CIO Activity Log and Performance Tracking: Excel File, See Attachment 1 and Exhibit C
*All staffing reports can be combined into one single report if the Contractor chooses. However, if it
does become one report, then it must be submitted on a monthly basis, not quarterly or as occurs. In
addition, all required information from each individual report must be captured in one Excel
Spreadsheet.
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ATTACHMENT 1
Community Integration Outreach Services
STATEMENT OF WORK
Services provided under this Contract Attachment shall be delivered in accordance with all laws, regulations,
and service delivery requirements as described in this Exhibit A: Statement of Work.
1. PROGRAM DESCRIPTION
1.1. The purpose of the Community Integration Outreach (CIO) program is to provide team based
intensive services in three (3) distinct but inter-related service areas. Services are intended to engage,
stabilize and coordinate care for “hard to serve” and “at risk” mentally ill adults. The three service
areas, general locations and target populations are:
1.1.1. Incarcerated individuals with a known or suspected mental illness, which contributed to their
involvement in the criminal justice system;
1.1.2. Incarcerated mentally ill individuals ready for release and transition back to the community;
and
1.1.3. Mentally ill enrolled individuals in the community or unenrolled consumers in institutions or
other settings ready for discharge, who are homeless or are likely to become homeless due to
their mental illness and eligible for RSN services. This would include homeless individuals
who are high utilizers of emergency services.
1.2. Services are to be provided in the jails and in the community, and should complement and not
duplicate other services available and/or being provided.
1.3. Community based services will emphasize outreach and not be provider clinic/facility based.
Outreach services will include case finding for enrolled and un-enrolled clients where traditional
clinic based services are ineffective.
1.4. Services are intended to focus on symptom management and community stabilization through direct
intervention. Transition to the community and linkage permanent support housing is an essential
element.
1.5. Services are to be provided in collaboration with other systems, such as law enforcement/criminal
justice, housing supports/programs, outpatient and inpatient mental health providers and
DSHS/Health Care Authority, to ensure a coordinated response for the individual.
1.6. Services are intended for individuals who meet the criteria for “priority population” as defined in
RCW 71.24. This includes those with an acute or chronic mental illness, and those individuals that
meet the Access to Care criteria that are Medicaid eligible or potentially eligible but need assistance
to apply for benefits.
1.7. A blend of funding resources is provided to meet the objectives of serving Medicaid eligible
individuals and/or facilitating Medicaid enrollment for individuals with a mental illness. Flexible
funds will also be available to assist with housing related rental costs, such as security/utility deposits
and monthly rent/utilities on a time limited basis when necessary.
Attachment 2 – Community Integration 2015-62ET
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2. SPECIFIC PROGRAM AREAS
Program Staff
(6.10 FTE)
Type of Service
Area
Types of services/
activities
Jail Intensive Case
Management (ICM)
Jail/incarcerated/
diversion/pre-release
Screen/ID MI; Brief
intake; Crisis intervention;
brief tx; psychoeducation;
transition planning;
diversions; warm handoffs to TCM; cross system
collaboration; identify jail
staff training/consultation
needs & provide
Transitional Case
Manager (TCM)
Transitional/
Community Integration
Transitional CM; brief Tx;
intakes; psychoeducation;
supportive interventions to
stabilize & return to
community; post-release &
post-d/c links to OP,
housing, other community
resources; cross system
collaboration; warm handoffs to OP
In jails – Olympia City,
Thurston County and
Mason County Jails
In jails and out in the
community – E&T,
inpatient psychiatric
facilities
Intensive Case Manager
(ICM)
Outreach/
Engagement
Early outreach;
identification of MI;
screen & referrals, intakes;
mental health interventions
and stabilization,
diversions; links to
housing, OP services,
community resources;
psychoeducation; cross
system collaboration;
identify need for
consultation on MI to
shelters, community
stakeholders
In the community shelters, streets, homeless
camps, E&T, inpatient
psychiatric facilities
Source of
Referrals/Access
Jail staff, court
liaison/staff, booking
reports, self/family
Jail/corrections staff,
courts, CIO staff, TMRSN,
Providers, E&T, IP d/c
planners, housing
resources, cross-systems
Shelters, homeless
advocates, providers,
E&T, IP d/c planners, care
managers, CIO staff,
TMRSN
Service Overlaps
With TCM for post-release
Transitional planning,
community outreach &
integration as needed
With TCM for
stabilization interventions,
brief tx, IP d/c housing
options, links to OP,
housing providers, other
community resources
Target Population/
Eligibility
Incarcerated or prebooking & Identified with
mental illness, history of
hospitalization &/or OP
MH tx; symptoms of
acute MI; at risk of harm
With Jail Coordinator for
pre-release planning; ICM
for outreach &
engagement, IP d/c
housing options, linkages
to OP, housing providers,
other community resources
Incarcerated pending
release/post release; in
E&T or IP hospital
pending or post discharge;
enrolled/previously
enrolled in MH tx
Locations
MI or symptoms of acute
MI & homeless or risk of
losing housing; IP d/c &
others with MI and
barriers to housing access;
Non-enrolled but eligible
for Medicaid
3. PROGRAM COMPONENTS/ACTIVITIES
3.1. The Contractor shall:
3.1.1. Identify key contacts in each jail location and develop specific communication and referral
process.
3.1.2. Provide crisis intervention and brief treatment to incarcerated individuals as
requested/needed.
3.1.3. Screening and referral to most appropriate service area.
3.1.4. Identify eligibility and enrollment status.
3.1.5. Provide brief or full intake assessments to determine provisional mental health
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3.2.
diagnosis, and determine if Medical Necessity and Access to Care criteria are met.
3.1.6. Assist with SSI/SSDI applications and reinstatements as needed.
3.1.7. Assist with enrollment in Health Exchange and assignment of a health plan/primary care
provider as needed.
3.1.8. Provide brief treatment and psycho-educational interventions to all identified populations as
needed.
3.1.9. Provide case management and stabilization treatment services.
3.1.10. Provide coordination of care with other outpatient mental health and chemical dependency
services, housing supports, and community resources as needed.
3.1.11. Facilitate “warm hand-offs” as needed to ensure connection with subsequent services and
supports.
3.1.12. Provide training and consultation to cross system partners on mental illness.
3.1.13. Accept and prioritize referrals from law enforcement, TMRSN, and points of critical care
such as homeless shelters and emergency rooms.
3.1.14. Services are not intended to be based on “normal business hours”, i.e. Monday thru Friday
8:00 am to 5:00 pm; service hours will fluctuate with the community need. Thurston County
Jail requires intensive case management services during weekend hours.
Intensive Case Management (ICM)
3.2.1. Intensive Case Management is defined as providing a sufficient level of services to ensure
the client remains stable in the community and is diverted from inpatient hospitalization,
incarceration and homelessness.
3.2.2. For ICM staff not housed in a correctional facility, caseloads shall be kept between ten (10)
and fifteen (15) clients per case manager. Length of stay is based on necessary time to
stabilize the client in the community. This would include assisting the client to find and
remain in housing. If the client is not stable or at risk of recycling to an acute state, they
may continue on the ICM caseload. The projected target is approximately one third (33%)
of a caseload is for "long term" clients.
3.2.3. The Contractor shall provide services within the community where the homeless or near
homeless population is located, to include; shelters, the "street", hospitals, emergency rooms
housing programs, and the jail. ICM personnel are expected to accept "warm handoffs" from
the transition case manager in the Thurston and Mason County jails and the Olympia City
Jail.
3.2.4. The Contractor is expected to provide ICM services to expedite and facilitate an individual’s
return to the community. This will include going on site to initiate treatment.
3.2.5. ICM will include stabilization services to maintain the person in the community when at risk
for inpatient care, homelessness, and incarceration.
3.2.6. If the client is already enrolled in outpatient services, the ICM and primary case manager are
expected to collaborate with one another and coordinate services, including scheduling, to
ensure the adequate level of care for the mutual client.
3.2.7. Referrals to ICM will come from any number of critical sites, to include, law enforcement,
the RSN, community housing personnel, and other behavioral health stakeholders.
3.2.8. The ICM case load will target approximately 50% community referrals and 50%
incarceration all of whom would be determined to be "high utilizers” or at risk of going
inpatient or becoming incarcerated. No more than 20% of the case load will be from existing
outpatient contractor services without RSN authorization.
Attachment 2 – Community Integration 2015-62ET
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3.3.
Housing Component of Intensive Case Management Services
3.3.1. The Contractor shall document all efforts to facilitate housing for consumers who are
homeless or at imminent risk of becoming homeless, in the appropriate ICM record.
3.3.1.1.
The primary goal of housing assistance is to link mentally ill adults and their
families, with or without chemical dependency issues, to safe and permanent
housing. The Contractor shall partner with qualified housing programs
utilizing the housing support funds from this contract to assist in identifying
housing options and placement for this highly vulnerable and high utilizer
homeless population. All efforts shall be made to assist with discharge
planning from institutions to prevent homelessness including placement into
shelters. These services may include, but not be limited to:
3.3.1.1.1. The Contractor partnering with other Thurston County Public
Health and Social Services (PHSS) programs (specifically
Housing) for the purpose of assisting and placement of mentally ill
individuals with sustainable housing;
3.3.1.1.2. The Contractor facilitating linkage to all necessary services to
assist the individual. Such services include primary care and
chemical dependency treatment services;
3.3.1.1.3. Assisting consumers with rental applications, credit checks,
background checks, and other tasks associated with securing
housing;
3.3.1.1.4. Assisting consumers, on a case-by-case basis, with damage and
security deposits, along with other associated rental fees; and
3.3.1.1.5. Coordinating with the consumer’s primary Case Manager.
3.3.1.2.
Rental subsidies are not intended to underwrite existing BHR owned property
without prior authorization from the RSN.
4. PROGRAM OBJECTIVES
4.1. Decrease the number and duration of inappropriate incarcerations of persons with mental illness.
4.2. Reduce recidivism of mentally ill individuals incarcerated and/or hospitalized by providing
meaningful assistance with transition planning and return to the community.
4.3. Decrease the number of homeless mentally ill individuals and those at risk of losing housing.
4.4. Provide timely response to requests for screening, identification and brief treatment of individuals
with mental illness or symptoms associated with an acute mental disorder.
4.5. Decrease the need for more restrictive levels of care by providing early outreach and engagement,
referrals and linkage to appropriate community resources.
4.6. Reduce barriers to obtaining stable housing by partnering and linking individuals with available
housing supports and resources, including but not limited to, Thurston County Housing Program,
Rapid Re-housing, and other housing programs.
4.7. Expedite the SSI application/reapplication process in accordance with SB 1290 and the MOU
between TMRSN and the CSO, to facilitate timely access to entitlements and benefits for "classic
Medicaid" and "welcome mat" Medicaid individuals.
4.8. Increase the likelihood of mentally ill individuals living successfully in the community by providing
timely mental health interventions along with coordinated “warm hand-offs” to outpatient mental
health services, housing providers, and other community resources.
4.9. Strengthen cross-system coordination and relationships by developing a screening and referral
Attachment 2 – Community Integration 2015-62ET
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process, and actively communicating and collaborating with other related systems, programs and
services.
5. SCREENING/ELIGIBILITY
5.1. Contractor shall develop a screening and referral process and use a Screening Log that incorporates
the following at a minimum:
5.1.1. Individual’s name and DOB;
5.1.2. Source of referral;
5.1.3. History of mental illness, hospitalizations, and previous treatment;
5.1.4. Status of enrollment with the RSN, Network Provider, and Medicaid;
5.1.5. Disposition (CIO services recommended/provided)
5.1.6. Reason for not serving if applicable.
5.2. Contractor will screen in the following individuals with a history of mental illness or symptoms of an
acute mental disorder regardless of funding. This includes individuals:
5.2.1. Incarcerated and experiencing a mental health crisis;
5.2.2. Incarcerated and nearing release from jail;
5.2.3. Released from jail and requesting outpatient mental health services or housing support;
5.2.4. At risk of being arrested or arrested, but not booked;
5.2.5. Staying at a homeless shelter, in temporary housing, at risk of losing housing, or identified
by a housing provider as homeless;
5.2.6. Being discharged from inpatient psychiatric treatment to a shelter for lack of more
appropriate housing; or
5.2.7. Enrolled in Medicaid that may need referrals to other available services.
5.3. Contractor will provide access to ProviderOne, TMRSN’s MCO “RSN Look” and other resources to
identify:
5.3.1. Medicaid eligibility and benefit information;
5.3.2. TMRSN/CMHA Network Provider enrollment status and history, treatment history, and
current individual mental health care provider.
5.3.3. Other programs and services being provided to coordinate but avoid duplication of services.
6. PERSONNEL/STAFFING
6.1. The CIO Program shall be staffed by a team of Mental Health Professionals with sufficient
experience to effectively work with the identified populations. The 6.10 FTEs shall be assigned to
provide sufficient coverage for each location in the following service areas:
6.1.1. (3 FTE) Jail Intensive Case Management – Olympia City Jail, Mason County Jail, and
Thurston County Jail. Thurston County Jail requires case management services on the
weekend.
6.1.2. (1 FTE) Transitional Case Management – Olympia City Jail, Mason County Jail,
Thurston County Jail, and E&T/IP d/c of Non-enrolled needing housing assistance.
6.1.3. (2 FTE) Intensive Case Management – Community based services to the Thurston County
service area, including E&T/IP d/c of Non-enrolled needing housing assistance, jail and
homeless who are high utilizers of emergency services.
6.1.4. (.10 FTE) Supervisor – Is responsible for oversight of the CIO Program.
6.2. Each of the three (3) service areas must have a staff lead designated for that area and develop
identified contacts in the associated locations to provide consistency.
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6.3.
Staff shall be cross-trained in each area and staffing patterns sufficiently fluid and flexible enough to
respond to the service areas of most critical need without excessive wait times or wait lists.
6.4. Ensure sufficient availability of supervision and oversight of the CIO services to provide clinical
supervision and respond to concerns from cross system partners and the community as needed.
6.5. Hours of operation are generally intended to be Monday through Friday, but may be flexible
depending on the needs of the client and types of interventions needed. Any after- hours’ crisis
support required will be the responsibility of Crisis Response Services and coordinated with those
providers as needed.
6.6. Ensure each CIO program staff has an annual training plan that includes all necessary and required
trainings as specified in the General Terms and Conditions of this contract.
7. CLINICAL/DOCUMENTATION REQUIREMENTS
7.1. General Clinical Requirements
7.1.1. Screening and referral for CIO services focuses on identification of individuals that are or
could be Medicaid eligible and meet the priority population of acute/chronic mentally ill,
and that meet the Medical Necessity and Access to Care criteria.
7.1.2. Individuals that don’t meet Access to Care or Medical Necessity will be referred to other
appropriate community resources, to include the Healthy Options Plans.
7.1.3. Clinical services are intended to provide sufficient encounters to meet the housing and
stabilization objectives of this service. This may require multiple services per week for
Intensive Case Management services.
7.1.4. Services may be prioritized based on available resources, with safety and the presence of
other systems and supports in mind.
7.1.5. Clinical focus should be on stabilization and community integration. Those clients who are
likely to remain stable in the community may be transferred to outpatient mental health
services if eligible.
7.1.6. Facility based intakes may be brief in order to make appropriate referrals, and can be
supplemented with a prior Intake Assessment if it has been done within the last twelve (12)
calendar months.
7.1.7. Transitions to outpatient mental health services should include informing consumer of their
choice of outpatient providers.
7.2. General Documentation Requirements
7.2.1. Provider must maintain a separate medical record of all documentation of CIO services
provided.
7.2.2. Documentation for all services and activities will be maintained on standard forms/format
and available on-site and upon request.
7.2.3. Provider must maintain confidentiality of all personal health information, and request a
signed Release of Information prior to sharing information when indicated.
7.2.4. Service provision and documentation must be provided and recorded in accordance with the
TMRSN Data Dictionary that includes Reporting Guidelines, TMRSN HIPAA and Native
Transaction Companion Guides, the TMRSN File and Data Submission Guide, the TMRSN
Outpatient Invoice and Data Send Calendar, and any other requirements consistent with
provider’s outpatient services. Allowable service codes that can be reported to TMRSN by
this program are contained within the TMRSN Data Dictionary.
7.2.5. A Jail Program Record must be recorded and submitted to TMRSN that includes the
following data elements. kept in the database that includes:
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7.2.5.1.
Program Start Date; and
7.2.5.2.
Program End Date.
8. DELIVERABLES
8.1. The Contractor shall document hours and services not typically entered into the MIS on the CIO
Specialized Service Activity Log, provided by TMRSN.
8.1.1. The Contractor shall ensure that information is gathered on the ‘Activity Log” tab as well as
the “Performance Tracking” tab. The timeframe of this report is every two (2) weeks and
shall be submitted within 3 days after the reporting period has ended.
Attachment 2 – Community Integration 2015-62ET
Page 7 of 7
ATTACHMENT 2
Evaluation and Treatment Facility
Maintenance Responsibilities
Services Provided by Thurston County
Service Name
Bids and Estimates
Bldg. Warranty Work
Building Appearance
Building Construction for
RSN only
Building Control System
Building Drawings
Building Modification
Building Repairs-floors,
walls, ceilings
CCTV/Monitors
Contracts
Detention System
Electrical
Emergency Power Systems
Fire Protection
Services Description
Provide cost estimates for doing minor remodel or maintenance work not
included within Base Level Services. Provide assistance in obtaining bids from
outside contractors or vendors for work not included within Base Level
Services.
Provide coordination services with contractors for repair of work within the
contractor’s warranty period.
Provide repairs and service to problems that arise regarding the appearance of
building interiors or exteriors, e.g. removing vandalism, painting under
projects or approved painting requests only, etc.
Implement major enhancements to buildings and/or building systems. Funding
to be determined.
Provide maintenance and repairs to the building automation control system
that monitors and controls building heating/cooling and other building
mechanical functions or systems, i.e. fire alarm systems, security systems, and
building automation systems, etc. Includes testing as required.
Provide electronic or hard copies of Master Drawing floor plans for countyowned or leased facilities.
Implement major and minor enhancements to buildings and/or building
systems. Funding to be determined.
Provide maintenance and repairs to the building, including doors, Doors,
windows, flooring, walls, and ceilings. For specific building system problems:
see also electrical, security, plumbing, or lighting, etc.
Repair to CCTV, monitors, cables, and pan tilt units.
Initiating a contract for services or materials.
Provide maintenance and repairs to the detention system. Includes electronic
detention systems, i.e. intercoms, MC panels, duress systems and electronics.
Provide maintenance and repairs to the electrical systems. May support the
addition of new circuits in County-owned buildings only for workstations and
copy machines or other equipment. New circuits requested by a Tenant for
their unique operation or workstation may be funded by that Tenant.
Provide maintenance of generators, UPS’s and Transfer Switches.
Provide periodic maintenance and testing of fire sprinkler, fire smoke systems
and fire extinguishers.
Attachment 2 – Maintenance Responsibilities 2015-62ET
Page 1 of 3
Furniture Repair
HVAC Systems
Hazards Response
Keys/Key Cards
Lighting
Locks and Door Hardware
Master Drawing
Modifications
Mounting to Walls
Pest Control
Plumbing
Preventive Maintenance
Safety Issues/Trip Hazards
Signage
Site Issues –
Parking/Drainage/Lighting
Snow Removal
Tenant Provided Services
Technical Consultation
Work Space Comfort
Heating-Cooling
Work Order System
Furniture repair, assembly and/or moving services NOT PROVIDED. Contact
an outside vendor or moving company for assistance.
Provide maintenance and repairs to building Heating, Ventilation and Air
Conditioning Systems (Also see work and space comfort).
Respond to reports of hazardous smells or situations, e.g. smoke, Smell of
Gas/Haz. Spills smells.
Use the email work request system with the person’s name and the type of
key(s) required. (One work request per person.) Have the person authorized to
approve the key request send the email work order as authorization.
Provide maintenance and repairs to building lighting systems. Includes
replacement of light bulbs and fixture repairs. (See also-Site Issues for outside
lighting).
Work on doors, door locks, hardware, closers, door closed indicators and
access as needed.
Make modifications to County master Drawing as a result of changes that have
been made to the building with a construction or remodel project. As resources
are available.
Bulletin Boards, Wall Hung Cabinet, Pencil Sharpeners, or any wall mounting
of any kind MAY be installed on a LOW priority basis if and when time
permits.
Provide assistance in response to apparent pest infestations in compliance with
the county pest control policy. Coordinate the work of an outside pest control
contractor.
Provide maintenance and repairs to the building plumbing systems.
Provide PM to major and minor Facilities-owned equipment, including filter
changes, new belts, grease bearings, cleaning, pumps, motors, chillers, etc.
Respond to Safety Issues.
Provide signs in parking lots and/or to buildings related to the County-owned
buildings. No service is provided to tenant’s own unique operation.
Provide maintenance and repairs to systems servicing the entire Outside e.g.
drainage, parking, outside lighting.
Provided deicing materials and walk behind snow blower for building. Some
snow and ice removal would be provided as resources become available.
Custodial services including minor facility repairs as a result of normal wear
and tear or vandalism; maintenance, repair, and replacement of appliances and
equipment associated with program operations. Replacement of security
glazing is performed by M&O with materials paid for by tenant.
Provide assistance in acquiring the services for Central Services on-call
consultants (architects and/or engineers) for technical consultations.
Research comfort issues in individual workspaces; provide modifications to
heating/cooling as available within the HVAC system.
Provide a system for requesting the above.
Attachment 2 – Maintenance Responsibilities 2015-62ET
Page 2 of 3
The following list may contain items Facilities maintains but tenant may pay for parts and support:

Kitchen Equipment repairs and parts: Stainless on walls, freezers, refrigerators, steam kettle, ovens,
dishwasher, garbage disposal, etc. are outsourced, i.e. tenant contracts with outside contractor.

Kitchen duct wash down and fire suppression system outsourced some wash down maintained by
Facilities with parts by tenant.

Laundry Equipment outsourced.

CCTV cameras, monitors, repairs and parts maintained by Facilities.

Internal door controls and lock parts maintained by Facilities.

Door closures maintained by Facilities.

Secure area intercom system repair and parts maintained by Facilities.

Vandalism: All: Toilets, light fixtures, etc. paid by tenant.

Control Electronics. Some outsourcing and some maintenance by Facilities.

Office furniture repair. Outsourced.

Requests to add to the Facility: Such as fences, barbed wire, CCTV, new electrical circuits, etc., will be
negotiated between Facilities and Tenant.

Secure area glass for cells, doors, nurses station, etc. Maintained by Facilities.

Sally port roll up door. Maintained by Facilities.

Anything owned by tenant: Such as rotating property rack, TVS, copy machines, UA Equipment, gun
locker, visitor’s boxes and locks, etc. Outsourced or by others.

Card Reader Systems: The card reader device at each door and the controller will be covered against
defects. Client damage will be covered by the tenant. The request for added reader devices and
controllers in order to expand the system will be negotiated. The County will coordinate the upgrade and
cost of software as required. The County will upgrade the PC operating the card reader system and the
card reader system through the County’s ITRP replacement program only to the required standard to
operate the card reader software. Tenant is responsible for the tracking, storage, archiving of data, and
all card related costs/efforts.
Attachment 2 – Maintenance Responsibilities 2015-62ET
Page 3 of 3
EXHIBIT B
Evaluation and Treatment Facility Services
COMPENSATION
1.
COMPENSATION ...................................................................................................................................2
2.
OTHER FUNDING SOURCES...............................................................................................................4
3.
FISCAL MANAGEMENT.......................................................................................................................4
4.
ACCOUNTING AND REPORTING REQUIREMENTS ....................................................................4
5.
BILLING PROCEDURE .........................................................................................................................5
6.
DELIVERABLES .....................................................................................................................................5
1.
ATTACHMENT 1 – COMMUNITY INTEGRATION OUTREACH ................................................7
INVOICE FORM ..............................................................................................................................................8
1.
HOSPITAL LIAISON ..............................................................................................................................9
INVOICE FORM ............................................................................................................................................10
Exhibit B – Compensation 2015-62ET
Page 1 of 10
1. COMPENSATION
1.1.
Program funding is based on the actual level of staffing, program costs and job performance as set
forth in the Program Contract. A portion of the monthly payment may be withheld if service data is
not entered into the MIS system in a timely manner for all programs that invoice based on actual
costs.
1.2.
The Contractor shall use all funds provided pursuant to this Contract, including interest earned to
support only the services as described within this Contract.
1.3.
Funding allocations are contingent upon the receipt of funds from contractual agreements between
TMRSN and other government agencies (DSHS-DBHR, DDD, and Mental Health Block Grant
contracts).
1.4.
Appropriate DOH Licensing and DBHR Certification as set forth in Exhibit A are required for
payment under this contract. If, at any time, licensing or credentials required for any portion of the
services or operation set forth in the Program Contract are going to be revoked, the Contractor shall
submit a corrective action plan to TMRSN. Corrective action plans developed by the Contractor
must be submitted to TMRSN within 30 calendar days of notification or sooner. TMRSN may
extend or reduce the time allowed for submitting corrective action depending upon the nature of the
situation as determined by TMRSN. Corrective action plans shall be subject to approval by TMRSN,
which may accept the plan as submitted, accept the plan with specified modifications, or reject the
plan. Should corrective actions fail to be implemented within 30 calendar days of receipt of written
notice of revocations, the TMRSN may reduce funding by 20% for the first month, 50% for the
second month, and all funding shall be discontinued thereafter until licensing and/or certification is
re-established.
1.5.
The Contractor shall invoice TMRSN for services based on actual costs. All costs shall be divided
and invoiced as such between Medicaid allowable and State Funded services. Medicaid allowable
services include those services to Medicaid clients whose program and match have a Medicaid
mental health benefit and/or whose service modality is allowable under the State Plan, except
inpatient services provided to persons involuntarily admitted must be paid with state funds,
regardless of the client’s pay source. Costs such as room and board, even for Medicaid clients, are
not allowable under Medicaid.
1.6.
Funding that supports this contract may come from Mental Health Block Grant funds from the
Department of Health and Human Services (DHHS), Catalog of Federal Domestic Assistance
(CFDA) # 93.958. Mental Health Block Grant funds may not be used for:
1.7.
1.6.1.
Services and programs that are covered under the capitation rate for Medicaid covered
services to Medicaid enrollees;
1.6.2.
Inpatient mental health services;
1.6.3.
Construction and/or renovation;
1.6.4.
Capital assets or the accumulation of operating reserve accounts;
1.6.5.
Equipment costs over $5,000.00;
1.6.6.
Cash payments to consumers; or
1.6.7.
State match for other federal funds.
The TMRSN shall compensate the Contractor for services as set forth in this contract as expenses are
accrued for maintenance of a staffing level and program expenses for all program components.
Payment for these services is based on and not to exceed actual expenses. TMRSN reserves the right
Exhibit B – Compensation 2015-62ET
Page 2 of 10
to: a) adjust the budgeted line item, or b) reconcile the difference if the amount exceeds the line item.
1.8.
Funding under this Contract shall not be utilized for retainer fees for contracted Primary Care
Physicians who perform medical services at the E&T Facility. Medical services must be delivered
under the physicians Medicaid license and not through the E&T. This requirement shall go into effect
May 01, 2015.
1.9.
Payment shall be based on the following table. It is the responsibility of the Contractor to monitor
their monthly expenses and ensure that they do not exceed the annual contract lid for each fund
source. In addition, any funds identified in an attachment must be used only for the service indicated
and shall not be used to supplement any other programs and/or services.
Payment Period: January 1, 2015 through December 31, 2015
Service Designation
Rate Method
Fund Source
Project
Code
Not to Exceed 12
Month Total
41408
41409
$3,124,245
$1,338,963
Subtotal: 4,463,208
E&T Inpatient Unit
Actual Costs
Medicaid
State
ITA Services
(DMHP and Court Services)
Actual Costs
Medicaid
State
41408
41409
$67,872
$886,224
Subtotal: $954,096
Hospital Liaison Only
*Funding thru June 30, 2015
Based on 1 FTE and must see a minimum of
20 clients per month.
MHBG
41401
$45,738
41408
41409
41499
$802,920
$294,000
$348,000
Subtotal: $1,444,920
CSTU
Actual Costs
Medicaid
State
Reserves
1:1 Safety Staff
Actual Costs
Medicaid
41408
$120,000
Reserves
Up to 5% per Section 4.4
Medicaid
41408
$300,000
State
Proviso
TST
Jails
41409
41417
CW006
41410
CIO Intensive Case Management
Medicaid
41408
$199,992
CIO Housing Supports
Reserves
41499
$87,996
CIO Performance Measure Incentives
Medicaid
41408
$30,000
CIO (Jail and Transitional): Actual Costs
Attachment 1: Community
Integration Outreach
Total Contract Lid for January 01, 2015 through December 31, 2015:
$42,456
$207,552
$83,640
$16,140
Subtotal: $349,788
$7,995,738
1.10. Any monitoring process, including TMRSN encounter validation audits that shows encounter
invalidation will result in corrective action and funding reconciliation. Funding will be reconciled if
the service event data does not comply with the DBHR Encounter Instructions; does not comply with
TMRSN reporting guidelines; or does not match or is missing from the clinical record.
1.10.1. Corrective action and funding reconciliation will occur for any missing or inaccurate
encounters reported by the Contractor. Reconciliation for outstanding invalid encounters
Exhibit B – Compensation 2015-62ET
Page 3 of 10
2.
3.
4.
will occur fifteen days (15) after the Contractor has received notification of errors. Within
this fifteen day period, the Contractor may resolve errors, and unresolved invalid encounters
will then be reconciled. Overall encounter validation accuracy outcome expectation is 100%
after necessary corrections.
OTHER FUNDING SOURCES
2.1.
The Contractor shall make all effort to collect from Third Party Insurers when available. The
Contractor shall be able to show by individual, those clients eligible for third party benefits,
including which services, how much was billed by service, and how much was collected. All third
party funding resources available to clients shall be identified and pursued in accordance with the
reasonable collection practice that the Contractor applies to all other payors for services. The
Contractor shall reduce the TMRSN invoice by the amount received from all third party payments
for services related to this Contract.
FISCAL MANAGEMENT
3.1.
The Contractor shall provide services in the most effective, efficient and economical manner
possible to establish a prudent financial management system. This shall include, but not be limited
to:
3.1.1.
Establishing a sliding fee scale. The sliding fee scale schedule shall be posted and
accessible to staff and clients and may not require payment from clients with income
levels equal to or below the grant standards for the general assistance program.
3.1.2.
In accordance with Federal and State regulations and statutes, ensuring Medicaid or
other RSN funds are not utilized to support administrative and/or direct services to
non-TMRSN authorized clients.
3.2.
The Contractor shall maintain records in such a manner so as to reasonably ensure that all thirdparty resources available to clients are identified and pursued, in accordance with Medicaid being
the payer of last resort. This information must be reported in the Financial Statement referenced in
Section 6.3 of this exhibit. Third party revenue received by the Contractor for TMRSN funded
services will be deducted from the RSN payment for same services.
3.3.
The Contractor shall ensure that Medicaid enrollees are not charged or held liable for any of the
following:
3.3.1.
Medicaid services covered under the terms of this Contract (42CFR447.15);
3.3.2.
Contractor’s debts in the event of insolvency;
3.3.3.
Covered services provided to an enrollee for whom DSHS does not pay TMRSN;
3.3.4.
Services for which DSHS or TMRSN does not pay the individual or health care
provider that furnishes the services under a contractual, referral or other arrangement;
3.3.5.
Any service provided under contract, on referral, or other arrangement, which
exceeds what TMRSN would cover if TMRSN provided the services directly.
ACCOUNTING AND REPORTING REQUIREMENTS
4.1.
Each month an initial invoice shall be submitted with the monthly budgeted amount. After all
expenses are accounted for, a final invoice shall be submitted for payment of the difference
between actual total expenses and the previously submitted estimated invoice. At the same time, a
complete invoice with cost reports shall be submitted reflecting all costs for that month.
4.2.
Funding for this program is only to be used to provide the services, as depicted in the Program
Contract, and may not supplement any other programs. The Contractor shall bill TMRSN for
services based on actual costs, provided the total billable amount is not exceeded during the term of
this Contract. Invoices must be submitted on forms provided by the TMRSN and follow the
invoicing instructions issued by the TMRSN. The Contractor shall be able to provide
Exhibit B – Compensation 2015-62ET
Page 4 of 10
5.
6.
documentation that will substantiate any expenditure billed for this program.
4.3.
A minimum of 90% of the available amount from primary funding to the Contractor shall be used
for direct mental health services and the Contractor shall fully cooperate to assure compliance with
this requirement.
4.4.
The Contractor shall have the right to establish capital, operating and risk reserves in accordance
with generally accepted accounting principles and prudent business practices, the total of which is
not to exceed 5% of total funding for this contract. Reserves may be retained with each monthly
invoice, however total costs are not to exceed the annual contracted amount. It is solely the
Contractors’ responsibility to manage monthly costs and maintain costs within the total allowable
contract lid. When any reserves are expended, such funds shall be appropriately reported as either
direct or indirect costs. The contractor shall maintain records sufficient to evidence that it has
incurred eligible Medicaid cost for reserve dollars and shall make such records available for
TMRSN’s review upon reasonable request. MHBG funds and the CIO Program are excluded
from reserves.
4.5.
The Contractor shall have an annual audit performed by an outside CPA firm. If Mental Health
Grant Funds (MHBG) are indicated in the Compensation Section 1 above, see the general terms
and conditions for A133 Single Audit requirements.
BILLING PROCEDURE
5.1.
The Contractor shall bill the TMRSN for services using the specified forms and instructions
referenced in this Exhibit. TMRSN reserves the right to: amend, delete, or add to the billing or
reporting forms required in this Exhibit.
5.2.
The Contractor must submit invoices to arrive at the TMRSN no later than the 10th calendar day of
the month in order to receive TMRSN reimbursement by the last working day of the month.
Billings received after the 10th calendar day shall be reimbursed no later than the last working day
of the following month. The Contractor agrees that receipt of any payment from the TMRSN is
expressly conditioned on submission to the TMRSN of any and all required reports and
documentation prior to the TMRSN deadlines. All invoices must be sent to the address listed on
the invoice form.
5.3.
Included in this exhibit is an invoice form that must be completed for reimbursement in accordance
with instructions provided by the TMRSN. An original signed invoice must be received prior to
dispersal of funds.
5.4.
All invoices must have an invoice number provided which must be unique and not be repeated.
5.5.
TMRSN shall not release reimbursement until the Contractor provides requisite reports identified
in this Contract.
5.6.
The Contractor must enter encounter information for services provided at the E&T into the MIS
data system according to policies, procedures, instructions, and protocols issued by the TMRSN.
DELIVERABLES
6.1.
The Contractor shall submit a budget vs actual report with each monthly invoice. Invoices
submitted without the report will not be processed until the report is received.
6.2.
A copy of the annual audit referenced in section 4.5 of this exhibit must be submitted to the
TMRSN upon receipt of the audit report by the Contractor.
6.3.
The Contractor will submit Certification that the Administrative Costs incurred by the Contractor
are no more than ten percent (10%) of the total revenue under this contract. Certification must be
submitted to the TMRSN no later than August 14, 2015.
6.4.
An individual financial statement for services set forth in this Contract shall be provided monthly.
Financial Statements may be sent electronically or via mail. The Financial Statement shall include
Exhibit B – Compensation 2015-62ET
Page 5 of 10
6.5.
6.6.
all third party revenues collected for services provided in this program and shown as revenue for
the program.
For MH Services in Residential Settings provided at the CSTU, a certification from the Contractor
that expenses was for allowable costs under this contract.
The Contractor shall run and submit monthly data error reports for any services that are considered
“cost reimbursed” or services paid on “actual costs” with the monthly invoice. Reports shall
include all pended and denied claims from the previous month(s) – please reference TMRSN MCO
Instruction: 402.01 MCO Provider Reports & Instructions, Section 4 – “837 Claims Reports” for
report details on “Claims Pended or Denied for Date Range”.
If the report shows there are claims data errors, the Contractor will have 60 days to correct and
resolve all claims errors listed. If 100% of the errors are not corrected, *penalties will apply per the
table below. The Contractor shall submit all reports as described in the table below each month.
This schedule is for the entire duration of the contract, not just the dates listed below.
TMRSN reserves the right to apply Remedial Actions per Section 23.2.2 of Exhibit A in addition
to the penalties below if the Contractor does not comply with this deliverable.
Due Date
February 10th
Deliverables
 January Invoice
 Claims Data Error report for Jan 01-31
March 10th
 February Invoice
 Claims Data Error Report for Feb 01-28
April 10th
 March Invoice
 Claims Data Error Report for Mar 01-31
 Re-run Claims Data Error Report for Jan 01-31
All claims errors for January must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total April Payment.
 71-80% errors are corrected – 5% will be deducted from the total April Payment.
 70% errors or less are corrected – 10% will be deducted from the total April Payment.
NOTE – Providers will not be able to recapture these penalties.
May 10th
 April Invoice
 Claims Data Error Report for Apr 01-30
 Re-run Claims Data Error Report for Feb 01-28
All claims errors for February must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total May Payment.
 71-80% errors are corrected – 5% will be deducted from the total May Payment.
 70% errors or less are corrected – 10% will be deducted from the total May Payment.
NOTE – Providers will not be able to recapture these penalties.
June 10th
 May Invoice
 Claims Data Error Report for May 01-31
 Re-run Claims Data Error Report for Mar 01-31
All claims errors for March must be corrected by this time. If claims errors are not corrected, the
following penalties will apply:
 91-100% errors are corrected – No penalty
 81-90% errors are corrected – 2.5% will be deducted from the total June Payment.
 71-80% errors are corrected – 5% will be deducted from the total June Payment.
 70% errors or less are corrected – 10% will be deducted from the total June Payment.
 NOTE – Providers will not be able to recapture these penalties.
This formula will continue monthly with the final reports due in February 2015.
Exhibit B – Compensation 2015-62ET
Page 6 of 10
Community Integration Outreach
COMPENSATION
1. ATTACHMENT 1 – Community Integration Outreach
1.1.
Program funding is based on compliance with the Program Services Statement of Work per Program
Services, Attachment 1.
1.2.
TMRSN shall reimburse the Contractor for services performed by 6.10 FTE under this attachment,
payable based on the table below. Incentive funding will be provided only when performance
measures are met, per Exhibit C.
Payment Period: January 1, 2015 through December 31, 2015
Type of Service(s)
Rate
Fund Source
Actual costs
State
Proviso
TST
Jails
Actual costs
Medicaid
$199,992
Actual Costs
Reserves
$87,996
Medicaid
$30,000
Community Integration Outreach:

Jail Case Management

Transitional Case Management
Intensive Case Management
Housing Support
(Rent, security deposits, etc)
Contract Lid
$42,456
$207,552
$83,640
$16,140
Subtotal: $349,788
$30 per SSI Application
Performance Measures Incentives
$30 per OP Enrollment
$100 for Housing Placement
(Up to $2500 per month)
Total Annual Program Lid:
$667,776
1.3.
When invoicing TMRSN, expenses for each program with multiple fund sources shall be charged in
order of Proviso, TST, Jails, and State.
1.4.
Housing support funding shall be accessed only to provide assistance to clients that are homeless or
are at imminent risk of becoming homeless. Funds shall be used towards rent support, application
assistance, security deposits, or any other time limited rental assistance that will either assist an
individual in obtaining housing, maintaining housing, or prevent them from losing housing.
1.4.1.
1.5.
Receipts must be attached to the invoice below in order to receive reimbursement for this
funding.
Performance measure incentive funding shall be based on the performance of meeting the goals set
per the CIO logic model under Exhibit C.
1.5.1.
The Specialized Service Activity Log, including the Performance Tracking, must be
submitted per the timelines indicated under Attachment 1, Section 8 in order to receive
incentive funding. This funding has its own invoice below.
Exhibit B – Compensation 2015-62ET
Page 7 of 10
Performance Measure / Logic Model
INVOICE FORM
From:
Behavioral Health Resources
3857 Martin Way East
Olympia WA 98506-5218
Invoice Number:
Submit To:
Public Health & Social Services
Fiscal Department
412 Lilly Rd NE
Olympia WA 98506
[email protected]
Submitted Date:
Vendor #: 62
For Service Dates:
Org
Performance Measure (per Exhibit C)
Object
541000
Project
41499
Number of Clients
Actual
Amount
SSI/SSDI Applications completed
Enrolled into outpatient services
Housing placement
Total:
I attest that the information contained on this invoice and the accompanying cost report(s) is complete,
accurate, and in accordance with the terms of the contract.
For Evaluation and Treatment Facility
Date
TMRSN Authorized Signature
Date
Exhibit B – Compensation 2015-62ET
Page 8 of 10
Hospital Liaison
COMPENSATION
1.
HOSPITAL LIAISON
1.1.
Funding is based on compliance with the Exhibit A Statement of Work Section 10.3.
1.1.1.
TMRSN shall reimburse the Contractor for services performed by 1.0 FTE payable based on
the table below. Services include providing case management services at WSH including
documentation, collaboration, discharge planning, and residential placement for a minimum
of 20 individuals per month.
1.1.1.1.
Should the Contractor provide less than the equivalent of 1.0 FTE in any
month of service, funding shall be reduced accordingly. For example, if the
Contractor only provides .75 FTE, then the Contractor shall only invoice 75%
of allowable funding, .5 FTE – 50% funding, etc.
1.1.1.2.
The number of minimum clients seen per month can be averaged over the term
of the contract, and will not necessarily effect payment, unless the average
number of individuals seen by the end of the contract term is less than 75% of
minimum individuals. If this occurs, final payment will be less 25% of
allowable monthly amount.
Payment Period: January 1, 2015 through June 30, 2015
Type of Service(s)
Hospital Liaison
Exhibit B – Compensation 2015-62ET
Rate
Fund
Source
Monthly Lid
(this program
ONLY)
Not to Exceed 6
Month Lid
Based on 1 FTE and must
see a minimum of 20 clients
per month.
MHBG
$7,623
$45,738
Page 9 of 10
Hospital Liaison
INVOICE FORM
From:
Behavioral Health Resources
3857 Martin Way East
Olympia WA 98506-5218
Invoice Number:
Submit To:
Public Health & Social Services
Fiscal Department
412 Lilly Rd NE
Olympia WA 98506
[email protected]
Submitted Date:
Vendor #: 62
For Service Dates:
Item
Org
Object
Project
Monthly Max
Hospital Liaison
1500D441
541000
41401
$7,623
Amount Invoiced
FTE Report Attached (if less than 1.0 FTE, amount invoiced must be prorated)
Number of Individuals Served Reported
I attest that the information contained on this invoice and the accompanying cost report(s) is complete,
accurate, and in accordance with the terms of the contract.
For Evaluation and Treatment Facility
Date
TMRSN Authorized Signature
Date
Exhibit B – Compensation 2015-62ET
Page 10 of 10
EXHIBIT C
PERFORMANCE MEASURE(S)
1. Performance Measure(s)
1.1. For each program identified hereunder in Exhibit C, the Contractor shall follow the indicated
Performance Measure (PM). The PM shall be based on quality improvement for “outputs” in
specified areas of contracted mental health service. Identified program PMs do not replace any other
specific contract requirements, deliverables, or performance standards under other Exhibits or
Attachments to this contract. The intent is to support program integrity in the specific programs by
clearly identifying targeted areas for improvement and/or for maintaining quality of care and resource
management. Such targets will be based on levels of service, size of eligible population, state
averages, actuarial information, and funding per program.
1.1.1. The PM(s) shall be outlined in the attached “Logic Model(s).” The Logic Model shall have
one or more expected “outputs” with targets for service delivery.
1.1.2. Outputs will be determined by TMRSN, with input from the Contractor, when requested,
based on industry program standards, expected levels of service delivery, funding, and
service method to be measured.
1.1.3. All outputs will determine a baseline for performance. For any new program, there will be a
three (3) month period to develop a baseline for expected program outputs. For established
programs, baseline for performance will be based on historical program data either from the
MIS or from contract deliverables. A PM will then identify the target level, if baseline
performance is not sufficient to achieve value service levels.
1.1.4. TMRSN may include a level of variance for each output to offset fluctuations in service
delivery.
1.1.5. Output data shall be tracked on a monthly basis and reported quarterly (see table below).
The party responsible for providing the quarterly report shall be identified on the PM; either
TMRSN or the Contractor. If the Contractor is identified as the responsible party for the
quarterly report, the report shall be submitted to TMRSN, in the format provided, by the due
date in the table below. TMRSN shall be responsible for analyzing all reports and
determining if the Contractor has or has not met the output.
1.1.5.1.
If the Contractor fails to meet the output for a quarter based on TMRSN’s
review, then the Contractor shall be required to submit a performance
improvement plan (PIP). The PIP shall include, the reason for not meeting
output(s), the reason for any exceptional variance of service delivery (when
applicable), and what change will be made, if any, to meet the output. The PIP
shall be submitted within thirty (30) calendar days after the request by
TMRSN. If a PIP is not submitted within the 30 days, 5% of the payment for
the program shall be withheld each month until the PIP is received. TMRSN
will review the PIP and respond accordingly to the Contractor within two (2)
weeks.
1.1.5.2.
If the Contractor fails to meet the output during the quarter following the PIP,
then corrective action shall be initiated by TMRSN. Please see Exhibit A –
Section 19, Remedial Action for a complete description. TMRSN shall
determine type of corrective action to be applied.
1.1.5.3.
If the output is failed during the third quarter, TMRSN shall complete a full
review of outputs and determine if the failure is due to under performance by
the Contractor or if the initial outputs were unattainable. Based on the results
of this review, TMRSN shall determine if a contract amendment is required to
Exhibit C – Performance Measures
Page 1 of 2
adjust the contract requirements or PM, including outputs and current funding
levels for expected delivery of services. Under performance by the Contractor
may result in contract termination per the remedial action section of the
contract.
1.1.6. Quarterly Report Table – Report due dates apply to both TMRSN and the Contractor:
Quarter
Report Due
January 01 – March 31
May 15th
April 01 – June 30
August 15th
July 01 – September 30
November 15th
October 01 – December 31
February 15th
*Note – If the contract start dates do not coincide with these quarters, please include previous months
data into the first full quarterly report. Example, if the contract starts February 1, the first quarterly
report will include data from each month, Feb 1 – June 30.
Exhibit C – Performance Measures
Page 2 of 2
THURSTON MASON
REGIONAL SUPPORT NETWORK
Performance Measure – Logic Model
TITLE of MEASURE:
Community Integration & Outreach (CIO) Program
BASELINE TIME PERIOD USED:
CY 2014
QUARTERLY REPORT PROVIDED BY:
TMRSN Quality Manager (supplemental information required from BHR)
CONTRACT:
2015-62ET
Resources
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
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1 (.1 FTE)
Supervisor
3 (1.0 FTE)
MHP for
Diversion and
Discharge
1 (1.0 FTE)
MHP for
Transitional
Case
Management
2 (1.0 FTE)
for Intensive
Case
Management /
Outreach
Program Components
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Standard Performance Expectations
Goals
Screening and referral process
for individuals identified as
having a mental illness or in
need of mental health services
Intake assessments for
unenrolled persons who meet
priority populations defined in
RCW 71.24 and WAC 388-8650215
Transitional Case Management
services to expedite and
facilitate an individual’s return
to the community.
Intensive Case Management
services related to finding and
obtaining permanent housing for
individuals released from
inpatient mental health facility.
Assistance with completing and
submitting benefit applications
prior to release
Collaboration with other jail,
correctional or court staff to
facilitate less restrictive
diversion options and/or
alternatives to jail
Pre-release direct mental
health/co-occurring services and
assistance prior to discharge

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Decrease the number and duration of inappropriate
incarcerations of persons with mental illness and
facilitate access to available community services for
this population per the Memorandum of
Understanding between TMRSN, the Contractor and:
Thurston County Jail, Mason County Jail and
Olympia City Jail.
Provide intensive case management services for
individuals who are homeless, or are at risk of
becoming homeless, by successfully linking
consumers with appropriate housing services and
facilitating permanent housing
Coordinate with local law enforcement and jail
personnel, Community Service Office(s) (CSOs) and
TMRSN Network Providers to expedite and facilitate
return of incarcerated individuals to the community.
Assess individuals placed in Thurston County,
Olympia City and Mason County Jails to determine
whether they have an acute or chronic mental illness.
Expedite and facilitate prompt reinstatement and
speedy eligibility determinations for persons likely to
be eligible for medical assistance and/or federal
benefits upon release from confinement
Provide short-term crisis intervention and brief
treatment services to inmates who are in an acute
state.
Identify training and consultation needs of
correctional staff, community housing staff, and
court employees regarding issues related to the
mentally illness and homelessness.
Outputs
A. Maintain total hours of
service on behalf of
consumers (based on 46
week/year working at 50%
productivity). Productivity
is a combination of
encounters and services
tracked on the Activity
Log.
Target: 76.67 hours/month
Variance: +/- 7 hours/month
B. Staff training and
consultation hours, per
calendar year.
Target: 300 hours combined
Variance: +/- 25 hours
C. Provision of services for
BHR-enrolled consumers
within 7 calendar days of
release from jail or
inpatient mental health
facility.
Target: 95 percent
Variance: +/- 3%
Outcomes
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
Percent of eligible
consumers referred
for ongoing
outpatient services.
Percent of
consumers assisted
with completion of
benefits
application.
Percentage of
consumers who
presented
themselves for
ongoing outpatient
services.
Resources
See Above
Contract Section
7.2.6.1.1: Number of individuals
diverted from jail prior to booking
See Above
7.2.6.1.3: Number of individuals
served in each service area
See Above
7.2.6.1.6: Number of community
referrals from law enforcement
Standard Contract-Based Deliverables
Description
This output number refers to the number of individuals
who were diverted from jail due to the direct
intervention of CIO staff. These consumers were
diverted because the courts / law enforcement saw the
consumer’s mental illness as the primary factor for the
infraction, and a more appropriate resolution for the
consumer was identified.
This output number refers to the total number of
consumers served in each of the primary areas within
the CIO program. This includes jails (by facility),
shelters, and any mental health facility or hospital.
The output number refers to the number of individuals
who were referred to the CIO program by any
correctional official – including court staff, jail
personnel, or probation.
Reporting Requirements
This should be reported each month as a raw number. Each
number represented must be backed up with documentation
in the CIO chart which supports the diversion.
This should be reported each month by key program area and
by facility and location.
This should be reported each month by facility and location.
Resources
See Above
Contract Section
7.2.6.1.2: Number of individuals
provided assistance with SSI/SSDI
applications /reapplications
See Above
7.2.6.1.4: Number of individuals
successfully linked with TMRSN
Outpatient services
See Above
7.2.6.1.5: Number of individuals
successfully linking with housing
supports.
Performance-Based Incentives
Description
This performance-based output refers to the number of
successful Medicaid applications submitted and
accepted (approved). It is expected that CIO staff sit
with consumers and fill out online Medicaid
applications. A successful application is approved and
can be verified through documentation in the
consumer’s CIO chart. *Note – In order to access
incentive, must complete 10 or more applications.
This performance-based output refers to the number of
successful referrals made to a TMRSN Outpatient
provider. A successful referral is defined as a
consumer who becomes enrolled within any outpatient
provider within the TMRSN catchment area, and must
be documented in the consumer’s CIO chart. *Note –
In order to access incentive, must complete 10 or
more enrollments.
This performance-based output refers to the number of
CIO consumers who have been successfully linked
with a housing support. A successful housing linkage
refers to both of the following: (1) A referral to a
housing support agency has been made and
documented, and (2) the consumer has been accepted,
and has moved into, a permanent housing option.
*Note – In order to access incentive, must complete 5
or more placements.
Incentive
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$30 will be paid for each successful Medicaid
application made on behalf of the consumer. This
incentive will become effective starting after the first
full quarter of this contract (beginning with applications
made during the fourth month of this contract). Each
request for payment must be verified with
documentation from the consumer’s CIO record.
Incentive not to exceed $750 per month.
$30 will be paid for each successful referral (enrollment)
made to a TMRSN outpatient provider. This incentive
will become effective starting after the first full quarter
of this contract (beginning with referrals made during
the fourth month of this contract). Each request for
payment must be verified with documentation from the
consumer’s CIO record. Incentive not to exceed $750
per month.
$100 will be paid for each successful housing linkage
and placement into a permanent housing option. This
incentive will become effective starting after the first
full quarter of this contract (beginning with permanent
placements made during the fourth month of this
contract). Each request for payment must be verified
with documentation from the consumer’s CIO record.
Incentive not to exceed $1000 per month.
EXHIBIT D
DATA SECURITY REQUIREMENTS
1.
2.
Data Transport. When transporting Protected Health Information (PHI) electronically, including via
email, the data will be protected by:
1.1.
Transporting the data within the (State Governmental Network) SGN or contractor’s internal
network, or;
1.2.
Encrypting any data that will be in transit outside the SGN or contractor’s internal network. This
includes transit over the public Internet.
Protection of Data. The contractor agrees to store data on one or more of the following media and protect
the data as described:
2.1.
Hard disk drives. Data stored on local workstation hard disks. Access to the data will be
restricted to authorized users by requiring logon to the local workstation using a unique user ID and
complex password or other authentication mechanisms which provide equal or greater security,
such as biometrics or smart cards.
2.2.
Network server disks. Data stored on hard disks mounted on network servers and made available
through shared folders. Access to the data will be restricted to authorized users through the use of
access control lists which will grant access only after the authorized user has authenticated to the
network using a unique user ID and complex password or other authentication mechanisms which
provide equal or greater security, such as biometrics or smart cards. Data on disks mounted to such
servers must be located in an area which is accessible only to authorized personnel, with access
controlled through use of a key, card key, combination lock, or comparable mechanism.
2.3.
Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by the
contractor on optical discs which will be used in local workstation optical disc drives and which
will not be transported out of a secure area. When not in use for the contracted purpose, such discs
must be locked in a drawer, cabinet or other container to which only authorized users have the key,
combination or mechanism required to access the contents of the container. Workstations which
access PHI data on optical discs must be located in an area which is accessible only to authorized
personnel, with access controlled through use of a key, card key, combination lock, or comparable
mechanism.
2.4.
Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by the
contractor on optical discs which will be attached to network servers and which will not be
transported out of a secure area. Access to data on these discs will be restricted to authorized users
through the use of access control lists which will grant access only after the authorized user has
authenticated to the network using a unique user ID and complex password or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on
discs attached to such servers must be located in an area which is accessible only to authorized
personnel, with access controlled through use of a key, card key, combination lock, or comparable
mechanism.
2.5.
Paper documents. Any paper records must be protected by storing the records in a secure area
which is only accessible to authorized personnel. When not in use, such records must be stored in
a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons
have access.
Exhibit D – Data Security
Page 1 of 3
2.6.
3.
Access via remote terminal/workstation over the State Governmental Network (SGN). Data
accessed and used interactively over the SGN. Access to the data will be controlled by TMRSN
staff who will issue authentication credentials (e.g. a unique user ID and complex password) to
authorized contractor staff. Contractor will notify TMRSN staff immediately whenever an
authorized person in possession of such credentials is terminated or otherwise leaves the employ of
the contractor, and whenever a user’s duties change such that the user no longer requires access to
perform work for this contract.
2.7.
Access via remote terminal/workstation over the Internet through Secure Access
Washington. Data accessed and used interactively over the SGN. Access to the data will be
controlled by TMRSN staff who will issue authentication credentials (e.g. a unique user ID and
complex password) to authorized contractor staff. Contractor will notify TMRSN staff
immediately whenever an authorized person in possession of such credentials is terminated or
otherwise leaves the employ of the contractor and whenever a user’s duties change such that the
user no longer requires access to perform work for this contract.
2.8.
Data storage on portable devices or media.
2.8.1.
PHI data shall not be stored by the Contractor on portable devices or media unless
specifically authorized within the Special Terms and Conditions of the contract. If so
authorized, the data shall be given the following protections:
2.8.1.1.
Encrypt the data with a key length of at least 128 bits
2.8.1.2.
Control access to devices with a unique user ID and password or stronger
authentication method such as a physical token or biometrics.
2.8.1.3.
Manually lock devices whenever they are left unattended and set devices to
lock automatically after a period of inactivity, if this feature is available.
Maximum period of inactivity is 20 minutes.
2.8.2.
Physically protect the portable device(s) and/or media by
2.8.2.1.
Keeping them in locked storage when not in use
2.8.2.2.
Using check-in/check-out procedures when they are shared, and
2.8.2.3.
Taking frequent inventories
2.8.3.
When being transported outside of a secure area, portable devices and media with
confidential PHI data must be under the physical control of contractor staff with
authorization to access the data.
2.8.4.
Portable devices include, but are not limited to; handhelds/PDAs, Ultramobile PCs, flash
memory devices (e.g. USB flash drives, personal media players), portable hard disks, and
laptop/notebook computers if those computers may be transported outside of a secure
area.
2.8.5.
Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic
media (e.g. floppy disks, tape, Zip or Jaz disks), or flash media (e.g. CompactFlash, SD,
MMC).
Data Segregation.
3.1.
PHI data must be segregated or otherwise distinguishable from non-PHI data. This is to ensure that
when no longer needed by the contractor, all PHI data can be identified for return or destruction. It
also aids in determining whether PHI data has or may have been compromised in the event of a
security breach.
3.2.
PHI data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no nonPHI data. Or,
3.3.
PHI data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to PHI data. Or,
Exhibit D – Data Security
Page 2 of 3
3.4.
3.5.
4.
PHI data will be stored in a database which will contain no non-PHI data. Or,
PHI data will be stored within a database and will be distinguishable from non-PHI data by the
value of a specific field or fields within database records. Or,
3.6.
When stored as physical paper documents, PHI data will be physically segregated from non-PHI
data in a drawer, folder, or other container.
3.7.
When it is not feasible or practical to segregate PHI data from non-PHI data, then both the PHI
data and the non-PHI data with which it is commingled must be protected as described in this
exhibit.
Data Disposition. When the contracted work has been completed or when no longer needed, data shall be
returned to TMRSN or destroyed. Media on which data may be stored and associated acceptable methods
of destruction are as follows:
Data stored on:
Will be destroyed by:

Server or workstation hard disks, or


Removable media (e.g. floppies, USB flash
drives, portable hard disks, Zip or similar
disks)


5.
6.
Using a “wipe” utility which will overwrite
the data at least three (3) times using either
random or single character data, or
Degaussing sufficiently to ensure that the
data cannot be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or confidential
data
Recycling through a contracted firm provided the
contract with the recycler assures that the
confidentiality of data will be protected.
Paper documents containing confidential
information requiring special handling (e.g.
protected health information)
On-site shredding, pulping, or incineration
Optical discs (e.g. CDs or DVDs)
Incineration, shredding, or completely defacing
the readable surface with a course abrasive
Magnetic tape
Degaussing, incinerating or crosscut shredding
Notification of Compromise or Potential Compromise. The compromise or potential compromise of
PHI shared data must be reported to the TMRSN Contact designated on the contract within one (1)
business day of discovery.
Data shared with Sub-contractors. If PHI data provided under this contract is to be shared with a subcontractor, the contract with the sub-contractor must include all of the data security provisions within this
contract and within any amendments, attachments, or exhibits within this contract. If the contractor cannot
protect the data as articulated within this contract, then the contract with the sub-contractor must be
submitted to the TMRSN Contact specified for this contract for review and approval.
Exhibit D – Data Security
Page 3 of 3
EXHIBIT E
STATE PLAN MODALITY DEFINITIONS
Brief Intervention Treatment: Solution-focused and outcomes-oriented cognitive and behavioral interventions
intended to ameliorate symptoms, resolve situational disturbances which are not amenable to resolution in a
crisis service model of care and which do not require long term-treatment, to return the individual to previous
higher levels of general functioning. Individuals must be able to select and identify a focus for care that is
consistent with time-limited, solution-focused or cognitive-behavioral model of treatment. Functional problems
and/or needs identified in the Medicaid Enrollee's Individual Service Plan must include a specific timeframe for
completion of each identified goal. This service does not include ongoing care, maintenance/monitoring of the
Enrollee’s current level of functioning and assistance with self care or life skills training. Enrollees may move
from Brief Intervention Treatment to longer term Individual Services at any time during the course of care. This
service is provided by or under the supervision of a Mental Health Professional.
Crisis Services: Evaluation and treatment of mental health crisis to all Medicaid-enrolled individuals
experiencing a crisis. A mental health crisis is defined as a turning point in the course of anything decisive or
critical, a time, a stage, or an event or a time of great danger or trouble, whose outcome decides whether
possible bad consequences will follow. Crisis services shall be available on a 24-hour basis. Crisis services are
intended to stabilize the person in crisis, prevent further deterioration and provide immediate treatment and
intervention in a location best suited to meet the needs of the individual and in the least restrictive environment
available. Crisis services may be provided prior to completion of an intake evaluation. Services are provided by
or under the supervision of a Mental Health Professional.
Day Support: An intensive rehabilitative program which provides a range of integrated and varied life skills
training (e.g., health, hygiene, nutritional issues, money management, maintaining living arrangement, symptom
management) for Medicaid Enrollees to promote improved functioning or a restoration to a previous higher
level of functioning. The program is designed to assist the individual in the acquisition of skills, retention of
current functioning or improvement in the current level of functioning, appropriate socialization and adaptive
coping skills. Eligible individuals must demonstrate restricted functioning as evidenced by an inability to
provide for their instrumental activities of daily living. This modality may be provided as an adjunctive
treatment or as a primary intervention. The staff to consumer ratio is no more than 1:20 and is provided by or
under the supervision of a Mental Health Professional in a location easily accessible to the client (e.g.,
community mental health agencies, clubhouses, community centers). This service is available 5 hours per day, 5
days per week.
Family Treatment: Psychological counseling provided for the direct benefit of a Medicaid-enrolled individual.
Service is provided with family members and/or other relevant persons in attendance as active participants.
Treatment shall be appropriate to the culture of the client and his/her family and should reinforce the family
structure, improve communication and awareness, enforce and reintegrate the family structure within the
community, and reduce the family crisis/upheaval. The treatment will provide family-centered interventions to
identify and address family dynamics and build competencies to strengthen family functioning in relationship to
the consumer. Family treatment may take place without the consumer present in the room but service must be
for the benefit of attaining the goals identified for the individual in his/her Individual Service Plan. This service
is provided by or under the supervision of a Mental Health Professional.
Freestanding Evaluation and Treatment: Services provided in freestanding inpatient residential (nonExhibit E – Modality Definitions
Page 1 of 5
hospital/non-IMD) facilities licensed by the Department of Health and certified by DBHR to provide medically
necessary evaluation and treatment to the Medicaid-enrolled individual who would otherwise meet hospital
admission criteria. These are not-for-profit organizations. At a minimum, services include evaluation,
stabilization and treatment provided by or under the direction of licensed psychiatrists, nurses and other Mental
Health Professionals, and discharge planning involving the individual, family, significant others so as to ensure
continuity of mental health care. Nursing care includes but is not limited to performing routine blood draws,
monitoring vital signs, providing injections, administering medications, observing behaviors and presentation of
symptoms of mental illness. Treatment modalities may include individual and family therapy, milieu therapy,
psycho-educational groups and pharmacology. The individual is discharged as soon as a less-restrictive plan for
treatment can be safely implemented.
This service is provided for individuals who pose an actual or imminent danger to self, others, or property due
to a mental illness, or who have experienced a marked decline in their ability to care for self due to the onset or
exacerbation of a psychiatric disorder.
The severity of symptoms, intensity of treatment needs or lack of necessary supports for the individual does not
allow him/her to be managed at a lesser level of care. This service does not include cost for room and board.
DBHR must authorize exceptions for involuntary length of stay beyond a fourteen (14) day commitment.
Group Treatment Services: Services provided to Medicaid-enrolled individuals designed to assist in the
attainment of goals described in the Individual Service Plan. Goals of Group Treatment may include:
developing self care and/or life skills enhancing interpersonal skills; mitigating the symptoms of mental illness
and lessening the results of traumatic experiences; learning from the perspective and experiences of others and
counseling/psychotherapy to establish and/or maintain stability in living, work or educational environment.
Individuals eligible for Group Treatment must demonstrate an ability to benefit from experiences shared by
others, demonstrate the ability to participate in a group dynamic process in a manner that is respectful of others’
right to confidential treatment and must be able to integrate feedback from other group members. This service is
provided by or under the supervision of a Mental Health Professional to two or more Medicaid-enrolled
individuals at the same time. Staff to consumer ratio is no more than 1:12. Maximum group size is 24.
High Intensity Treatment: Intensive levels of service otherwise furnished under this State plan amendment
that is provided to Medicaid-enrolled individuals who require a multi-disciplinary treatment team in the
community that is available upon demand based on the individuals’ needs. Twenty-four hours per day, seven
days per week, access is required if necessary. Goals for High Intensity Treatment include the reinforcement of
safety, the promotion of stability and independence of the individual in the community, and the restoration to a
higher level of functioning. These services are designed to rehabilitate individuals who are experiencing severe
symptoms in the community and thereby avoid more restrictive levels of care such as psychiatric inpatient
hospitalization or residential placement.
The team consists of the individual, Mental Health Care Providers, under the supervision of a Mental Health
Professional, and other relevant persons as determined by the individual (e.g., family, guardian, friends,
neighbor). Other community agency members may include probation/parole officers*, teacher, minister,
physician, chemical dependency counselor*, etc. Team members work together to provide intensive coordinated
and integrated treatment as described in the Individual Service Plan. The team’s intensity varies among
individuals and for each individual across time. The assessment of symptoms and functioning shall be
continuously addressed by the team based on the needs of the individual allowing for the prompt assessment for
needed modifications to the Individual Service Plan or crisis plan. Team members provide immediate feedback
to the individual and to other team members. The staff to consumer ratio for this service is no more than 1:15.
Exhibit E – Modality Definitions
Page 2 of 5
Billable components of this modality include time spent by the mental health professionals, mental health care
providers and peer counselors.
*Although they participate, these team members are paid staff of other Departments and therefore not
reimbursed under this modality.
Individual Treatment Services: A set of treatment services designed to help a Medicaid-enrolled individual
attain goals as prescribed in his/her Individual Service Plan. These services shall be congruent with the age,
strengths, and cultural framework of the individual and shall be conducted with the individual, his or her family,
or others at the individual’s behest who play a direct role in assisting the individual to establish and/or maintain
stability in his/her daily life. These services may include developing the individual's self care/life skills;
monitoring the individual's functioning; counseling and psychotherapy. Services shall be offered at the location
preferred by the Medicaid-enrolled individual. This service is provided by or under the supervision of a Mental
Health Professional.
Intake Evaluation: An evaluation that is culturally and age relevant initiated prior to the provision of any other
mental health services, except crisis services, stabilization services and free-standing evaluation and treatment.
The intake evaluation must be initiated within ten (10) working days of the request for services, establish the
medical necessity for treatment and be completed within 30 working days. Routine services may begin before
the completion of the intake once medical necessity is established. This service is provided by a Mental Health
Professional.
Medication Management: The prescribing and/or administering and reviewing of medications and their side
effects. This service shall be rendered face-to-face by a person licensed to perform such services. This service
may be provided in consultation with collateral, primary therapists, and/or case managers, but includes only
minimal psychotherapy.
Medication Monitoring: Face-to-face, one-on-one cueing, observing, and encouraging a Medicaid-enrolled
individual to take medications as prescribed. Also includes reporting back to persons licensed to perform
medication management services for the direct benefit of the Medicaid-enrolled individual. This activity may
take place at any location and for as long as it is clinically necessary. This service is designed to facilitate
medication compliance and positive outcomes. Enrollees with low medication compliance history or persons
newly on medication are most likely to receive this service. This service is provided by or under the supervision
of a Mental Health Professional. Time spent with the Enrollee is the only direct service billable component of
this modality.
Mental Health Services provided in Residential Settings: A specialized form of rehabilitation service (non
hospital/non IMD) that offers a sub-acute psychiatric management environment. Medicaid-enrolled individuals
receiving this service present with severe impairment in psychosocial functioning or have apparent mental
illness symptoms with an unclear etiology due to their mental illness. Treatment for these individuals cannot be
safely provided in a less restrictive environment and they do not meet hospital admission criteria. Individuals in
this service require a different level of service than High Intensity Treatment. The Mental Health Care Provider
is sited at the residential location (e.g., boarding homes, supported housing, cluster housing, SRO apartments)
for extended hours to provide direct mental health care to a Medicaid Enrollee. Therapeutic interventions both
in individual and group format may include medication management and monitoring, stabilization, and
cognitive and behavioral interventions designed with the intent to stabilize the individual and return him/her to
more independent and less restrictive treatment. The treatment is not for the purpose of providing custodial care
or respite for the family, nor is it for the sole purpose of increasing social activity or used as a substitute for
Exhibit E – Modality Definitions
Page 3 of 5
other community-based resources. This service is billable on a daily rate. In order to bill the daily rate for
associated costs for these services, a minimum of eight (8) hours of service must be provided. This service does
not include the costs for room and board, custodial care, and medical services, and differs for other services in
the terms of location and duration.
Peer Support: Services provided by peer counselors to Medicaid-enrolled individuals under the consultation,
facilitation or supervision of a Mental Health Professional who understands rehabilitation and recovery. This
service provides scheduled activities that promote socialization, recovery, self-advocacy, development of
natural supports, and maintenance of community living skills. Consumers actively participate in decisionmaking and the operation of the programmatic supports.
Self-help support groups, telephone support lines, drop-in centers, and sharing the peer counselor’s own life
experiences related to mental illness will build alliances that enhance the consumer’s ability to function in the
community. These services may occur at locations where consumers are known to gather (e.g., churches, parks,
community centers, etc). Drop-in centers are required to maintain a log documenting identification of the
consumer including Medicaid eligibility.
Services provided by peer counselors to the consumer are noted in the consumer’s Individualized Service Plan
which delineates specific goals that are flexible, tailored to the consumer and attempt to utilize community and
natural supports. Monthly progress notes document consumer progress relative to goals identified in the
Individualized Service Plan, and indicates where treatment goals have not yet been achieved.
Peer counselors are responsible for the implementation of peer support services. Peer counselors may serve on
High Intensity Treatment Teams.
Peer support is available to each Enrollee for no more than four (4) hours per day. The ratio for this service is
no more than 1:20.
Psychological Assessment: All psychometric services provided for evaluating, diagnostic, or therapeutic
purposes by or under the supervision of a licensed psychologist. Psychological assessments shall: be culturally
relevant; provide information relevant to a consumer’s continuation in appropriate treatment; and assist in
treatment planning within a licensed mental health agency.
Rehabilitation Case Management: A range of activities by the outpatient Community Mental Health
Agency’s liaison conducted in or with a facility for the direct benefit of a Medicaid-enrolled individual in the
public mental health system. To be eligible, the individual must be in need of case management in order to
ensure timely and appropriate treatment and care coordination. Activities include assessment for discharge or
admission to community mental health care, integrated mental health treatment planning, resource identification
and linkage to mental health rehabilitative services, and collaborative development of individualized services
that promote continuity of mental health care. These specialized mental health coordination activities are
intended to promote discharge, maximize the benefits of the placement, minimize the risk of unplanned readmission and to increase the community tenure for the individual. Services are provided by or under the
supervision of a Mental Health Professional.
Special Population Evaluation: Evaluation by a child, geriatric, disabled, or ethnic minority specialist that
considers age and cultural variables specific to the individual being evaluated and other culturally and age
competent evaluation methods. This evaluation shall provide information relevant to a consumer's continuation
in appropriate treatment and assist in treatment planning. This evaluation occurs after intake. Consultation from
a non-staff specialist (employed by another CMHA or contracted by the CMHA) may also be obtained, if
Exhibit E – Modality Definitions
Page 4 of 5
needed, subsequent to this evaluation and shall be considered an integral, billable component of this service.
Stabilization Services: Services provided to Medicaid-enrolled individuals who are experiencing a mental
health crisis. These services are to be provided in the person's own home, or another home-like setting, or a
setting which provides safety for the individual and the Mental Health Professional. Stabilization services shall
include short-term (less than two weeks per episode) face-to-face assistance with life skills training, and
understanding of medication effects. This service includes: a) follow up to crisis services; and b) other
individuals determined by a mental health professional to need additional stabilization services. Stabilization
services may be provided prior to an intake evaluation for mental health services.
Therapeutic Psychoeducation: Informational and experiential services designed to aid Medicaid-enrolled
individuals, their family members (e.g., spouse, parents, siblings) and other individuals identified by the
individual as a primary natural support, in the management of psychiatric conditions, increase knowledge of
mental illnesses and understanding the importance of their individual plans of care. These services are
exclusively for the benefit of the Medicaid-enrolled individual and are included in the Individual Service Plan.
The primary goal is to restore lost functioning and promote reintegration and recovery through knowledge of
one’s disease, the symptoms, precautions related to decompensation, understanding of the “triggers” of crisis,
crisis planning, community resources, successful interrelations, medication action and interaction, etc. Training
and shared information may include brain chemistry and functioning; latest research on mental illness causes
and treatments; diagnostics; medication education and management; symptom management; behavior
management; stress management; crisis management; improving daily living skills; independent living skills;
problem-solving skills, etc. Services are provided at locations convenient to the consumer, by or under the
supervision of a Mental Health Professional. Classroom style teaching, family treatment and individual
treatment are not billable components of this service.
Exhibit E – Modality Definitions
Page 5 of 5
EXHIBIT F
ACCESS TO CARE STANDARDS
Access to Care Standards – 1/1/06
Eligibility Requirements for Authorization of Services for Medicaid Adults & Medicaid Older Adults
Please note: The following standards reflect the authorization criteria that can be applied. The standards should not
be applied as continuing stay criteria.
An individual must meet all of the following before being considered for a level of care assignment:
 The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the
list of Covered Adult & Older Adult Disorders.
 The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness.
 The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning
resulting from the presence of a mental illness.
 The individual is expected to benefit from the intervention.
 The individual’s unmet need can not be more appropriately met by any other formal or informal system or support.
* = Descriptive Only
Level One - Brief Intervention
Level Two - Community Support
Longer term treatment is necessary to achieve or
Brief Intervention Treatment/short term crisis
Goal & Period
maintain stability OR requires high intensity
resolution is necessary for the purpose of
of
treatment to prevent hospitalization, out of home
Authorization* strengthening ties within the community,
identifying and building on innate strengths of the placement and/or decrease the use of other costly
services.
family and/or other natural supports and
preventing the need for long term treatment OR
long term low intensity treatment is provided
allowing a person who has previously received
treatment at a higher level of care to maintain
their recovery.
The period of authorization may be up to six
The period of authorization may be up to six
months of care OR may be up to twelve months
months of care OR may be up to twelve months
of care when an individual is receiving long term, of care as determined by medical necessity and
treatment goal(s).
low intensity treatment.
Functional
 Must demonstrate moderate functional
 Must demonstrate serious functional
Impairment
impairment in at least one life domain
impairment in at least one life domain
requiring assistance in order to meet the
requiring assistance in order to meet the
Must be the
identified need ANDidentified need ANDresult of a
 Impairment is evidenced by a Global
 Impairment is evidenced by a Global
mental illness.
Assessment of Functioning (GAF) Score of
Assessment of Functioning (GAF) Score of
60 or below.
50 or below.
Domains include:
Domains include:
 Health & Self-Care, including the ability to
 Health & Self-Care, including the ability to
access medical, dental and mental health care
access medical, dental and mental health care
to include access to psychiatric medications
to include access to psychiatric medications
 Cultural Factors
 Cultural Factors
 Home & Family Life Safety & Stability
 Home & Family Life Safety & Stability
 Work, school, daycare, pre-school or other
 Work, school, daycare, pre-school or other
daily activities
daily activities
 Ability to use community resources to fulfill
 Ability to use community resources to fulfill
needs
needs
Exhibit F – Access to Care Standards
Page 1 of 13
Access to Care Standards – 1/1/06
Eligibility Requirements for Authorization of Services for Medicaid Adults & Medicaid Older Adults
Please note: The following standards reflect the authorization criteria that can be applied. The standards should not
be applied as continuing stay criteria.
An individual must meet all of the following before being considered for a level of care assignment:
 The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the
list of Covered Adult & Older Adult Disorders.
 The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness.
 The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning
resulting from the presence of a mental illness.
 The individual is expected to benefit from the intervention.
 The individual’s unmet need can not be more appropriately met by any other formal or informal system or support.
* = Descriptive Only
Level One - Brief Intervention
Level Two - Community Support
Assessment is provided by or under the
Assessment is provided by or under the
Covered
supervision of a mental health professional and
supervision of a mental health professional and
Diagnosis
determines the presence of a covered mental
determines the presence of a covered mental
health diagnosis. Special population consultation health diagnosis. Special population consultation
should be considered.
should be considered.
Diagnosis A = Covered
Diagnosis A = Covered
Diagnosis B = Covered + One Additional Criteria Diagnosis B = Covered + One Additional Criteria
(See Covered Adult & Older Adult Disorders)
(See Covered Adult & Older Adult Disorders)
May have lack of or severely limited natural
May have limited social supports and impaired
Supports &
supports in the community due to mental illness.
interpersonal functioning due to mental illness.
Environment*
May be involvement with one or more formal
Individual and natural supports may lack
systems requiring coordination in order to
resources or have difficulty accessing
achieve goals. Active outreach may be needed to
entitlements (food, income, coupons,
transportation) or available community resources; ensure treatment involvement. Situation exceeds
language and/or cultural factors may pose barriers the resources of the natural support system.
to accessing services. May be involvement with
one or more additional formal systems requiring
coordination. Requires treatment to develop
supports, address needs and remain in the
community.
Access to the following modalities is based on
Access to the following modalities is based on
Minimum
clinical assessment, medical necessity and
clinical assessment, medical necessity and
Modality Set
individual need. In addition to the modalities
individual need. Individuals may be referred for
the following treatment:
listed in Level of Care One, individuals may be
referred for the following treatment:
 Brief Intervention Treatment
 Individual Treatment
 Medication Management
 Medication Monitoring
 Psychoeducation
 Peer Support
 Group Treatment
The full scope of available treatment modalities
The full scope of available treatment modalities
may be provided based on clinical assessment,
may be provided based on clinical assessment,
medical necessity and individual need.
medical necessity and individual need.
Individuals who have both a covered and a nonDual Diagnosis Individuals who have both a covered and a noncovered diagnosis are eligible for service based
covered diagnosis are eligible for service based
on the covered diagnosis.
on the covered diagnosis.
Exhibit F – Access to Care Standards
Page 2 of 13
Access to Care Standards – 1/1/06
Eligibility Requirements for Authorization of Services for Medicaid Children & Youth
Please note: The following standards reflect the authorization criteria that can be applied. The standards should not
be applied as continuing stay criteria.
An individual must meet all of the following before being considered for a level of care assignment:
 The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the
list of Covered Childhood Disorders.
 The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness.
 The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning
resulting from the presence of a mental illness.
 The individual is expected to benefit from the intervention.
 The individual’s unmet need would not be more appropriately met by any other formal or informal system or support.
* = Descriptive Only
Level One - Brief Intervention
Level Two - Community Support
Longer term treatment is necessary to achieve or
Brief Intervention Treatment/short term crisis
Goal & Period
maintain stability OR requires high intensity
resolution is necessary for the purpose of
of
treatment to prevent hospitalization, out of home
Authorization* strengthening ties within the community,
identifying and building on innate strengths of the placement and/or decrease the use of other costly
services.
family and/or other natural supports and
preventing the need for long term treatment OR
long term low intensity treatment is provided
allowing a person who has previously received
treatment at a higher level of care to maintain
their recovery.
The period of authorization may be up to six
The period of authorization may be up to six
months of care OR may be up to twelve months
months of care OR may be up to twelve months
of care when an individual is receiving long term, of care as determined by medical necessity and
treatment goal(s).
low intensity treatment.
Functional
 Must demonstrate moderate functional
 Must demonstrate severe and persistent
Impairment
impairment in at least one life domain
functional impairment in at least one life
requiring assistance in order to meet the
domain requiring assistance in order to
Must be the
identified need ANDmeet identified need ANDresult of an
 Impairment is evidenced by a Children’s
emotional
 Impairment is evidenced by a Children’s
Global Assessment Scale (CGAS) Score of
disorder or a
50 or below. (Children under 6 are exempted
Global Assessment Scale (CGAS) Score of
mental illness.
60 or below. (Children under 6 are exempted
from CGAS.)
from CGAS.)
Domains include:
Health & Self-Care, including the ability to
Domains include:
access medical, dental and mental health care
Health & Self-Care, including the ability to
to include access to psychiatric medications
access medical, dental and mental health care
Cultural Factors
to include access to psychiatric medications
Cultural Factors
 Home & Family Life Safety & Stability
 Home & Family Life Safety & Stability
 Work, school, daycare, pre-school or other
daily activities
 Work, school, daycare, pre-school or other
daily activities
 Ability to use community resources to fulfill
need
 Ability to use community resources to fulfill
needs
Exhibit F – Access to Care Standards
Page 3 of 13
Access to Care Standards – 1/1/06
Eligibility Requirements for Authorization of Services for Medicaid Children & Youth
Please note: The following standards reflect the authorization criteria that can be applied. The standards should not
be applied as continuing stay criteria.
An individual must meet all of the following before being considered for a level of care assignment:
 The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the
list of Covered Childhood Disorders.
 The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness.
 The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning
resulting from the presence of a mental illness.
 The individual is expected to benefit from the intervention.
 The individual’s unmet need would not be more appropriately met by any other formal or informal system or support.
* = Descriptive Only
Level One - Brief Intervention
Level Two - Community Support
Assessment is provided by or under the
Assessment is provided by or under the
Covered
supervision of a mental health professional and
supervision of a mental health professional and
Diagnosis
determines the presence of a covered mental
determines the presence of a covered mental
health diagnosis.
health diagnosis.
Consultation with a children’s mental health
Consultation with a children’s mental health
specialist is required.
specialist is required.
Diagnosis A = Covered
Diagnosis A = Covered
Diagnosis B = Covered + One Additional Criteria Diagnosis B = Covered + One Additional Criteria
(See Covered Childhood Disorders)
(See Covered Childhood Disorders)
Significant stressors are present in home
Natural support network is experiencing
Supports &
environment, i.e., change in custodial adult; out
challenges, i.e., multiple stressors in the home;
Environment*
of home placement; abuse or history of abuse;
family or caregivers lack resources or have
and situation exceeds the resources of natural
difficulty accessing entitlements (food, income,
support system. May be involvement with one or
coupons, transportation) or available community
more child serving system requiring coordination.
resources; language and/or cultural factors may
pose barriers to accessing services. May be
involvement with one or more child serving
systems requiring coordination.
Children eligible for Level Two EPSDT services
Level One Services are defined as short-term
EPSDT Plan
in the 1992 EPSDT plan are defined as needing
mental health services for children/families with
longer term, multi-agency services designed to
less severe need. An ISP should be developed
and appropriate referrals made. Children eligible meet the complex needs of an individual child
and family.
for Level One EPSDT services in the 1992
Level Two is authorized for children with multiEPSDT plan are included here.
system needs or for children who are high
utilizers of services from multiple agencies.
EPSDT children authorized for this level will be
referred to and may require an individual
treatment team in accordance with the EPSDT
Plan.
Exhibit F – Access to Care Standards
Page 4 of 13
Access to Care Standards – 1/1/06
Eligibility Requirements for Authorization of Services for Medicaid Children & Youth
Please note: The following standards reflect the authorization criteria that can be applied. The standards should not
be applied as continuing stay criteria.
An individual must meet all of the following before being considered for a level of care assignment:
 The individual is determined to have a mental illness. The diagnosis must be included as a covered diagnosis in the
list of Covered Childhood Disorders.
 The individual’s impairment(s) and corresponding need(s) must be the result of a mental illness.
 The intervention is deemed to be reasonably necessary to improve, stabilize or prevent deterioration of functioning
resulting from the presence of a mental illness.
 The individual is expected to benefit from the intervention.
 The individual’s unmet need would not be more appropriately met by any other formal or informal system or support.
* = Descriptive Only
Level One - Brief Intervention
Level Two - Community Support
Access to the following modalities is based on
Minimum
Access to the following modalities is based on
clinical assessment, medical necessity and
Modality Set
clinical assessment, medical necessity and
individual need. In addition to the modalities
individual need. Individuals may be referred
for the following treatment:
listed in Level of Care One, individuals may be
referred for the following treatment:
 Brief Intervention Treatment
 Individual Treatment
 Medication Management
 Medication Monitoring
 Psychoeducation
 Group Treatment
 Family Supports
Dual Diagnosis
The full scope of available treatment modalities
may be provided based on clinical assessment,
medical necessity and individual need.
Individuals who have both a covered and a noncovered diagnosis may be eligible for service
based on the covered diagnosis.
Exhibit F – Access to Care Standards
The full scope of available treatment modalities
may be provided based on clinical assessment,
medical necessity and individual need.
Individuals who have both a covered and a noncovered diagnosis may be eligible for service
based on the covered diagnosis.
Page 5 of 13
Washington State Medicaid Program
Minimum Covered Diagnoses for Medicaid Adults & Medicaid Older Adults
1/1/06
Washington State defines acutely mentally ill, chronically mental ill adult, seriously disturbed person, and severely
emotionally disturbed child in RCW 71.24 and RCW 71.05. The following diagnoses are considered to further interpret
the statute criteria in establishing eligibility under the Washington State Medicaid Program. Additional eligibility
requirements must be met to qualify for outpatient mental health services. Minimum eligibility requirements for
authorization of services for Medicaid Adults and Older Adults are further defined in the Access to Care Standards.
Please note: The following covered diagnoses must be considered for eligibility.
DSM-IVTR CODE
314.01
314.00
314.01
314.9
294.10
294.11
294.10
294.11
290.40
290.41
290.42
290.43
294.10
294.11
294.10
294.11
294.10
294.11
294.10
294.11
294.10
294.11
294.10
294.11
294.10
294.11
---.----.-294.8
294.9
295.30
295.10
DSM-IV-TR DEFINITION
ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR DISORDERS
Attention-Deficit/Hyperactivity Disorder, Combined type
Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type
Attention-Deficit/Hyperactivity Disorder DOS
DEMENTIA
Dementia of the Alzheimer’s Type, With Early Onset Without Behavioral Disturbance
Dementia of the Alzheimer’s Type, With Early Onset With Behavioral Disturbance
Dementia of the Alzheimer’s Type, With Late Onset Without Behavioral Disturbance
Dementia of the Alzheimer’s Type, With Late Onset With Behavioral Disturbance
Vascular Dementia Uncomplicated
Vascular Dementia With Delirium
Vascular Dementia With Delusions
Vascular Dementia With Depressed Mood
Dementia Due to HIV Disease Without Behavioral Disturbance
Dementia Due to HIV Disease With Behavioral Disturbance
Dementia Due to Head Trauma Without Behavioral Disturbance
Dementia Due to Head Trauma With Behavioral Disturbance
Dementia Due to Parkinson’s Disease Without Behavioral Disturbance
Dementia Due to Parkinson’s Disease With Behavioral Disturbance
Dementia Due to Huntington’s Disease Without Behavioral Disturbance
Dementia Due to Huntington’s Disease With Behavioral Disturbance
Dementia Due to Pick’s Disease Without Behavioral Disturbance
Dementia Due to Pick’s Disease With Behavioral Disturbance
Dementia Due to Creutzfeldt-Jakob Disease Without Behavioral Disturbance
Dementia Due to Creutzfeldt-Jakob Disease With Behavioral Disturbance
Dementia Due to... (Indicate the General Medical Condition not listed above) Without
Behavioral Disturbance
Dementia Due to... (Indicate the General Medical Condition not listed above) With
Behavioral Disturbance
Substance-Induced Persisting Dementia (refer to Substance-related Disorders for
substance specific codes)
Dementia Due to Multiple Etiologies
Dementia NOS
OTHER COGNITIVE DISORDERS
Cognitive Disorder NOS
SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Schizophrenia Paranoid Type
Schizophrenia Disorganized Type
Exhibit F – Access to Care Standards
A = Covered
B = Covered with
Additional Criteria
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
A
A
Page 6 of 13
DSM-IVTR CODE
295.20
295.90
295.60
295.40
295.70
297.1
298.8
297.3
293.81
293.82
DSM-IV-TR DEFINITION
296.01
296.02
296.03
296.04
296.05
296.06
296.00
296.40
296.41
296.42
296.43
Schizophrenia Catatonic Type
Schizophrenia Undifferentiated Type
Schizophrenia Residual Type
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder
Psychotic Disorder Due to (Indicate the General Medical Condition) With Delusions
Psychotic Disorder Due to (Indicate the General Medical Condition) With
Hallucinations
Psychotic Disorder NOS
MOOD DISORDERS
DEPRESSIVE DISORDERS
Major Depressive Disorder Single Episode, Mild
Major Depressive Disorder Single Episode, Moderate
Major Depressive Disorder Single Episode, Severe Without Psychotic Features
Major Depressive Disorder Single Episode, Severe With Psychotic Features
Major Depressive Disorder Single Episode, In Partial Remission
Major Depressive Disorder Single Episode, In Full Remission
Major Depressive Disorder Single Episode, Unspecified
Major Depressive Disorder Recurrent, Mild
Major Depressive Disorder Recurrent, Moderate
Major Depressive Disorder Recurrent, Severe Without Psychotic Features
Major Depressive Disorder Recurrent, Severe With Psychotic Features
Major Depressive Disorder Recurrent, In Partial Remission
Major Depressive Disorder Recurrent, In Full Remission
Major Depressive Disorder Recurrent, Unspecified
Dysthymic Disorder
Depressive Disorder NOS
BIPOLAR DISORDERS
Bipolar I Disorder Single Manic Episode, Mild
Bipolar I Disorder Single Manic Episode, Moderate
Bipolar I Disorder Single Manic Episode, Severe Without Psychotic Features
Bipolar I Disorder Single Manic Episode, Severe With Psychotic Features
Bipolar I Disorder Single Manic Episode, In Partial Remission
Bipolar I Disorder Single Manic Episode, In Full Remission
Bipolar I Disorder Single Manic Episode, Unspecified
Bipolar I Disorder Most Recent Episode Hypomanic
Bipolar I Disorder Most Recent Episode Manic, Mild
Bipolar I Disorder Most Recent Episode Manic, Moderate
Bipolar I Disorder Most Recent Episode Manic, Severe Without Psychotic Features
296.44
296.45
296.46
296.40
296.61
296.62
296.63
296.64
296.65
296.66
Bipolar I Disorder Most Recent Episode Manic, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Manic, In Partial Remission
Bipolar I Disorder Most Recent Episode Manic, In Full Remission
Bipolar I Disorder Most Recent Episode Manic, Unspecified
Bipolar I Disorder Most Recent Episode Mixed, Mild
Bipolar I Disorder Most Recent Episode Mixed, Moderate
Bipolar I Disorder Most Recent Episode Mixed, Severe Without Psychotic Features
Bipolar I Disorder Most Recent Episode Mixed, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Mixed, In Partial Remission
Bipolar I Disorder Most Recent Episode Mixed, In Full Remission
298.9
296.21
296.22
296.23
296.24
296.25
296.26
296.20
296.31
296.32
296.33
296.34
296.35
296.36
296.30
300.4
311
Exhibit F – Access to Care Standards
A = Covered
B = Covered with
Additional Criteria
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
Page 7 of 13
DSM-IVTR CODE
296.60
296.51
296.52
296.53
296.54
296.55
296.56
296.50
296.7
296.89
301.13
296.80
296.90
300.01
300.21
300.22
300.29
300.23
300.3
309.81
308.3
300.02
300.00
300.81
300.82
300.11
307.80
307.89
300.7
300.7
300.82
300.16
300.19
300.19
300.19
300.12
300.13
300.14
300.6
300.15
DSM-IV-TR DEFINITION
Bipolar I Disorder Most Recent Episode Mixed, Unspecified
Bipolar I Disorder Most Recent Episode Depressed, Mild
Bipolar I Disorder Most Recent Episode Depressed, Moderate
Bipolar I Disorder Most Recent Episode Depressed, Severe Without Psychotic
Features
Bipolar I Disorder Most Recent Episode Depressed, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Depressed, In Partial Remission
Bipolar I Disorder Most Recent Episode Depressed, In Full Remission
Bipolar I Disorder Most Recent Episode Depressed, Unspecified
Bipolar I Disorder Most Recent Episode Unspecified
Bipolar II Disorder
Cyclothymic Disorder
Bipolar Disorder NOS
Mood Disorder NOS
ANXIETY DISORDERS
Panic Disorder Without Agoraphobia
Panic Disorder With Agoraphobia
Agoraphobia Without History of Panic Disorder
Specific Phobia
Social Phobia
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder NOS
SOMATOFORM DISORDERS
Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Pain Disorder Associated With Psychological Factors
Pain Disorder Associated With Both Psychological Factors and a General Medical
Condition
Hypochondriasis
Body Dysmorphic Disorder
Somatoform Disorder NOS
FACTITIOUS DISORDERS
Factitious Disorder With Predominantly Psychological Signs and Symptoms
Factitious Disorder With Predominantly Physical Signs and Symptoms
Factitious Disorder With Combined Psychological and Physical Signs and Symptoms
Factitious Disorder NOS
DISSOCIATIVE DISORDERS
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Depersonalization Disorder
Dissociative Disorder NOS
SEXUAL AND GENDER IDENTITY DISORDERS
A = Covered
B = Covered with
Additional Criteria
A
A
A
A
A
A
A
A
A
A
B
A
B
B
B
B
B
B
B
A
A
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
EATING DISORDERS
307.1
307.51
307.50
Anorexia Nervosa
Bulimia Nervosa
Eating Disorder NOS
Exhibit F – Access to Care Standards
B
B
B
Page 8 of 13
DSM-IVTR CODE
309.0
309.24
309.28
309.3
309.4
309.9
301.0
301.20
301.22
301.7
301.83
301.50
301.81
301.82
301.6
301.4
301.9
DSM-IV-TR DEFINITION
A = Covered
B = Covered with
Additional Criteria
ADJUSTMENT DISORDERS
Adjustment Disorder With Depressed Mood
Adjustment Disorder With Anxiety
Adjustment Disorder With Mixed Anxiety and Depressed Mood
Adjustment Disorder With Disturbance of Conduct
Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
Adjustment Disorder Unspecified
PERSONALITY DISORDERS
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Personality Disorder NOS
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
Additional Criteria for Diagnosis B
An individual with a “B” diagnosis must meet at least one of the following criteria to be considered for a level of care
placement decision. Behaviors/symptoms must be the result of a mental illness.




High Risk Behavior demonstrated during the previous ninety days – aggressive and/or dangerous, puts self or others
at risk of harm, is at risk of grave disability, is at risk of psychiatric hospitalization or at risk of loss of current
placement due to the symptoms of a mental illness
Two or more hospital admissions due to a mental health diagnosis during the previous two years
Psychiatric hospitalization or residential treatment due to a mental health diagnosis of more than six months duration
in the previous year OR is currently being discharged from a psychiatric hospitalization
Received public mental health treatment on an outpatient basis within the PIHP system during the previous ninety
days and will deteriorate if services are not resumed (crisis intervention is not considered outpatient treatment)
Washington State Medicaid Program
Minimum Covered Diagnoses for Medicaid Children & Youth
1/1/06
Washington State defines acutely mentally ill, chronically mental ill adult, seriously disturbed person, and severely
emotionally disturbed child in RCW 71.24 and RCW 71.05. The following diagnoses are considered to further interpret
the statute criteria in establishing eligibility under the Washington State Medicaid Program. Additional eligibility
requirements must be met to qualify for outpatient mental health services. Minimum eligibility requirements for
authorization of services for Medicaid Children and Youth are further defined in the Access to Care Standards.
Please note: The following covered diagnoses must be considered for coverage.
DSM-IVTR CODE
314.01
314.00
314.01
DSM-IV-TR DEFINITION
ATTENTION-DEFICIT AND DISRUPTIVE BEHAVIOR DISORDERS
Attention-Deficit/Hyperactivity Disorder, Combined type
Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
Attention-Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive
Exhibit F – Access to Care Standards
A = Covered
B = Covered with
Additional Criteria
B
B
B
Page 9 of 13
314.9
312.81
312.82
312.89
313.81
312.9
309.21
313.23
313.89
307.3
313.9
295.30
295.10
295.20
295.90
295.60
295.40
295.70
297.1
298.8
297.3
293.81
293.82
298.9
Type
Attention-Deficit/Hyperactivity Disorder DOS
Conduct Disorder, Childhood-Onset Type
Conduct Disorder, Adolescent-Onset Type
Conduct Disorder, Unspecified Onset
Oppositional Defiant Disorder
Disruptive Behavior Disorder NOS
OTHER DISORDERS OF INFANCY, CHILDHOOD, OR ADOLESCENCE
Separation Anxiety Disorder
Selective Mutism
Reactive Attachment Disorder of Infancy or Early Childhood
Stereotypical Movement Disorder
Disorder of Infancy, Childhood, or Adolescence NOS
SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
Schizophrenia Paranoid Type
Schizophrenia Disorganized Type
Schizophrenia Catatonic Type
Schizophrenia Undifferentiated Type
Schizophrenia Residual Type
Schizophreniform Disorder
Schizoaffective Disorder
Delusional Disorder
Brief Psychotic Disorder
Shared Psychotic Disorder
Psychotic Disorder Due to
(Indicate the General Medical Condition) With Delusions
Psychotic Disorder Due to
(Indicate the General Medical Condition) With Hallucinations
Psychotic Disorder NOS
Exhibit F – Access to Care Standards
B
B
B
B
B
B
A
B
B
B
B
A
A
A
A
A
A
A
A
A
A
A
A
A
Page 10 of 13
296.22
296.23
296.24
296.25
296.26
296.20
296.31
296.32
296.33
296.34
296.35
296.36
296.30
300.4
311
296.01
296.02
296.03
296.04
296.05
296.06
296.00
296.40
296.41
296.42
296.43
296.44
296.45
296.46
296.40
296.61
296.62
296.63
296.64
296.65
296.66
296.60
296.51
296.52
296.53
296.54
296.55
296.56
296.50
296.7
296.89
301.13
296.80
296.90
300.01
MOOD DISORDERS
DEPRESSIVE DISORDERS
Major Depressive Disorder Single Episode, Moderate
Major Depressive Disorder Single Episode, Severe Without Psychotic Features
Major Depressive Disorder Single Episode, Severe With Psychotic Features
Major Depressive Disorder Single Episode, In Partial Remission
Major Depressive Disorder Single Episode, In Full Remission
Major Depressive Disorder Single Episode, Unspecified
Major Depressive Disorder Recurrent, Mild
Major Depressive Disorder Recurrent, Moderate
Major Depressive Disorder Recurrent, Severe Without Psychotic Features
Major Depressive Disorder Recurrent, Severe With Psychotic Features
Major Depressive Disorder Recurrent, In Partial Remission
Major Depressive Disorder Recurrent, In Full Remission
Major Depressive Disorder Recurrent, Unspecified
Dysthymic Disorder
Depressive Disorder NOS
BIPOLAR DISORDERS
Bipolar I Disorder Single Manic Episode, Mild
Bipolar I Disorder Single Manic Episode, Moderate
Bipolar I Disorder Single Manic Episode, Severe Without Psychotic Features
Bipolar I Disorder Single Manic Episode, Severe With Psychotic Features
Bipolar I Disorder Single Manic Episode, In Partial Remission
Bipolar I Disorder Single Manic Episode, In Full Remission
Bipolar I Disorder Single Manic Episode, Unspecified
Bipolar I Disorder Most Recent Episode Hypomanic
Bipolar I Disorder Most Recent Episode Manic, Mild
Bipolar I Disorder Most Recent Episode Manic, Moderate
Bipolar I Disorder Most Recent Episode Manic, Severe Without Psychotic Features
Bipolar I Disorder Most Recent Episode Manic, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Manic, In Partial Remission
Bipolar I Disorder Most Recent Episode Manic, In Full Remission
Bipolar I Disorder Most Recent Episode Manic, Unspecified
Bipolar I Disorder Most Recent Episode Mixed, Mild
Bipolar I Disorder Most Recent Episode Mixed, Moderate
Bipolar I Disorder Most Recent Episode Mixed, Severe Without Psychotic Features
Bipolar I Disorder Most Recent Episode Mixed, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Mixed, In Partial Remission
Bipolar I Disorder Most Recent Episode Mixed, In Full Remission
Bipolar I Disorder Most Recent Episode Mixed, Unspecified
Bipolar I Disorder Most Recent Episode Depressed, Mild
Bipolar I Disorder Most Recent Episode Depressed, Moderate
Bipolar I Disorder Most Recent Episode Depressed, Severe Without Psychotic
Features
Bipolar I Disorder Most Recent Episode Depressed, Severe With Psychotic Features
Bipolar I Disorder Most Recent Episode Depressed, In Partial Remission
Bipolar I Disorder Most Recent Episode Depressed, In Full Remission
Bipolar I Disorder Most Recent Episode Depressed, Unspecified
Bipolar I Disorder Most Recent Episode Unspecified
Bipolar II Disorder
Cyclothymic Disorder
Bipolar Disorder NOS
Mood Disorder NOS
ANXIETY DISORDERS
Panic Disorder Without Agoraphobia
Exhibit F – Access to Care Standards
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
A
B
A
A
A
Page 11 of 13
300.21
300.22
300.29
300.23
300.3
309.81
308.3
300.02
300.00
300.81
300.82
300.11
307.80
307.89
300.7
300.7
300.82
300.16
300.19
300.19
300.19
300.12
300.13
300.14
300.6
300.15
Panic Disorder With Agoraphobia
Agoraphobia Without History of Panic Disorder
Specific Phobia
Social Phobia
Obsessive-Compulsive Disorder
Posttraumatic Stress Disorder
Acute Stress Disorder
Generalized Anxiety Disorder
Anxiety Disorder NOS
SOMATOFORM DISORDERS
Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Pain Disorder Associated With Psychological Factors
Pain Disorder Associated With Both Psychological Factors and a General Medical
Condition
Hypochondriasis
Body Dysmorphic Disorder
Somatoform Disorder NOS
FACTITIOUS DISORDERS
Factitious Disorder With Predominantly Psychological Signs and Symptoms
Factitious Disorder With Predominantly Physical Signs and Symptoms
Factitious Disorder With Combined Psychological and Physical Signs and Symptoms
Factitious Disorder NOS
DISSOCIATIVE DISORDERS
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Depersonalization Disorder
Dissociative Disorder NOS
SEXUAL AND GENDER IDENTITY DISORDERS
A
A
B
B
A
A
A
A
A
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
EATING DISORDERS
307.1
307.51
307.50
309.0
309.24
309.28
309.3
309.4
309.9
301.0
301.20
301.22
301.7
301.83
301.50
301.81
301.82
301.6
301.4
301.9
Anorexia Nervosa
Bulimia Nervosa
Eating Disorder NOS
ADJUSTMENT DISORDERS
Adjustment Disorder With Depressed Mood
Adjustment Disorder With Anxiety
Adjustment Disorder With Mixed Anxiety and Depressed Mood
Adjustment Disorder With Disturbance of Conduct
Adjustment Disorder With Mixed Disturbance of Emotions and Conduct
Adjustment Disorder Unspecified
PERSONALITY DISORDERS
Paranoid Personality Disorder
Schizoid Personality Disorder
Schizotypal Personality Disorder
Antisocial Personality Disorder
Borderline Personality Disorder
Histrionic Personality Disorder
Narcissistic Personality Disorder
Avoidant Personality Disorder
Dependent Personality Disorder
Obsessive-Compulsive Personality Disorder
Personality Disorder NOS
Exhibit F – Access to Care Standards
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
B
Page 12 of 13
Additional Criteria for Diagnosis B
An individual with a “B” diagnosis must meet at least one of the following criteria to be considered for a level of care
placement decision. Behaviors/symptoms must be the result of a mental illness.
[Please note: CGAS is generally not considered valid for children under the age of six. The DC03 may be substituted.
Children under six are exempted from Axis V scoring. Very young children in need of mental health care may not readily
fit diagnostic criteria. The degree of functional impairment related to the symptoms of an emotional disorder or mental
illness should determine eligibility. Functional impairment for very young children is described in the last bullet.]






High Risk Behavior demonstrated during the previous ninety days – aggressive and/or dangerous, puts self or others
at risk of harm, is at risk of severe functional deterioration, is at risk of hospitalization or at risk of loss of current
placement due to mental illness or at risk of out of home placement due to the symptoms of an emotional disorder or
mental illness
At risk of escalating symptoms due to repeated physical or sexual abuse or neglect and there is significant impairment
in the adult caregiver’s ability to adequately address the child’s needs.
Two or more hospital admissions due to a mental health diagnosis during the previous two years
Psychiatric hospitalization or residential treatment due to a mental health diagnosis of more than six months duration
in the previous year OR is currently being discharged from a psychiatric hospitalization
Received public mental health treatment on an outpatient basis within the PIHP system during the previous ninety
days and will deteriorate if services are not resumed (crisis intervention is not considered outpatient treatment)
Child is under six years of age and there is a severe emotional abnormality in the child’s overall functioning as
indicated by one of the following:
1. Atypical behavioral patterns as a result of an emotional disorder or mental illness (odd disruptive or
dangerous behavior which is aggressive, self injurious, or hypersexual; display of indiscriminate
sociability/excessive familiarity with strangers).
2. Atypical emotional response patterns as a result of an emotional disorder or mental illness which
interferes with the child’s functioning (e.g. inability to communicate emotional needs; inability to tolerate
age-appropriate frustrations; lack of positive interest in adults and peers or a failure to initiate or respond
to most social interaction; fearfulness or other distress that doesn’t respond to comfort from caregivers).
Exhibit F – Access to Care Standards
Page 13 of 13
2015 Budgeted Revenue
1 PIHP/SMHC
2 Other State
Contracts (WISe)
$5.4m
m
(state & federal Medicaid)
$19.9m
3 Other Federal
Contracts (PATH/MHBG)
$361k
$6.2m
5 Dedicated
Millage
$293k
$306k
4 Treatment Sales Tax
(County)
$748k
6 Intergovernmental
/Other
$727k
7 Reserves
$2.4m
Thurston Mason RSN Provider Network
$29.8m
Budgeted expenditures and
actual subcontract
amounts may fluctuate.
Infrastructure Support
$1.7m -10.25 FTE
(1,2,4,5,7)
Includes: Administration, Management
Info Systems and Utilization
Management/Quality Assurance
amounts may vary
Outpatient Services
$16.4m
Community
Youth
Services
(1,2,4,7)
Capital
Recovery
Center
(1,3,5,7)
St. Peter
Hospital
(1,7)
Sea Mar
(1)
Catholic
Community
Services
(1,2,4,7)
Behavioral Health
Resources (BHR)
(1,6,7)
Kids MH Liaison
Multisystemic
Therapy (MST)
Mentally Ill
Juvenile
Offender
PATH
Homeless
Peer
Support
Intensive
Outpatient
Program
Wraparound
ITA Court
WISe
Kids Crisis
WISe and TAY
[Type text]
Program of
Assertive
Community
Treatment (PACT)
Professional Services
Additional Expenses
$9.1 (1,3,4,6,7)
$894k (1,2,3,4,7)
$1.7m (1,6,7)
Providence
St. Peter
Hospital
SMHC: State Mental Health Contract
DCFS: Department of Children and Family Services
FAMH: Family Alliance for Mental Health
.
ITA: Involuntary Treatment Act
UM: Utilization Management
TAY: Transition Aged Youth
PATH: Projects for Assistance to Transition from
Homelessness
TC E&T
Facility
Operated by
BHR
DSHS - WSH
Jet Computer
Grays Harbor
Timberlands
Crisis Court
Ombuds
UW –
Wraparound
and MST
Fidelity
Donna
Obermeyer
Wraparound
& FAMH
Medical
Director
Crisis Clinic:
Information
and Referral
Community
Integration
Outreach
(CIO)
King County
Southwest
Behavioral Health
North Sound MH
Administration
NAMI
ProtoCall
Inpatient UM
ITA
Agreements
Kitsap MH
Kids ITA
Key:
PIHP: Prepaid Inpatient Health Plan
MHBG: Mental Health Block Grant
NAMI: National Alliance on Mental Illness
E&T: Evaluation & Treatment
EBP: Evidence Based Practice
WISe: Wraparound with Intense Services
HATC: Housing Authority of Thurston County
Community
Housing Support
Inpatient Services
CIO includes the
Mentally Ill
Offender (MIO)
Program provided
in Olympia, Mason,
and Thurston Jails
HATC Homeless
Veteran’s Leasing
Assistance Program
Central
Services
Medicaid
Personal
Care
Out of
Network
Outpatient
NetSmart
Board of County Commissioners
AGENDA ITEM SUMMARY
Date Created: 2/5/2015
Agenda Date: 03/03/2015
Created by:
Presenter:
Agenda Item #: 6
Christina Chaput, Compliance Unit Supervisor - Resource Stewardship - 786-5490 ext.
6875
Scott Clark, Director - Resource Stewardship - 709-3005
Item Title:
A resolution authorizing the Resource Stewardship Director to designate Code
Enforcement Officers and authorize Code Enforcement Officers to issue Civil Infractions
for violations of Thurston County Code
Action Needed: Pass Resolution
Class of Item: Department
List of Exhibits
CivilInfractionResolution_
final.docx
Microsoft Word
Document
15.4 KB
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Recommended Action:
Move to adopt the resolution authorizing the Resource Stewardship Department Director to designate
Code Enforcement Officers by job title or special appointment by memorandum and authorize
Enforcement Officers to issue civil infractions for Thurston County Code violations.
Item Description:
This is a resolution, authorizes the Director of Thurston County Resource Stewardship Department to
designate Code Enforcement Officers by memorandum and authorizes Code Enforcement Officers to
issue civil infractions for violations of Thurston County Codes.
Date Submitted: 2/10/2015
RESOLUTION NO. ________________
A RESOLUTION of the Thurston County Board of County Commissioners, pursuant to
Thurston County Code 14.21.020, 20.60.055(3), 21.102.030(C), 22.64.050(C), 23.73.050(C) and
Thurston County Title 26 (upon adoption).
WHEREAS, Thurston County Code 14.21.020, 20.60.055(3), 21.102.030(C),
22.64.050(C), 23.73.050(C) and Title 26 (when adopted) require the Thurston County Board of
County Commissioners to resolve to appoint “Enforcement Officers” to enforce the Thurston
County Code; and
WHEREAS, the Board of County Commissioners has previously appointed specific
persons within the Resource Stewardship Department to issue civil infractions for Code
violations; and
WHEREAS, this practice has created difficulties when those persons have resigned or
otherwise left county employment, leaving lengthy periods where no one in Resource
Stewardship is authorized to issue infractions until a new Resolution is passed;
NOW THEREFORE THE THURSTON COUNTY BOARD OF COUNTY
COMMISSIONERS DOES RESOLVE AS FOLLOWS:
1
The Thurston County Board of County Commissioners authorizes Director of the
Thurston County Resource Stewardship Department to designate “Enforcement
Officers” as authorized by job title and/or special appointment by Memorandum.
These “Enforcement Officers” are hereby authorized to issue civil infractions for
Thurston County Code violations on behalf of Thurston County, effective as of the
approval of this resolution.
2
These appointments shall last until revoked by action of the Thurston County Board
of County Commissioners and/or the termination of employment by Thurston County
of the appointees.
ADOPTED: ___________________
BOARD OF COUNTY COMMISSIONERS
Thurston County, Washington
ATTEST:
______________________________
Clerk of the Board
APPROVED AS TO FORM:
____________________________________
Chair
____________________________________
Vice-Chair
PROSECUTING ATTORNEY
_____________________________
Deputy Prosecuting Attorney
____________________________________
Commissioner
Page 1
Board of County Commissioners
AGENDA ITEM SUMMARY
Date Created: 2/24/2015
Agenda Date: 03/03/2015
Created by:
Presenter:
Agenda Item #:
Katie Pruit, Planner, Associate - Resource Stewardship - 786-5490 ext. 6485
Katie Pruit, Planner, Associate - Resource Stewardship - 786-5490 ext. 6485
Presenter #2:
Rick Peters, Deputy Prosecuting Attorney, Senior - Prosecuting Attorney 754-3355, x 7875
Item Title:
Public Hearing - Title 26, a new enforcement code
Action Needed: Pass Motion
Class of Item: Timed - Public Hearing
List of Exhibits
Title 26 Draft
Ordinance_Code
Enforcement_03.03.15.p
df
Adobe Acrobat Document
768 KB
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Recommended Action:
Move to close the public hearing.
Item Description:
Title 26 is a new enforcement code that consolidates the land use enforcement requirements from
eleven different titles into one title and adds some new enforcement tools and processes. A unified
development code creates a more focused reference for staff and the public, and ensures consistency in
how code violations are handled. The new title adds civil penalties and liens, allows penalties and
infractions to be issued to the violator, and simplifies the table of penalties and the infraction process.
Date Submitted: 2/24/2015
Title 26 Findings - Page 1
ORDINANCE NO. __________
AN
ORDINANCE
OF
THURSTON
COUNTY,
WASHINGTON, ADDING TITLE 26 OF THE THURSTON
COUNTY CODE FOR CODE ENFORCEMENT AND TO
AMEND THURSTON COUNTY CODE CHAPTER 13.56,
SECTION 13.56.190, SECTION 13.56.400, SECTION
13.60.050, TITLE 14, SECTION 14.17.060, SECTION
14.18.060, SECTION 14.19.060, CHAPTER 14.21, SECTION
14.21.010, SECTION 14.32.050, SECTION 14.34.050,
SECTION 14.35.050, SECTION 15.05.020, SECTION
15.09.300, SECTION 15.10.300, SECTION 15.11.070,
CHAPTER 17.09, CHAPTER 17.15, SECTION 17.15.430,
CHAPTER 17.20, SECTION 17.20.280, CHAPTER 17.25,
SECTION 17.25.800, SECTION 17.30.090, CHAPTER 18.48,
SECTION 18.48.020, TITLE 19, TITLE 20, SECTION
20.31.040, SECTION 20.40.035, CHAPTER 20.60, SECTION
20.60.010, TITLE 21, CHAPTER 21.102, SECTION
21.102.010, TITLE 22, SECTION 22.43.080, SECTION
22.44.070, SECTION 22.47.040, CHAPTER 22.64, SECTION
22.64.010, TITLE 23, CHAPTER 23.73, SECTION 23.73.010,
TITLE 24, SECTION 24.30.070, CHAPTER 24.92, SECTION
24.92.010,
AND REPEALING SECTION 14.21.020,
SECTION 14.21.040, 14.21.050, SECTION 14.21.060,
SECTION 14.21.070, SECTION 17.15.435, SECTION
17.15.440, SECTION 18.48.040, SECTION 20.60.050,
SECTION 20.60.055, SECTION 21.102.020, SECTION
21.102.030, SECTION 22.64.030, SECTION 22.64.040,
SECTION 22.64.050, SECTION 23.73.030, SECTION
23.73.040, SECTION 23.73.050, SECTION 24.92.020,
SECTION 24.92.030, SECTION 24.92.040, SECTION
24.92.050, SECTION 24.92.060, SECTION 24.02.070,
SECTION 24.92.080, AND ADDING SECTION 17.09.200,
CHAPTER 19.13, AND SECTION 19.13.010 AND FOR
OTHER MATTERS PROPERLY RELATED THERETO.
WHEREAS, Thurston County is required to plan under Chapter 36.70A RCW, the
Growth Management Act (GMA), which contains fourteen goals that are intended to guide the
development and adoption of comprehensive plans and associated development regulations,
which relate to urban growth, rural development, reduced sprawl, transportation, housing,
economic development, property rights, permits, natural resource industries, open space and
recreation, the environment, citizen participation and coordination, public facilities and services,
historic preservation, and Shoreline Management Act goals and policies; and
Title 26 Findings - Page 2
WHEREAS, the GMA requires the comprehensive plan and development regulations in
the Thurston County Code (TCC) to demonstrate and uphold the concepts of internal
consistency, conformity, and concurrency; and
WHEREAS, the GMA also requires a process of early and continuous citizen
participation for amending comprehensive plans and development regulations; and
WHEREAS, Thurston County has performed professional review, public notice, and
comment with respect to these amendments; and
WHEREAS, the development regulations in Thurston County adopted under the GMA
must be consistent with the Thurston County Comprehensive Plan and associated Joint Plans;
and
WHEREAS, the Thurston County Comprehensive Plan, as amended, collectively
includes Joint Plans with the cities of Bucoda, Lacey, Olympia, Rainier, Tenino, Tumwater,
Yelm, and other sub-area plans, with chapters on land use, natural resource lands, housing,
transportation, capital facilities, utilities, economic development, the natural environment,
archeological, and historic resources that govern development throughout unincorporated
Thurston County and comply with GMA requirements for comprehensive plans and
development regulations; and
WHEREAS, the Board of County Commissioners (Board) finds that the proposed
amendments in this ordinance are consistent with the Thurston County Comprehensive Plan and
associated Joint Plans; and
WHEREAS, the Board finds that the current system and regulations for enforcing
development code requirements in Title 13 TCC Roads and Bridges, Title 14 TCC Buildings and
Construction, Title 15 TCC Public Works, Title 17 TCC Environment, Title 18 TCC Platting and
Subdivisions , the provisions of Title 19 TCC and the Thurston County Shoreline Master
Program, Title 20 TCC Zoning , Title 21 TCC Lacey Urban Growth Area Zoning , Title 22 TCC
Tumwater Urban Growth Area Zoning , Title 23 TCC Olympia Urban Growth Area Zoning, and
Title 24 TCC Critical Areas are fragmented and should be unified under one code enforcement
title; and
WHEREAS, Title 13 TCC Roads and Bridges applies to road closures, speed
restrictions, construction and permits, street vacations, street naming and house numbering, street
lights, accommodation of utilities in rights-of-way, telecommunications, licenses, franchises and
other matters properly related thereto; and
WHEREAS, Title 14 TCC Buildings and Construction applies to the construction of
buildings in unincorporated Thurston County, abatement of dangerous buildings, development in
flood hazard areas, and other matters properly related thereto; and
Title 26 Findings - Page 3
WHEREAS, Title 15 TCC Public Works establishes road standards, stormwater
standards, storm and surface water utility rates, illicit discharges, sewer systems, water systems,
rates, right-of-way acquisition and other matters properly related thereto; and
WHEREAS, Title 17 TCC Environment includes regulations for the State
Environmental Policy Act, critical areas regulations for agricultural uses and lands, mineral
extraction and asphalt production, forest lands conversion, noxious weed containment, and other
matters properly related thereto; and
WHEREAS, Title 18 TCC Platting and Subdivisions governs the division of land in
Thurston County, and other matters properly related thereto; and
WHEREAS, Title 19 TCC Shoreline Master Program constitutes a local ordinance and
supersedes portions of the Shoreline Master Program for the Thurston Region (Chapter 19.01
TCC), and the provisions of Title 19 TCC and the Thurston County Shoreline Master Program
are supplementary to the provisions of Chapter 90.58 RCW and Title 173 WAC; and
WHEREAS, Title 20 TCC Zoning governs development regulations in the
unincorporated rural county as well as the unincorporated Urban Growth Areas (UGA) of
Rainier, Yelm, Tenino and Grand Mound. The locations and boundaries of the zoning districts
established in the Thurston County Zoning Ordinance are shown on the Official Zoning Map,
Thurston County, Washington (Chapter 20.06 TCC); and
WHEREAS, Title 21 TCC Lacey Urban Growth Area Zoning governs development
regulations in the City of Lacey unincorporated area. The locations and boundaries of the zoning
districts established in the Zoning Ordinance of the Lacey Urban Growth Area are shown on the
Official Zoning Map, Thurston County Washington, North County Urban Growth Areas (Section
21.09.020 TCC); and
WHEREAS, Title 22 TCC Tumwater Urban Growth Area Zoning governs development
regulations in the City of Tumwater unincorporated area. The locations and boundaries of the
zoning districts established in the Tumwater UGA Zoning Ordinance are shown on the Official
Zoning Map, Thurston County Washington, North County Urban Growth Areas (Section
22.06.020 TCC); and
WHEREAS, Title 23 TCC Olympia UGA Zoning governs development regulations in
the City of Olympia unincorporated area. The locations and boundaries of the zoning districts
established in the Olympia UGA Zoning Ordinance are shown on the Official Zoning Map,
Thurston County Washington, North County Urban Growth Areas (Chapter 23.02.160 TCC);
and
WHEREAS, Title 24 TCC Critical Areas includes regulations governing critical areas
for non agricultural uses and lands; and
Title 26 Findings - Page 4
WHEREAS, unifying the various code enforcement provisions in the Thurston County
Code will provide a clear enforcement process for development code requirements in Thurston
County and a clear penalty system for rectifying violations; and
WHEREAS, the code enforcement provisions in the new unified code enforcement title
shall supersede the enforcement provisions from other titles unless otherwise provided for in the
new title, and
WHEREAS, civil infractions are governed by Chapter 7.80 RCW, and will be heard
pursuant to that chapter; and
WHEREAS, the Board finds it beneficial to add civil penalties to the list of available
remedies to ensure speedy compliance with development code requirements, so long as those
penalties do not violate the due process rights of the land owner; and
WHEREAS, a duly noticed public hearing was held on October 15, 2013 before the
Thurston County Planning Commission to take public testimony on the new code enforcement
title and associated amendments in other sections of the Thurston County Code to facilitate the
new unified code enforcement title; and
WHEREAS, the Planning Commission voted to recommend the proposed amendments
to the Thurston County Code for a new code enforcement title and associated amendments in
other sections of the Thurston County Code to facilitate the new title; and
WHEREAS, the Board of County Commissioners held a duly noticed public hearing on
February 18, 2014 to allow for public testimony on the amendments adopted with this ordinance;
and
WHEREAS, the amendments adopted by this ordinance were included on the 2014-2015
Development Code Official Docket as required by Chapter 2.05 Thurston County Code (TCC),
Growth Management Public Participation; and
WHEREAS, on February 4, 2014 notice was provided to the Washington State
Department of Commerce on the intent to adopt revised development regulations applicable to
land use code enforcement in accordance with RCW 36.70A.470; and
WHEREAS, on January 29, 2015 the Board of County Commissioners amended Title 26
to direct all appeals to the Hearing Examiner and establish civil penalty fee rates within the title;
and
WHEREAS, on March 3, 2015 the Board of County Commissioners held a second duly
noticed public hearing on the two amendments; and
Title 26 Findings - Page 5
WHEREAS, the Board believes the code enforcement provisions and associated
penalties enabled by the adoption of this ordinance are necessary for the preservation of the
public health, safety, and general welfare of Thurston County residents.
NOW, THEREFORE, THE THURSTON COUNTY BOARD OF COUNTY
COMMISSIONERS ORDAINS AS FOLLOWS:
SECTION 1. TITLE 26 CODE ENFORCEMENT. The Thurston County Code is hereby
amended as shown in Attachment A to add Title 26 Code Enforcement.
SECTION 2. AMENDMENTS TO OTHER AFFECTED SECTIONS OF THE
THURSTON COUNTY CODE. The Thurston County Code is hereby amended as shown in
Attachment B to remove unnecessary code enforcement provisions being replaced by Title 26
Code Enforcement and to update other references. Affected titles include Title 26 TCC Code
Enforcement, Title 13 TCC Roads and Bridges, Title 14 TCC Buildings and Construction, Title
15 TCC Public Works, Title 17 TCC Environment, Title 18 TCC Platting and Subdivisions, the
provisions of Title 19 TCC and the Thurston County Shoreline Master Program, Title 20 TCC
Zoning, Title 21 TCC Lacey Urban Growth Area Zoning, Title 22 TCC Tumwater Urban
Growth Area Zoning, Title 23 TCC Olympia Urban Growth Area Zoning, and Title 24 TCC
Critical Areas.
SECTION 3. SEVERABILITY. If any section, subsection, sentence, clause, phrase or other
portion of this ordinance or its application to any person is, for any reason, declared invalid,
illegal or unconstitutional in whole or in part by any court or agency of competent jurisdiction,
said decision shall not affect the validity of the remaining portions hereof.
SECTION 4. EFFECTIVE DATE. This ordinance shall take effect immediately upon
adoption.
ADOPTED: __________________________
ATTEST:
BOARD OF COUNTY COMMISSIONERS
Thurston County, Washington
_____________________________
Clerk of the Board
________________________________
Chair
APPROVED AS TO FORM:
JON TUNHEIM
________________________________
Title 26 Findings - Page 6
PROSECUTING ATTORNEY
____________________________
Rick Peters
Deputy Prosecuting Attorney
Vice-Chair
________________________________
Commissioner
Attachment A – Page 1
Attachment A
TITLE 26 – CODE ENFORCEMENT
CHAPTER 26.05 GENERAL PROVISIONS
26.05.005
26.05.010
26.05.020
26.05.030
26.05.040
26.05.050
26.05.060
26.05.070
26.05.080
26.05.090
26.05.100
26.05.110
26.05.120
Short Title.
Purpose.
Administration.
Calculation of penalties and damages.
Enforcement and violation remedies.
Abatement of illegal use, structure or development.
Enforcement, violations, and penalties – Stop work orders.
Revocation of permits.
Appeals.
Code enforcement interpretation and application.
Definitions.
Restoration orders for critical areas.
Liability for violations.
26.05.005
Short Title.
This title shall be known as the “Thurston County Code Enforcement Ordinance.”
26.05.010
Purpose.
This title is adopted for the purpose of governing enforcement and penalties for the following
codes now or as subsequently amended: Roads and Bridges (Title 13 TCC), Buildings and
Construction (Title 14 TCC), Thurston County Stormwater Standards (Chapter 15.05 TCC),
Sewer Systems (Chapter 15.09 TCC), Water Systems (Chapter 15.10 TCC), Cross-connections
(Chapter 15.11 TCC), State Environmental Policy Act (Chapter 17.09 TCC) Agricultural
Activities Critical Areas (Chapter 17.15 TCC), Mineral Extraction and Asphalt Production
(Chapter 17.20 TCC), Thurston County Forest Lands Conversion Ordinance (Chapter 17.25
TCC), Platting and Subdivisions (Title 18 TCC), Shoreline Master Program for the Thurston
Region (Title 19 TCC), Zoning Ordinances (Titles 20, 21, 22, and 23 TCC), Critical Areas (Title
24 TCC), and including any permit, permit condition, or order issued pursuant to any of the
codes listed above. This Title hereby replaces and supersedes all code provisions referenced
herein.
26.05.020
A.
Administration.
Any person, whether owner, lessee, principal, agent, employee or otherwise, who violates
a provision of the Thurston County Code as listed in Section 26.05.010 TCC, or permits
any such violation, or fails to comply with any of the requirements thereof, shall not be
granted a permit or approval pursuant to the Thurston County Code, and shall be guilty of
Attachment A – Page 2
a misdemeanor and, upon conviction thereof, shall be subject to punishment as provided
by law.
B.
No permit or approval shall be granted pursuant to the Thurston County Code if any
violation of the Thurston County Code as listed in 26.05.010 TCC exists on the subject
property.
C.
A permit or approval may be granted if conditioned on having the violation remedied
within a reasonable time as provided by the approval authority. If a permit or approval is
conditioned on remedial action, security in the form of a letter of credit or similar
instrument shall be required unless waived by the approval authority for good cause. This
section shall not apply to requests for a permit or approval to remedy a violation.
D.
Any building erected or improvements constructed contrary to any of the requirements of
a provision of the Thurston County Code as listed in 26.05.010 TCC, and any use of any
building or land which is conducted, operated or maintained contrary to any of the
requirements of a provision of the Thurston County Code as listed in 26.05.010, or
permits issued pursuant thereto shall be and is declared to be unlawful.
E.
The enforcement officer(s) for violations of the Thurston County Code Titles and
Chapters 14, 15.05, 15.09 through 15.11, 17.09, 17.15, 17.20, 17.25, 18, 19, 20, 21, 22,
23, and 24 is the director of Resource Stewardship or his or her designee, for violations of
Thurston County Code Title 13 and the remainder of 15 is the director of Public Works or
his or her designee. For civil infraction and civil penalties purposes, the enforcement
officer shall be designated by resolution of the board of county commissioners upon the
recommendation of the director.
F.
The prosecuting attorney is authorized to bring actions by any appropriate means to
prevent the violation of a provision of the Thurston County Code as listed in 26.05.010,
and to enforce the provisions therein.
26.05.030
Calculation of penalties and damages.
A.
Each violation of a provision of a section of the Thurston County Code as listed in
26.05.010 TCC, is a separate offense.
B.
Each day in which such a violation is not remedied is a separate and distinct violation at
the discretion of the director.
C.
The director is not required to issue a notice of violation, notice of abatement, restoration
order, stop work order, civil infraction, civil penalty or other order for each day of the
violation.
D.
The initiation of a singular remedy under this title, or a provision of the Thurston County
Code as listed in 26.05.010 TCC, for a violation does not preclude the initiation of a
separate remedy.
Attachment A – Page 3
E.
The County may seek recovery of all costs, fees, and expenses in connection with
enforcement actions as damages against the violator. Costs, fees, and expenses may
include, but are not limited to, costs of restoration, abatement, or cleanup, including staff
time and court expenses.
26.05.040
Enforcement and violation remedies
A.
If the director finds that any person, whether owner, lessee, principal, agent, employee or
otherwise, violates a provision of the Thurston County Code as listed in 26.05.010, or permits
any such violation, or fails to comply with any of the requirements hereof, or who erects any
building or uses any building or uses any land in violation of a provision of the Thurston County
Code as listed in 26.05.010 TCC, the director may:
1. Issue a stop work order to halt any activity which is in violation of this title;
2. Issue a restoration order for complete or partial restoration, rehabilitation, or replacement
of a critical area or other effected site, structure or area by the property owner. It is the
responsibility of the property owner(s) to contact and seek a remedy from any other
person(s) who may be responsible for the violation;
3. Revoke a permit or approval;
4. Issue a civil infraction to the property owner(s) of record or to the known violator or
both;
5. Issue a civil penalty to the property owner(s) of record or to the known violator or both;
6. Require abatement of an illegal use, structure or development; and
7. Request that the prosecuting attorney commence a criminal prosecution, seek a temporary
restraining order or seek equitable relief to enjoin any act or practices and abate any
conditions which constitute or will constitute a violation.
B.
Prior to issuance of a civil infraction or a civil penalty or referral to the prosecuting
attorney, the enforcement officer shall give the violator a written warning with an
opportunity to cure the violation within thirty calendar days, except in situations where
the violation being carried out cannot be undone or is an imminent public health or safety
concern, or a greater or lesser timeframe is appropriate at the discretion of the director.
26.05.050
Abatement of illegal use, structure or development.
Any use, structure, site improvement, or development not established in compliance with use and
development standards in effect at the time of establishment shall be deemed illegal and shall be
discontinued or terminated and subject to removal.
26.05.060
Enforcement, violations, and penalties – Stop work orders.
Stop work orders shall become effective immediately upon posting of the stop work order in a
conspicuous place on the property where the violation exists or when provided to the alleged
violator. Failure to comply with the terms of a stop work order may result in additional
Attachment A – Page 4
enforcement actions including, but not limited to, the issuance of a civil infraction, civil penalty,
or referral to the prosecuting attorney. The stop work order shall set forth the following terms
and conditions:
A.
A dated description of the nature and extent of the violation, and where appropriate, the
damage or potential damage done; and
B.
A notice that the violation or the potential violation cease immediately or, in appropriate
cases, the specific corrective action to be taken within a given time.
26.05.070
Revocation of permits.
Unless otherwise provided or restricted by law, the director may, in writing, suspend or revoke a
permit or approval required by a provision of the Thurston County Code as listed in 26.05.010
TCC, whenever the permit is issued in error or on the basis of incorrect information, or in
violation of an ordinance or regulation or any provision of the Thurston County Code as listed in
26.05.010 TCC, or when a use or building is being maintained in a manner contrary to the terms
and conditions of the permit or approval.
26.05.080
Appeals.
Notices of violation, stop work orders, and restoration orders may be appealed to the County
Hearing Examiner pursuant to Section 20.60.060 TCC. Appeal of a Hearing Examiner decision
shall be submitted to Superior Court.
26.05.090
Code enforcement interpretation and application.
Where conflicts occur between code enforcement, violation and penalty regulations in this title
and other regulations in the Thurston County Code listed in Section 26.05.010 TCC, the code
enforcement regulations in this title shall supersede other titles, unless otherwise provided for in
this title. For code enforcement regarding critical areas, the regulation more protective of
preserving and maintaining critical areas shall apply.
26.05.100
Definitions.
A.
The Thurston County Code Enforcement Ordinance governs code enforcement for a
number of different titles and sections of the Thurston County Code specified in Section
26.05.010 TCC. Definitions for words may vary depending on which section of the
Thurston County Code is violated. For the purposes of this title, words, phrases, or uses
will be defined as they are in the respective title or section for which the code
enforcement action is being taken.
B.
The following definitions shall apply to this title:
"Department" or “department” means the Thurston County Resource Stewardship
Department or the Thurston County Public Works Department, as appropriate.
"Director" or “director” means the director of the Thurston County Resource Stewardship
Department, or the director of the Thurston County Public Works Department, as
appropriate, and the director's designees.
Attachment A – Page 5
“TCC” means the Thurston County Code.
“Title” or “title” means Title 26 of the Thurston County Code unless otherwise stated.
26.05.110
Restoration orders for critical areas.
A.
Restoration orders shall become effective immediately upon receipt by the person or
property owner to whom the order is directed. Failure to comply with the terms of a
restoration order may result in additional enforcement actions including, but not limited
to, the issuance of a civil infraction, civil penalty, or referral to the prosecuting attorney.
B.
If warranted due to the scale of the damage or the sensitivity of the affected critical area,
associated buffer or dependent fish and wildlife habitat, the county may require
submission of a restoration plan and implementation schedule prior to initiation of the
restoration activity. If so, any development activity on the site where the violation
occurred shall cease until the county approves the restoration plan and schedule. The plan
shall be prepared by a qualified professional as determined by the approval authority, and
shall describe how the proposed actions meet the requirements of this title. Restoration
activities shall be reviewed by the approval authority under the requirements for a critical
area review permit (Chapter 24.40 TCC). Inadequate plans as determined by the approval
authority shall be returned to the violator/property owner for revision and resubmittal.
C.
Restoration plans shall comply with the following requirements unless the property
owner/violator demonstrates that equal or greater critical area and buffer functions can
otherwise be obtained.
1. The pre-violation structure, condition, and functions of the critical area, associated buffer
and management zone, as applicable, shall be restored including, but not limited to,
topography; soil types; vegetation types, sizes and densities (not including noxious weeds
or invasive plants); water quality; hydrologic functions; habitat functions; and other
relevant conditions.
2. If information is not available regarding pre-violation conditions at the violation site, the
county shall determine the restoration goals based on similar sites.
D.
The property owner/violator shall submit a surety consistent with Chapter 24.70 TCC and
with the requirements of Title 24 TCC to ensure that restoration is successful.
E.
The property owner/violator shall be responsible for all costs associated with the
restoration plan, including review costs.
26.05.120 Liability for violations.
The owner of property on which a violation of the Thurston County Code as specified in Section
26.05.010 TCC has occurred and the persons or entities carrying out actions in violation of the
Thurston County Code as specified in Section 26.05.010 TCC are each responsible and liable for
the violation.
Attachment A – Page 6
CHAPTER 26.10 CIVIL INFRACTIONS.
26.10.010
26.10.030
26.10.040
Civil infractions - Purpose.
Civil infractions - Procedures.
Civil infractions – Class of infraction.
26.10.010
Civil infractions - Purpose.
In addition to or as an alternative to any other judicial or administrative remedy provided herein
or by law, any person who violates any portion of the Thurston County Code as listed in Section
26.05.010 TCC by each act of commission or omission, or procures, aids or abets such violation,
may be subject to a civil infraction pursuant to Chapter 7.80 RCW. Civil infractions shall be
heard and determined according to Chapter 7.80 RCW, as amended, and any applicable court
rules. Pursuant to 7.80.120 RCW each person found to have committed a civil infraction shall be
assessed a monetary penalty based on the class of infraction as provided in Section 26.10.040
TCC and Table 26-1. The purpose of this section is remedial. Use of the civil infraction
procedure will better protect the public from the harmful effects of violations, and will aid
enforcement.
26.10.030
Civil infractions - Procedures.
A.
Hearing Procedure. Civil infractions shall be heard and determined according to Chapter
7.80 RCW, as amended, and any applicable court rules.
B.
Identification of Violators. An enforcement officer issuing a notice of civil infraction
shall take all due diligence to correctly identify the alleged violator.
C.
Administrative Responsibilities. The director is responsible for assuring county
compliance with 7.80.150 RCW. The director may publicize a list of persons found
committed of violations in the newspaper or other means deemed appropriate.
D.
Recording of Civil Infractions.
1. Notice of civil infraction may be recorded with the Thurston County Auditor against the
property on which the violation took place in the following instances:
a. The owner of the property affected by the civil infraction has been given prior notice
with an opportunity to cure the violation.
b. The person receiving the notice of civil infraction does not respond as required by
7.80.080 RCW
c. The person receiving the notice of civil infraction fails to appear at a hearing
requested under 7.80.080(3) or (4) RCW.
Attachment A – Page 7
d. The person assessed a monetary penalty for the civil infraction fails to pay such
penalty within the time required by law and does not appeal the penalty. If the penalty
is appealed, the enforcement officer may record the notice of civil determination only
if a penalty remains unpaid after a final appellate determination has been entered.
2. The auditor shall record any notice of civil infraction submitted for recording under this
section.
3. Superceding of a Recording. The recording of a notice of civil infraction with the auditor
shall be superceded with a subsequent recording when:
a. The civil infraction proceeding has been dismissed or decided in favor of the person
to whom the notice was issued; or
b. Any monetary penalty assessed for the infraction has been paid and the violation has
been remedied to the satisfaction of the county.
26.10.040
Civil infractions – Class of infraction.
With the exceptions as listed in Table 26-1, civil infractions for all violations of the Thurston
County Code as listed in Section 26.05.010 TCC are Class 2. Applicable fines are set by state
law.
CHAPTER 26.20 CIVIL PENALTIES
26.20.010
26.20.120
26.20.030
26.20.040
26.20.050
26.20.060
26.20.070
26.20.080
26.20.090
26.20.100
26.20.110
26.20.120
Civil penalties – Purpose.
Civil penalties – Identification of violators.
Civil penalties – Lien authorized.
Civil penalties – Personal obligation authorized.
Civil penalties – Notice lien may be claimed.
Civil penalties – Priority of lien.
Civil penalties – Claim of Lien.
Civil penalties – Recording.
Civil penalties – Duration of lien – Limitation of action.
Civil penalties – Foreclosure parties.
Civil penalties – Settlement of civil penalty claims.
Civil penalties – Notice, Right to Appeal and Final Penalty Assessment.
26.20.010
Civil penalties – Purpose.
In addition to, or as an alternative to, any other judicial or administrative remedy provided in the
Thurston County Code or by law, any person who violates a provision of the Thurston County
Code as listed in Section 26.05.010 TCC, by each act of commission or omission or procures,
aids or abets such violation, may be subject to a civil penalty as provided in Section 26.20.110
Attachment A – Page 8
TCC and Table 26-1. All civil penalties assessed shall be enforced and collected in accordance
with the lien, personal obligation, and other procedures specified in this title, or as authorized by
law. The purpose of this section is coercive. Use of the civil penalty procedure will better protect
the public from the harmful effects of violations, will aid enforcement, and will help reimburse
the county for the expenses of enforcement. The Administrative Civil Penalty procedure adopted
by this Chapter provides an additional and independent method of enforcement to procedures
found elsewhere in Title 26 TCC.
26.20.020
Civil penalties – Identification of violators.
An enforcement officer issuing a notice of civil penalty shall take all due diligence to correctly
identify the alleged violator.
26.20.030
Civil penalties – Lien authorized.
Upon the obtaining of a judgment by the Prosecuting Attorney after the authorization of Final
Civil Penalties as described in this Chapter, Thurston County may claim a lien and record same
with the County Auditor for any civil penalty imposed or for the cost of any work of abatement
done pursuant to this title, or both, against the real property on which the civil penalty was
imposed or any of the above work was performed.
26.20.040
Civil penalties – Personal obligation authorized.
The civil penalty and the cost of abatement are also joint and separate personal obligations of any
person or party in violation. The prosecuting attorney on behalf of Thurston County may collect
the civil penalty and the abatement work costs by use of all appropriate legal remedies.
26.20.050
Civil penalties – Notice lien may be claimed.
The notice of violation pursuant to violations of the Thurston County Code as listed in Section
26.05.010 TCC shall give notice to the owner that a lien for the civil penalty or the cost of
abatement, or both, may be claimed by Thurston County.
26.20.060
Civil penalties – Priority of lien.
The lien shall be subordinate to all existing special assessment liens previously imposed upon the
same property and shall be paramount to all other liens except for state and county taxes with
which it shall be on a parity.
26.20.070
Civil penalties – Claim of Lien.
A.
After 90 days from the date the civil penalty is due or within 90 days from the date of
completion of the work or abatement performed pursuant to this title, the Prosecuting
Attorney shall seek a judgment of the final civil penalties imposed by Thurston County.
After obtaining judgment, the Director may cause a claim for lien to be filed for record in
the Thurston County Auditor’s Office.
B.
Contents. The claim of lien shall contain the following:
1.
The authority for imposing a civil penalty, or proceeding to abate the violation, or
both;
Attachment A – Page 9
2.
A brief description of the civil penalty imposed, or the abatement work done, or
both, including the violations charged and the duration thereof, including the time the
work is commenced and completed and the name of the persons or organizations
performing the work;
3.
A description of the property to be charged with the lien;
4.
The name of the known owner or reputed owner, and if not known the fact shall
be alleged; and
5.
The amount, including lawful and reasonable costs, for which the lien is claimed.
C.
Verification. The director shall sign and verify the claim by oath to the effect that the
affiant believes the claim is just.
D.
The claim of lien may be amended in case of action brought to foreclose same, by order
of the court, insofar as the interests of third parties shall not be detrimentally affected by
amendment.
26.20.080
Civil penalties – Recording.
The director or his designee may record and index the claims and notices described in this
chapter with the Thurston County Auditor.
26.20.090
Civil penalties – Duration of lien -Limitation of action.
No lien created by this title binds the property subject to the lien for a period longer than three
years after the claim has been filed unless an action is commenced in the proper court within that
time to enforce the lien.
26.20.100
Civil penalties – Foreclosure parties.
A.
Foreclosure. The lien provided by this title may be foreclosed and enforced by a civil
action in a court having jurisdiction.
B.
Joinder. All persons who have legally filed claims of liens against the same property prior
to commencement of the action shall be joined as parties, either plaintiff or defendant.
C.
Actions saved. Dismissal of an action to foreclose a lien at the instance of a plaintiff shall
not prejudice another party to the suit who claims a lien.
26.20.110
Civil penalties – Settlement of civil penalty claims.
The Director is authorized to settle and compromise claims for civil penalties accruing pursuant
to this chapter where such settlement is clearly in the interests of Thurston County; provided, that
the director shall periodically report such settlements and compromises to the board.
26.20.120
Civil penalties – Notice, Right to Appeal and Final Penalty Assessment
The Director or his designee shall serve the Notice of Civil Penalty upon the person to whom it is
directed, either personally or by mailing a registered or certified copy of the Notice of Civil
Attachment A – Page 10
Penalty to such person at their last known address. If the person to whom it is directed cannot
after due diligence be personally served within Thurston County and if an address for mailed
service cannot after due diligence be ascertained, notice shall be served by posting a copy of the
Notice of Civil penalty conspicuously on the affected property or structure. Proof of service
shall be made by a written declaration under penalty of perjury executed by the person affecting
the service, declaring the time and date of service, the manner which the service was made, and
if by posting the facts showing that due diligence was used in attempting to serve the person or
by mail.
A person to whom a Notice of Civil penalty has been issued may appeal the Notice of Civil
Penalty to the Hearing Examiner. Appeal procedures shall be in accordance with Section
20.60.060 TCC and as described above in Section 26.05.080 TCC. Notice of Right to Appeal
shall be indicated in the Notice of Civil Penalty. For daily or accruing civil penalties, Notice of
Right to Appeal for each day that a civil penalty shall accrue should be conspicuously included
in the Notice of Civil Penalty.
With the exceptions listed in Table 26-1, penalties for violations of the Thurston County Codes
listed in 26.05.010 TCC shall be Class 2 civil penalties with an assessment of $256.00 for first
violations and double that amount for subsequent violations within any five (5) year period.
Violations listed in Table 26-1 shall be Class 1 civil penalties with an assessment set of $513.00
for first violations and double that amount for subsequent violations within any five (5) year
period.
Prior to a final determination of assessment of civil penalties, Notice of Hearing for Final
Assessment shall be sent to the person upon whom the final assessment would be directed.
Notice and Right to Appeal shall be served as described above in this provision. At the hearing
for Final Assessment, the Hearing Examiner shall take into consideration the following factors:
a) The person’s efforts to correct the violation and whether corrective action has been
completed;
b) Whether the person failed to appear at the hearing;
c) Whether the violation was a complete violation;
d) Whether the person showed due diligence and/or substantial progress in correcting
the violation;
e) The amount of time and resources expended to abate the violation;
f) Whether a genuine code interpretation issue exists; and
g) Any other relevant factors.
Upon considering the factors above, the Hearing Examiner shall make a Final Assessment
constituting the total civil penalties to be imposed. Upon issuing a Final Order of Civil Penalty,
the Thurston County Prosecuting Attorney shall seek to obtain judgment on the amount assessed
unless the Final Order is appealed to the Superior Court under the provisions described in
Section 20.60.060 TCC.
Attachment A – Page 11
Table 26-1: Class 1 Civil Infractions and Class 1 Civil Penalties
Code Violation Description
1.Building or installation without a permit or proper permit
2. Change of occupancy violation
3.Dangerous Building
4.Grading or unlawful fill without a permit or proper permit
5.Unauthorized alteration of critical area or buffer
6.Failure to comply with stop work or restoration order
7.Removal or irreparable damage to each protected tree
8.Unauthorized work in the right-of-way
9.Any Class 2 civil infraction or civil penalty violation may
be re-classified to a Class 1 if such violation is repetitive, is
unduly detrimental in nature, or is committed by a repeat
violator, as determined by the director
Attachment B - Page 1
Attachment B
All sections of the Thurston County Code (TCC) must be
updated to add references to the new Code Enforcement
Title and amend references that refer to the new Title
for Code Enforcement.
Amendments in this attachment include changes to the
following Titles and Chapters:
Titles 14, 19, 20, 21, 22, 23 and 24 and Chapters
13.56, 13.60, 15.05, 15.09 through 15.11, 17.09, 17.15,
17.20, 17.25, 17.30, and 18.48.
A.
The table of contents for Chapter 13.56
hereby amended to read as follows:
TCC is
Sections:
…
13.56.400 Violations and penaltiesenforcement.
…
B.
Section 13.56.190 TCC is hereby amended to read as
follows:
…
5. Upon the owner's failure to accomplish such work, the county or other governmental
agencies may perform or cause the performance of such work at the owner's expense to
be reimbursed within thirty days after receipt of a written invoice or take compliance
action pursuant to Section 13.56.400 Violations and Penalties Title 26 TCC. Following
relocation, removal and/or alteration, all affected property shall be restored to, at a
minimum, the condition which existed prior to construction and to the county's
satisfaction, by the owner at their expense. Notwithstanding the requirements of this
section, an owner may request additional time to complete a relocation project. The
director may grant a reasonable extension if, in his or her sole discretion, the extension
will not adversely affect the public project.
…
C.
Section 13.60.050 TCC is hereby amended to read as
follows:
…
Attachment B - Page 2
B. Civil infractions. The violation of any provision of Chapters 13.60 through 13.92 is
designated as a Class 1 Civil Infraction pursuant to Chapter 7.80 RCW and subject to the
provisions of Title 26 TCC.
D.
The table of contents for Title 14 TCC is hereby
amended to read as follows:
Chapters:
…
Chapter 14.21 Civil infractionsViolations and enforcement.
…
E.
Section 14.17.060 TCC is hereby amended to read as
follows:
…
[A] 114.4 Violation penalties. The violation of International Building Code [A] 105.1
(building without a permit); Thurston County Code Chapter 14.37 (grading) or
International Building Code section 3408 (change in use or character of occupancy) shall
be designated as a class 1 civil infraction pursuant to Chapter 7.80 RCW and Title 26
Chapter 14.21 Thurston County Code.
Any violation of International Building Code [A] 110.1 (forgoing inspections) shall be
designated as a class 2 civil infraction pursuant to Chapter 7.80 RCW.
Each day of any such violation is a separate civil infraction. A notice of infraction may be
issued for each day of any such violation; however, the enforcement officer is not
required to issue a notice of infraction for each day of such violation.
Civil infractions shall be heard and determined according to Chapter 7.80 RCW, Chapter
14.21 TCC as amended, Title 26 TCC, and any applicable court rules. Notwithstanding
the existence or use of any other remedy, the building official may seek legal or equitable
relief to enjoin any acts or practices and abate any conditions which constitute or will
constitute a violation of the Thurston County Building Code or other regulations herein
adopted.
…
F.
Section 14.18.060 TCC is hereby amended to read as
follows:
…
Section R113.4 Violation penalties. The violation of International Residential Code
R105.1 (building without a permit); Thurston County Code Chapter 14.37 (grading) or
International Building Code section 3408 (change in use or character of occupancy) shall
be designated as a class 1 civil infraction pursuant to Chapter 7.80 RCW and Title 26
Chapter 14.21 Thurston County Code.
Attachment B - Page 3
Any violation of International Residential Code R109.4 (forgoing inspections) shall be
designated as a class 2 civil infraction pursuant to Chapter 7.80 RCW.
Each day of any such violation is a separate civil infraction. A notice of infraction may be
issued for each day of any such violation; however, the enforcement officer is not
required to issue a notice of infraction for each day of such violation. Civil infractions
shall be heard and determined according to Chapter 7.80 RCW, Chapter 14.21 TCC as
amended, Title 26 TCC, and any applicable court rules.
…
G.
Section 14.19.060 TCC is hereby amended to read as
follows:
…
Section [A] 113.4 Violation penalties. Any person who violates a provision of this code
or fails to comply with any of the requirements thereof or who repairs or alters or changes
the occupancy a building or structure in violation of the approved construction documents
or directive of the code official or of a permit or certificate issued under the provisions of
this code shall be subject to penalties as prescribed by law. The violation of International
Existing Building Code [A] 105.1 (building without a permit) or Thurston County Code
Chapter 14.37 (grading) shall be designated as a class 1 civil infraction pursuant to
Chapter 7.80 RCW and Title 26Chapter 14.21 Thurston County Code.
Any violation of the International Existing Building Code [A] 109.1 (forgoing
inspections) shall be designated as a class 2 civil infraction pursuant to Chapter 7.80
RCW.
Each day of any such violation is a separate civil infraction. A notice of infraction may be
issued for each day of any such violation; however, the enforcement officer is not
required to issue a notice of infraction for each day of such violation. Civil infractions
shall be heard and determined according to Chapter 7.80 RCW, Chapter 14.21 TCC as
amended, Title 26 TCC, and any applicable court rules.
…
H.
Section 14.21.010 TCC is
amended to read as follows:
hereby
re-titled
and
14.21.010 Purpose Enforcement authority.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
It is imperative that Thurston County Code Title 14 regulations governing the
construction of buildings and grading of land be properly enforced. To better accomplish
this goal, the Thurston County board of commissioners has designated certain violations
of Thurston County Code Title 14 to be civil infractions pursuant to Chapter 7.80 RCW.
The purpose of this action is remedial. Use of the civil infraction procedure will better
Attachment B - Page 4
protect the public from the harmful effects of violations, will aid enforcement, and will
help reimburse the county for the expenses of enforcement.
I.
Section 14.21.020 TCC is hereby repealed.
J.
Section 14.21.040 TCC is hereby repealed.
K.
Section 14.21.050 TCC is hereby repealed.
L.
Section 14.21.060 TCC is hereby repealed.
M.
Section 14.21.070 TCC is hereby repealed.
N.
Section 14.32.050
follows:
is
hereby
amended
to
read
as
…
[A] 109.3 Violation Penalties. Persons who shall violate a provision of this code or shall
fail to comply with any of the requirements thereof or who shall erect, install, alter, repair
or do work in violation of the approved construction documents or directive of the fire
code official, or of a permit or certificate used under provisions of this code, shall be
guilty of a misdemeanor, punishable by a fine of not more than one thousand dollars or
by imprisonment not exceeding ninety days, or both such fine and imprisonment. Such
person shall be deemed guilty of a separate offense for each and every day or portion
thereof during which any violation of any of the provisions of this Code is committed,
continued, or permitted. Violations shall be prosecuted through Title 26 Thurston County
Code Chapter 14.21.
O.
Section 14.34.050
follows:
is
hereby
amended
to
read
as
…
C110.2 Violation penalties. The violation of the International Energy Conservation Code
- Commercial shall be designated as a class 1 civil infraction pursuant to Chapter 7.80
RCW and Title 26Chapter 14.21 Thurston County Code.
Any violation of International Energy Conservation Code - Commercial C104 (forgoing
inspections) shall be designated as a class 2 civil infraction pursuant to Chapter 7.80
RCW.
Each day of any such violation is a separate civil infraction. A notice of infraction may be
issued for each day of any such violation; however, the enforcement officer is not
required to issue a notice of infraction for each day of such violation. Civil infractions
shall be heard and determined according to Chapter 7.80 RCW, Chapter 14.21 TCC as
amended, Title 26 TCC, and any applicable court rules. Notwithstanding the existence or
Attachment B - Page 5
use of any other remedy, the building official may seek legal or equitable relief to enjoin
any acts or practices and abate any conditions which constitute or will constitute a
violation of the Thurston County Building Code or other regulations herein adopted.
…
P.
Section 14.35.050
follows:
is
hereby
amended
to
read
as
…
R110.2 Violation penalties. The violation of the International Energy Conservation Code
- Residential shall be designated as a class 1 civil infraction pursuant to Chapter 7.80
RCW and Title 26Chapter 14.21 Thurston County Code.
Any violation of International Energy Conservation Code - Residential R104 (forgoing
inspections) shall be designated as a class 2 civil infraction pursuant to Chapter 7.80
RCW.
Each day of any such violation is a separate civil infraction. A notice of infraction may be
issued for each day of any such violation; however, the enforcement officer is not
required to issue a notice of infraction for each day of such violation. Civil infractions
shall be heard and determined according to Chapter 7.80 RCW, Chapter 14.21 TCC as
amended, Title 26 TCC, and any applicable court rules. Notwithstanding the existence or
use of any other remedy, the building official may seek legal or equitable relief to enjoin
any acts or practices and abate any conditions which constitute or will constitute a
violation of the Thurston County Building Code or other regulations herein adopted.
…
Q.
Section 15.05.020
follows:
is
hereby
amended
to
read
as
…
C. Determination of Civil Infractions. Violations of the provisions of this chapter,
including the manual standards, are designated as civil infractions pursuant to Chapter
7.80 RCW and Title 26 TCC. Civil infractions shall be heard and determined according
to Chapter 7.80 RCW, as amended, Title 26 TCC, and any applicable court rules.
Pursuant to RCW 7.80.120 each person found to have committed a civil infraction shall
be assessed a monetary penalty based on the class of infraction. Maximum penalties (not
including any statutory assessments) are as follows: Class 1 equals two hundred fifty
dollars; Class 2 equals one hundred twenty-five dollars; Class 3 equals fifty dollars; Class
4 equals twenty-five dollars.
…
R.
Section 15.09.300
follows:
is
hereby
amended
to
read
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
as
Attachment B - Page 6
A.
B.
C.
S.
Section 15.10.300
follows:
…
B.
T.
Any person who violates or fails to comply with any provision of this chapter
shall be guilty of a misdemeanor, and upon conviction thereof shall be punishable
by a fine in a sum not to exceed five hundred dollars for each violation.
Industrial dischargers who violate TCC 15.09.060 shall be subject to the
following civil penalties:
1.
A user, which has violated, or continues to violate a provision of this
Section 15.09.060 including a pretreatment standard or requirement, or a permit
or order issued hereunder shall be liable to the county for a maximum civil
penalty of ten thousand dollars per violation, per day. In the case of a monthly or
other long-term average discharge limit, penalties shall accrue for each day during
the period of the violation.
2.
The county may recover reasonable attorney's fees, court costs, and other
expenses associated with any emergency response, enforcement activities,
additional monitoring and oversight, and cost of any actual damages to the
county.
3.
Filing a suit for civil penalties shall not be a bar against, or a prerequisite
for, any other action the county may take to resolve noncompliance by a user.
The prosecuting attorney is authorized to bring actions by any appropriate means
to enforce the provisions of this chapter.
is
hereby
amended
to
read
as
The prosecuting attorney is authorized to bring actions by any appropriate means
to enforce the provisions of this chapter including enforcement under Title 26
TCC.
Section 15.11.070
follows:
is
hereby
amended
to
read
as
…
B. The prosecuting attorney may bring such actions as are deemed necessary to prevent
the violation of and compel compliance with the provisions of the chapter including
enforcement under Title 26 TCC.
U.
The table of contents for Chapter 17.09 TCC
hereby amended by adding the following section:
17.09.200 Violations and enforcement.
is
Attachment B - Page 7
V.
A new section, Section 17.09.200 TCC
added to Chapter 17.09 TCC as follows:
is
hereby
17.09.200 Enforcement authority.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC or
197-11 WAC, as applicable.
W.
The table of contents for Chapter 17.15 Part 400
Administrative Actions is hereby amended to read as
follows:
17.15.430 Administrative actions – Enforcement Violations and enforcement.
17.15.435 Administrative actions – Violations.
17.15.440 Administrative actions – Misdemeanor penalty.
X.
Section 17.15.430 TCC is
amended to read as follows:
hereby
re-titled
and
17.15.430 Administrative actions – Enforcement Violations and enforcement.
Violations of this Chapter shall be enforced through the provisions of TCC Title 26 TCC.
A.
Adherence to the requirements of this chapter and to any permit conditions or
orders issued pursuant to this chapter is required throughout the construction period and
thereafter.
B.
Each violation of this chapter or of any permit, permit condition, or order issued
pursuant to this chapter is a separate offense. Each day in which such a violation is not
remedied is a separate and distinct violation.
C.
If the review authority determines that a violation has occurred, the review
authority may:
1.
Issue a stop work order to halt any activity which is in violation of this chapter.
The stop work order shall set forth the following terms and conditions:
a.
A description of the specific nature, extent, and time of violation and the damage
or potential damage, and
b.
A notice that the violation or the potential violation cease and desist or, in
appropriate cases, the specific corrective action to be taken within a given time;
2.
Issue a restoration order for complete or partial restoration of the critical area by
the person or agent responsible for the violation who may not be the property owner;
3.
Issue a civil infraction under TCC Section 17.15.435; or
4.
Request that the prosecuting attorney commence a criminal prosecution, seek a
temporary restraining order or seek equitable relief to enjoin any act or practices and
abate any conditions which constitute or will constitute a violation to this chapter.
Attachment B - Page 8
D.
The stop work or restoration order shall become effective immediately upon
receipt by the person to whom the order is directed.
E.
Failure to comply with the terms of a stop work or restoration order may result in
additional enforcement actions including, but not limited to, the issuance of a civil
infraction, or referral to the prosecuting attorney to seek equitable or injunctive relief or
for criminal prosecution.
F.
All costs, fees, and expenses in connection with enforcement actions may be
recovered as damages against the violator.
G.
No permit or approval shall be granted pursuant to this title if there exists on the
subject property any land use violation known by the approval authority unless expressly
authorized by this section. For purposes of this section, a land use violation is any
violation of the Thurston County Critical Areas Ordinance (Title 24) the Thurston County
Agricultural Activities Critical Areas Ordinance (Chapter 17.15 TCC), Thurston County
Forest Land Conversion Ordinance (Chapter 17.25 TCC), Thurston County Zoning
Ordinances (Titles 20, 21, 22 and 23 TCC), Thurston County Platting and Subdivision
Ordinance (Title 18 TCC), Sanitary Code for Thurston County, Shoreline Master
Program for the Thurston Region or Title 14 TCC (Buildings and Construction).
A permit or approval may be granted if conditioned on having the violation remedied
within a reasonable time as provided by the approval authority. If a permit or approval is
conditioned on remedial action, security in the form of a letter of credit or similar
instrument shall be required unless waived by the approval authority for good cause. This
section shall not apply to requests for a permit or approval to remedy a violation.
H.
The owner of property on which a violation of this chapter has occurred and the
persons or entities carrying out actions in violation of this chapter are each responsible
and liable for the violation.
I.
No use or activity listed in Tables 2 and 5 may be carried out within a critical area
or its buffer until any violation of this chapter which has occurred in such critical area or
buffer has been fully remedied.
Y.
Section 17.15.435 TCC is hereby repealed.
Z.
Section 17.15.440 is hereby repealed.
AA. The table of contents for Chapter 17.20 is hereby
amended to read as follows:
17.20.280 Civil Infractions Violations and enforcement.
BB. Section 17.20.280 TCC is
amended to read as follows:
hereby
re-titled
17.20.280 Civil Infractions Violations and enforcement.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
and
Attachment B - Page 9
A.
Violations of the provisions of this chapter are designated as Class I civil
infractions pursuant to RCW Chapter 7.80. Each day of any such violation is a separate
civil infraction. However, a notice of infraction shall not be issued until the person
responsible has been notified of the alleged violation and has been afforded a reasonable
period of time to come into compliance. Civil infractions shall be heard and determined
according to RCW Chapter 7.80, as amended, and any applicable court rules.
B.
The enforcement officer for implementation of this chapter is the director of the
resource stewardship department or designee.
C.
An enforcement officer issuing a notice of civil infraction shall require the person
receiving the notice to identify himself by producing a valid driver's license or identicard.
If the person receiving the notice is unable to produce such a card, the enforcement
officer shall require the person to give name, address and date of birth. If the person is
unable or unwilling to give such information, the enforcement officer may, with the
assistance of a deputy sheriff, detain such person for a period of time not longer than is
reasonably necessary to identify the person.
D.
The resource stewardship department director is responsible for assuring county
compliance with RCW 7.80.150.
E.
Notice of civil infractions may be recorded with the Thurston County auditor
against the property on which the violation took place in the following instances:
1.
The person receiving the notice of civil infraction does not respond as required by
RCW 7.80.080;
2.
The person receiving the notice of civil infraction fails to appear at a hearing
requested under RCW 7.80.080(3) and (4);
3.
The person assessed a monetary penalty for the civil infraction fails to pay such
penalty within the time required by law and does not appeal the penalty. If the penalty is
appealed, the enforcement officer may record the notice of civil infraction only if a
penalty remains unpaid after a final appellate determination has been entered.
F.
The auditor shall record any notice of civil infraction submitted for recording
under this section.
G.
The purpose of this section is remedial. Use of the civil infraction procedure will
better protect the public from the harmful effects of violations, will aid enforcement, and
will help reimburse the county for the expenses of enforcement.
CC. The table of contents for Chapter 17.25 is hereby
amended to read as follows:
17.25.800 Enforcement Violations and enforcement.
Attachment B - Page 10
DD. Section 17.25.800 TCC is
amended to read as follows:
hereby
re-titled
and
17.25.800 Enforcement Violations and enforcement.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
A.
Enforcement Authority.
1.
The director shall have authority to enforce this chapter, any rule or regulation
adopted, and any permit, order or approval issued pursuant to this chapter, against any
violation. If there is a threatened violation, the director may issue a cease and desist
order.
2.
Enforcement actions include: civil infractions, cease and desist orders, restoration
orders and judicial enforcement actions. Recourse to any single remedy shall not
preclude recourse to any of the other remedies.
3.
Each violation of this chapter, or any rule or regulation adopted, or any permit,
permit conditions, approval or order issued pursuant to this chapter, shall be a separate
offense. In cases of a violation, each day's continuance shall be deemed to be a separate
and distinct offense. Each tree cut in violation of this chapter shall constitute a separate
offense.
4.
Any person who violates this chapter, or any permit, order or approval issued
pursuant to this chapter shall be liable for all costs, fees and expenses incurred in
connection with enforcement activities.
B.
Cease and Desist Orders.
1.
The director may serve a cease and desist order when any person engages in any
use of land, development or any activity in violation of this chapter.
2.
The cease and desist order shall include the following:
a.
A description of the specific nature, extent, approximate time of the violation if
known, and any damage or potential damage resulting from the violation;
b.
A notice that the violation or the potential violation cease and desist or, in
appropriate cases, the specific corrective action to be taken within a given time.
3.
The cease and desist order issued under this section shall become effective
immediately upon service on the person to whom the order is directed or upon posting
of the order in a conspicuous manner on the property.
C.
Restoration Orders.
1.
The director may serve a restoration order for complete or partial restoration of
the site by the person responsible for any violation of this chapter.
2.
The restoration order shall include the following:
Attachment B - Page 11
a.
A description of the specific nature, extent, approximate time of the violation if
known, and any damage or potential damage resulting from the violation;
b.
A notice that the violation or the potential violation cease and desist or, in
appropriate cases, the specific corrective action to be taken within a given time.
3.
The restoration order shall include the specific corrective measures to be taken to
mitigate environmental damage or restore the site and shall specify a date by which
such measures must be accomplished.
4.
The restoration order issued under this section shall become effective immediately
upon service upon the person to whom the order is directed.
D.
Compliance.
1.
It is unlawful for any person to fail to comply with the terms of a cease and desist
order or a restoration order. Each and every such violation shall constitute a separate
violation of this chapter which may result in further enforcement actions including, but
not limited to, the issuance of a civil infraction.
2.
A cease and desist order or restoration order shall be appealable to the hearing
examiner. Any aggrieved person may request a hearing by sending a written request for
a hearing to the director within ten days of the service of such order.
3.
The filing of an appeal shall operate as a stay of corrective measures required by a
restoration order except where such order determines that an emergency exists,
requiring immediate action to protect public health, safety or the environment. The
filing of an appeal shall not operate as a stay of a cease and desist order.
E.
Civil Infractions. In addition to any other remedy provided in this chapter, the
director or his/her designee may issue a civil infraction pursuant to TCC Section
17.15.430 for agricultural activities governed by the Thurston County Agricultural
Activities Critical Areas Ordinance (Chapter 17.15 TCC), or a civil infraction pursuant to
Chapter 24.92 TCC for all other uses governed by the Thurston County Critical Areas
Ordinance (Title 24 TCC). Any violation of this chapter shall constitute a Class II civil
infraction. Except where trees are removed without a required permit, such civil
infraction shall be given only after the owner of the property has been given prior notice
with an opportunity to cure the violation.
F.
Judicial Enforcement Actions. The prosecuting attorney is authorized to
commence an action at law or in equity, including an action for injunctive relief to secure
compliance with this chapter.
G.
Misdemeanor. Any person found to have violated any provision of this chapter or
who knowingly makes a false statement, representation or certification in any application,
record or other document filed or required to be maintained under this chapter, shall be
guilty of a misdemeanor.
H.
Permit Approval Limitations. No permit or approval shall be granted pursuant to
this title if there exists on the subject property any land use violation known by the
approval authority unless expressly authorized by this section. For purposes of this
Attachment B - Page 12
section, a land use violation is any violation of the Thurston County Critical Areas
Ordinance (Title 24 of the Thurston County Code), the Thurston County Agricultural
Activities Critical Areas Ordinance (Chapter 17.15 of the Thurston County Code),
Thurston County Forest Land Conversion Ordinance (Chapter 17.25 of the Thurston
County Code), Thurston County Zoning Ordinances (Titles 20, 21, 22 and 23 of the
Thurston County Code), Thurston County Platting and Subdivision Ordinance (Title 18
of the Thurston County Code), Sanitary Code for Thurston County, Shoreline Master
Program for the Thurston Region or Title 14 of the Thurston County Code (Buildings and
Construction).
A permit or approval may be granted if conditioned on having the violation remedied
within a reasonable time as provided by the approval authority. If a permit or approval is
conditioned on remedial action, security in the form of a letter of credit or similar
instrument shall be required unless waived by the approval authority for good cause. This
section shall not apply to requests for a permit or approval to remedy a violation.
I.
Responsible Parties. The owner of property on which a violation of this chapter
has occurred, any person who engages in any activity in violation of this chapter, or any
person who, through an act of commission or omission, procures, aids or abets a violation
of this chapter, may be considered to have committed a violation of this chapter and may
be individually responsible and liable.
EE. Section 17.30.090
follows:
is
hereby
amended
to
read
as
…
D. The violation of any provision of this chapter is designated as a Class I civil infraction
pursuant to Chapter 7.80 RCW. Civil infractions shall be heard and determined according
to Chapter 7.80 RCW, as amended, Title 26 TCC and any applicable court rules.
…
FF. The table of contents for Chapter 18.48 TCC
hereby amended to read as follows:
is
Sections:
18.48.020 Violations -- Penaltiesand enforcement.
…
18.48.040 Prosecuting attorney.
GG. Section 18.48.020 TCC is
amended to read as follows:
18.48.020 Violations -- Penaltiesand enforcement.
hereby
re-titled
and
Attachment B - Page 13
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
Except as provided by Section 18.04.050, any person, firm, corporation or association, or
any agent of any person, firm, corporation or association, who violates any provisions of
this title relating to the sale, offer for sale, lease or transfer of any lot, tract or parcel of
land, is guilty of a gross misdemeanor, and each sale, offer for sale, lease or transfer of
each separate lot, tract or parcel of land in violation of any provision of this title is a
separate and distinct offense. Any other violation of this title shall be considered a
misdemeanor and shall be punishable as provided by state law for the commission of
misdemeanor.
HH. Section 18.48.040 TCC is hereby repealed.
II. The table of contents for Title 19 TCC is hereby
amended by adding the following chapter:
Chapters:
...
Chapter 19.13 Violations and enforcement.
…
JJ. A new Chapter TCC 19.13 is hereby added to Title 19
TCC to read as follows:
19.13 Violations and enforcement.
KK. A new section, Section 19.13.010 TCC is hereby
added to Chapter 19.13 TCC to read as follows:
Section 19.13.010 Enforcement authority.
Violations of this Title shall be enforced through the provisions of Title 26 TCC or the
Shoreline Master Program for the Thurston Region, as applicable.
LL. The table of contents for Title 20 TCC is hereby
amended to read as follows:
Chapters:
…
Chapter 20.60 Administration, Fees, Violations and Penaltiesenforcement.
…
Attachment B - Page 14
MM. Section 20.31.040
follows:
is
hereby
amended
to
read
as
…
7. Chapter 20.60, Administration, Fees, Violations and enforcementPenalties.
NN.
Section 20.40.035
follows:
is
hereby
amended
to
read
as
…
15.
Political campaign signs advertising a candidate or candidates for public elective office,
or a political party, or a sign urging a particular vote on a public issue decided by ballot
may be erected on any privately owned lot or parcel, excluding right-of-way. Each sign
shall be removed within fifteen days after that election. For a successful candidate in a
primary election, the sign may remain until the final election but shall be removed within
fifteen days after that election. The candidate or committee for which the sign is
displayed shall be responsible for its removal and subject to the penalties as provided in
this title and Title 26 TCC;
…
OO. The table of contents for Chapter 20.60 TCC
hereby amended to read as follows:
is
Sections:
20.60.010 Title enforcementEnforcement authority.
...
20.60.050 Violations, civil infractions and penalties.
20.60.055 Civil infraction procedures.
...
PP. Section 20.60.010 TCC is
amended to read as follows:
hereby
re-titled
and
20.60.010 Title enforcementEnforcement authority.
Violations of this title shall be enforced through the provisions of Title 26 TCC.
This title shall be administered and enforced by the department, which shall have all
necessary authority on behalf of the board to administer and enforce the provisions of this
title. The authority shall include the ability to order, in writing, the remedy of any
condition found in violation of this title and the ability to institute legal action with the
Attachment B - Page 15
prosecuting attorney's office to insure compliance with the provisions, including
injunction, abatement or other appropriate action or proceeding.
QQ. Section 20.60.050 TCC is hereby repealed.
RR. Section 20.60.055 TCC is hereby repealed.
SS. The table of contents for Title 21 TCC is hereby
amended to read as follows:
Chapters:
...
Chapter 21.102 Violations and enforcement.
...
TT. The table of contents for Chapter 21.102 TCC is
hereby amended to read as follows:
Sections:
21.102.010 Violations, civil infractions and penaltiesEnforcement authority.
21.102.020 Remedy.
21.102.030 Civil infraction procedures.
UU. Section 21.102.010 TCC is
amended to read as follows:
hereby
re-titled
and
21.102.010 Violations, civil infractions and penalties. Enforcement authority.
Violations of this title shall be enforced through the provisions of Title 26 TCC.
A.
Any person, whether owner, lessee, principal, agent, employee or otherwise, who
violates any of the provisions of this title or permits any such violation, or fails to comply
with any of its requirements or who erects any building or uses any building or uses any
land in violation of any detailed statement or plan submitted by him and approved under
the provisions of this title shall be guilty of a misdemeanor and, upon conviction thereof,
shall be punished as provided by the statutes of the state for the commission of a
misdemeanor.
B.
Any violations of TCC Section 21.57.060C1 shall be designated as a Class 1 civil
infraction. The violation of any other provision of Title 21 TCC shall be designated as a
Class 2 civil infraction. Each day of any such violation is a separate civil infraction; a
Attachment B - Page 16
notice of infraction may be issued for each day of any such violation, however the
enforcement officer is not required to issue a notice of infraction for each day of such
violation. Civil infractions shall be heard and determined according to Chapter 7.80 RCW
and TCC Section 21.102.030
The civil infraction procedure adopted in this chapter and by TCC Section 21.102.030
provides an additional method of civil enforcement to procedures found in subsections A,
C, and D of this section. The initiation of a proceeding under subsections A, C and D of
this section does not preclude the initiation of a civil infraction proceeding under TCC
Section 21.102.030.
C.
Any building erected or improvements constructed contrary to any of the
provisions of this title and any use of any building or land which is conducted, operated
or maintained contrary to any of the provisions of this title or permits issued pursuant
thereto shall be and is declared to be unlawful. The prosecuting attorney is authorized to
bring actions by any appropriate means to prevent the violation of this title and to enforce
its provisions.
D.
The director may, in writing, suspend or revoke a permit or approval required by
this title whenever the permit is issued in error or on the basis of incorrect information, or
in violation of any ordinance or regulation or any provision of this title, or when a use or
building is being maintained in a manner contrary to the terms of the permit or approval.
E.
Permit Approval Limitations. No permit or approval shall be granted pursuant to
this title if there exists on the subject property any land use violation known by the
approval authority unless expressly authorized by this section. For purposes of this
section, a land use violation is any violation of the Thurston County Critical Areas
Ordinance (Title 24 of the Thurston County Code), Thurston County Agricultural
Activities Critical Areas Ordinance (Chapter 17.15 of the Thurston County Code),
Thurston County Forest Land Conversion Ordinance (Chapter 17.25 of the Thurston
County Code), Thurston County Zoning Ordinances (Titles 20, 21, 22 and 23 of the
Thurston County Code), Thurston County Platting and Subdivision Ordinance (Title 18
of the Thurston County Code), Sanitary Code for Thurston County, Shoreline Master
Program for the Thurston Region or Title 14 of the Thurston County Code (Buildings and
Construction).
A permit or approval may be granted if conditioned on having the violation remedied
within a reasonable time as provided by the approval authority. If a permit or approval is
conditioned on remedial action, security in the form of a letter of credit or similar
instrument shall be required unless waived by the approval authority for good cause. This
section shall not apply to requests for a permit or approval to remedy a violation.
VV. Section 21.102.020 TCC is hereby repealed.
WW. Section 21.102.030 TCC is hereby repealed
Attachment B - Page 17
XX. The table of contents for Title 22 TCC is hereby
amended to read as follows:
Chapters:
…
Chapter 22.64 Enforcement and penalty. Violations and enforcement.
…
YY. Section 22.43.080
follows:
is
hereby
amended
to
read
as
Any person found to have violated any of the provision of this chapter shall be deemed to
have committed a civil infraction pursuant to Title 26Section 22.64.030 TCC.
ZZ. Section 22.44.070
follows:
is
hereby
amended
to
read
as
…
L. Political campaign signs advertising a candidate or candidates for public elective
office, or a political party, or a sign urging a particular vote on a public issue decided by
ballot may be erected on any privately owned lot or parcel, excluding right-of-way. Each
sign shall be removed within fifteen days after that election. For a successful candidate in
a primary election, the sign may remain until the final election but shall be removed
within fifteen days after that election. The candidate or committee for which the sign is
displayed shall be responsible for its removal and subject to the penalties as provided in
Title 26 TCCthis title;
…
AAA. Section 22.47.040
follows:
is
hereby
amended
to
read
as
…
C. Action Upon Noncompliance. Failure, neglect or refusal of owner to perform the
required maintenance action shall be taken in accordance with Title 26 TCC.Section
22.64.030
BBB. The table of contents for
hereby amended as follows:
Sections:
22.64.010 GenerallyViolations and enforcement.
Chapter 22.64 TCC
is
Attachment B - Page 18
…
22.64.030 Violations, civil infractions and penalties.
22.64.040 Other remedies.
22.64.050 Civil infraction procedures.
CCC. Section 22.64.010 TCC is
amended to read as follows:
hereby
re-titled
and
22.64.010 GenerallyViolations and enforcement.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
The department shall administer and enforce this title. If the department finds that any of
the provisions of this title are being violated, it shall notify in writing the person
responsible for such violation, indicating the nature of the violation and ordering the
action necessary to correct it. The department shall take any action authorized by this title
to insure compliance with or to prevent violation of its provisions, including the issuance
of orders to stop work.
DDD. Section 22.64.030 TCC is hereby repealed.
EEE. Section 22.64.040 TCC is hereby repealed.
FFF. Section 22.64.050 TCC is hereby repealed.
GGG. The table of contents for Title 23 TCC is hereby
amended to read as follows:
Chapters:
…
23.73 Violations and eEnforcement and penalty.
…
HHH. The table of contents for Chapter 23.73 TCC is
hereby amended to read as follows:
Sections:
23.73.010 GenerallyEnforcement authority.
…
23.73.030 Violations, civil infractions and penalties.
23.73.040 Other remedies.
23.73.050 Civil infraction procedures.
Attachment B - Page 19
III. Section 23.73.010 TCC is hereby re-titled and
amended to read as follows:
23.73.010 GenerallyEnforcement authority.
Violations of this chapter shall be enforced through the provisions of Title 26 TCC.
The department shall administer and enforce this title. If the department finds that any of
the provisions of this title are being violated, it shall notify in writing the person
responsible for such violation, indicating the nature of the violation and ordering the
action necessary to correct it. The department shall take any action authorized by this title
to insure compliance with or to prevent violation of its provisions, including the issuance
of orders to stop work.
JJJ. Section 23.73.030 TCC is hereby repealed.
KKK. Section 23.73.040 TCC is hereby repealed.
LLL. Section 23.73.050 TCC is hereby repealed.
MMM. The table of contents for Title 24 TCC is hereby
amended to read as follows:
…
Chapter 24.92 Violations and enforcement. Enforcement, violations, and penalties.
NNN. Section 24.30.070
follows:
is
hereby
amended
to
read
as
…
F. Mitigation for Illegal Alterations. See Title 26, Code EnforcementChapter 24.92,
Enforcement—Violations—Penalties.
OOO. The table of contents for Chapter 24.92 is hereby
re-titled and amended to read as follows:
Sections:
24.92.010 GenerallyEnforcement authority.
24.92.020 Calculation of penalties and damages.
24.92.030 Violation remedies.
24.92.040 Stop work orders.
Attachment B - Page 20
24.92.050 Restoration orders.
24.92.060 Revocation of permits.
24.92.070 Civil infractions.
24.92.080 Liability for violations.
PPP. Section 24.92.010 TCC is
amended to read as follows:
hereby
re-titled
and
24.92.010 Generally Enforcement authority.
Violations of this title shall be enforced through the provisions of Title 26 TCC.
A.
The director shall administer and enforce this title. For the purposes of Chapter
7.80 RCW, the director is the enforcement officer for this title. If the director finds that
any of the provisions of this title are being violated, it shall notify in writing the person
responsible for such land use violation, indicating the nature of the land use violation and
ordering the action necessary to correct it. The director shall take any action authorized
by this title to ensure compliance with or to prevent a land use violation of its provisions,
including the issuance of orders to stop work.
B.
Adherence to the requirements of this title and to any permit conditions or orders
issued pursuant to this title is required throughout the construction period and thereafter.
No use or activity subject to this title may be carried out within a critical area, buffer, or
management zone where a violation occurred, until the county determines that all
violations of this title in the affected critical area, buffer, or management zone have been
fully remedied.
C.
No permit or approval shall be granted pursuant to this title if there exists on the
subject property any land use violation known by the approval authority unless expressly
authorized by this section.
D.
A permit approval may be granted if conditioned on having the violation
remedied within a reasonable time as provided by the approval authority. If a permit or
approval is conditioned on remedial action, a bond, surety or similar instrument that
meets the requirements of Chapter 24.70 TCC may be required.
E.
Permits may be granted to remedy a violation.
F.
For the purposes of this chapter, a land use violation is a violation of this title, the
Agricultural Activities Critical Areas Ordinance (Chapter 17.15 TCC), Thurston County
Forest Land Conversion Ordinance (Chapter 17.25 TCC), the Thurston County Zoning
Ordinances (Titles 20, 21, 22, and 23 TCC), the Thurston County Platting and
Subdivision Ordinance (Title 18 TCC), Sanitary Code for Thurston County, Shoreline
Master Program (Title 19 TCC), or the Buildings and Construction Code (Title 14 TCC).
QQQ. Section 24.92.020 TCC is hereby repealed.
Attachment B - Page 21
RRR. Section 24.92.030 TCC is hereby repealed.
SSS. Section 24.92.040 TCC is hereby repealed.
TTT. Section 24.92.050 TCC is hereby repealed.
UUU. Section 24.92.060 TCC is hereby repealed.
VVV. Section 24.92.070 TCC is hereby repealed.
WWW. Section 24.92.080 TCC is hereby repealed.
Board of County Commissioners
AGENDA ITEM SUMMARY
Agenda Date: 03/03/2015
Created by:
Presenter:
Date Created: 2/19/2015
Agenda Item #: 7a
Shawn McDonald, Senior Management Analyst - Commissioners - 754-3355 x6219
Robin Campbell, County Manager, Assistant - Commissioners - 709-3063
Item Title:
Office of Assigned Council Budget Increase
Action Needed: Pass Motion
Class of Item: Commissioners and Manager's Items
List of Exhibits
File Attachment
Recommended Action:
Move to approve the transfer of $40,000 in ap propriation authority from General Fund Non Departmental to the Office of Assigned Counsel.
Item Description:
As of February 27, 2015, the Office of Assigned Counsel (OAC) has 2014 payments due in excess of
their appropriation authority of approximately $40,000. The over -expenditure is mainly caused by
professional services bills being higher than anticipated. Professional services include panel attorneys,
expert witnesses, special investigations, and other services related to public defense cases.
RCW 36.40.130 prohibits p ayments in excess of budget. In order to pay vendors the amount due, the
OAC budget must be increased.
The Thurston County 2014 Budget, Resolution 14826, includes the following provision: Upon action by
the Board of County Commissioners, the County Manager or designee may distribute, to any General
Fund department, amounts consistent with said decisions, from the General Fund Non-Dep artmental
reserve line items.
There is $10,000 available in the 2014 Budget for General Fund Non-Departmental from unspent funds
that had been reserved for a video court capital project. Additionally, there is $30,000 available in the
2014 Budget for General Fund Non-Departmental from unspent funds that had been reserved
for professional services. The Assistant County Manager recommends transferring $10,000 from the
video court capital project and $30,000 from professional services to the Office of Assigned Counsel.
Date Submitted: 2/19/2015
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