HomeMy WebLinkAboutWashington State Health Care Authority for Law Enforcement Assisted Diversion (LEAD) - Interlocal Agreement DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
Washington State INTERAGEN fYo AGREEMENT HCA Contract Number: K7592
Health I CarekuthorI Law Enforcement Assisted Contractor Contract Number:
Diversion (LEAD) "X IOU 3
THIS AGREEMENT is made by and between Washington State Health Care Authority (HCA) and Mason
County Public Health and Human Services, pursuant to the authority granted by Chapter 39.34 RCW.
CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA)
Mason County Public Health and Human Services
CONTRACTOR ADDRESS Street Citv State Zip Code
415 N 61h Street Shelton WA 98584
CONTRACTOR CONTRACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS
Melissa Casey 360-427-9670 x 404 mcasey(aD_masoncountywa.gov
HCA PROGRAM HCA DIVISION/SECTION
Division of Behavioral Health & Recovery (DBHR)
HCA CONTRACT MANAGER NAME AND TITLE HCA CONTRACT MANAGER ADDRESS
Health Care Authority
Grace Burkhart, Diversion Services Program Manager 626 8th Avenue SE
PO Box 2730
Olympia, WA 98504-2730
HCA CONTRACT MANAGER TELEPHONE HCA CONTRACT MANAGER E-MAIL ADDRESS
(360) 725-0973 grace.burkhart@hca.wa.gov
CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT
Date of Execution June 30, 2025 $515,000
PURPOSE OF CONTRACT:
Expand the operational capabilities of an existing LEAD Program that adheres to the Core Principles of Law
Enforcement Assisted Diversion (LEAD) as noted in Substitute Senate Bill (SSB) 5380 and Revised Code of Washington
(RCW) 71.24.589.
The parties signing below warrant that they have read and understand this Contract, and have authority to execute this
Contract. This Contract will only be binding upon signature by both parties. The parties may execute this contract in
multiple counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail
(electronic mail) transmission of a signed copy of this contract shall be the same as delivery of an original.
CONTRACTOR SIGNATURE PRINTED NA E AND TITLE DATE
V,ardv Wnk�NP_4n hay X 6unc ��
HCA SIGNATURE PRINTED NAME A D TITLE DATE
Andria Howerton
-Aµ Deputy Contracts Administrator 6/12/2024
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DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
1. DEFINITIONS
"Authorized Representative" means a person to whom signature authority has been delegated in
writing acting within the limits of the person's authority.
"Confidential Information" means information that may be exempt from disclosure to the public or
other unauthorized persons under chapter 42.56 RCW or chapter 70.02 RCW or other state or
federal statutes or regulations. Confidential Information includes, but is not limited to, any information
identifiable to an individual that relates to a natural person's health, finances, education, business,
use or receipt of governmental services, names, addresses, telephone numbers, social security
numbers, driver license numbers, financial profiles, credit card numbers, financial identifiers and any
other identifying numbers, law enforcement records, HCA source code or object code, or HCA or
State security information.
"Contract" or "Agreement" means the entire written agreement between HCA and the contractor,
including any exhibits, documents, or materials incorporated by reference. MContract and
Agreement may be used interchangeably.
"Contractor" means Mason County Public Health and Human Services, its employees and
agents. Contractor includes any firm, provider, organization, individual or other entity performing
services under this Agreement. It also includes any Subcontractor retained by Contractor as
permitted under the terms of this Agreement.
"Data" means information disclosed, exchanged or used by Contractor in meeting requirements
under this Agreement. Data may also include Confidential Information as defined in this Contract.
"Health Care Authority" or "HCA" means the Washington State Health Care Authority, any
division, section, office, unit or other entity of HCA, or any of the officers or other officials lawfully
representing HCA.
"Information and Communication Technology" or "ICT" means information technology and other
equipment, systems, technologies, or processes, for which the principal function is the creation,
manipulation, storage, display, receipt, or transmission of electronic data and information, as well as
any associated content. Examples include computers and peripheral equipment; information kiosks
and transaction machines; telecommunications equipment; customer premises equipment;
multifunction office machines; software; applications; websites; videos; and electronic
documents."Services" means all work performed or provided by Contractor pursuant to this
Contract.
"Statement of Work" or "SOW" means a detailed description of the work activities the Contractor is
required to perform under the terms and conditions of this Contract, including the deliverables and
timeline, and is included as Attachment 1.
"Subcontractor" means a person or entity that is not in the employment of the Contractor, who is
performing all or part of the business activities under this Agreement under a separate contract with
Contractor. The term "Subcontractor" means subcontractor(s) of any tier.
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2. STATEMENT OF WORK
Contractor will furnish the necessary personnel, equipment, material and/or service(s) and otherwise
do all things necessary for or incidental to the performance of work set forth in Attachment 1.
3. PERIOD OF PERFORMANCE
Subject to its other provisions, the period of performance of this Contract will commence on date of
last signature, and be completed on June 30, 2025, unless terminated sooner or extended upon
written agreement between the parties.
4. PAYMENT
Compensation for the work provided in accordance with this Agreement has been established under
the terms of RCW 39.34.130. The parties have determined that the cost of accomplishing the work
herein will not exceed $515,000. Payment for satisfactory performance of the work will not exceed
this amount unless the parties mutually agree to a higher amount. Compensation for services will be
based on the following rates or in accordance with Attachment 1, Statement of Work.
5. BILLING PROCEDURE
5.1. Contractor must submit accurate invoices to the following address for all amounts to be paid by
HCA via e-mail to the HCA Contract Manager for this Contract. Include the HCA Contract
number in the subject line of the email.
5.2. Invoices must describe and document to HCA's satisfaction a description of the work performed,
the progress of the project, and fees. If expenses are invoiced, invoices must provide a detailed
breakdown of each type. Any single expense in the amount of$50.00 or more must be
accompanied by a receipt in order to receive reimbursement. All invoices will be reviewed and
must be approved by the Contract Manager or designee prior to payment.
5.3. Contractor must submit properly itemized invoices to include the following information, as
applicable:
A. The HCA Contract number;
B. Contractor name, address, phone number;
C. Description of Services;
D. Date(s) of delivery;
E. Net invoice price for each item;
F. Applicable taxes;
G. Total invoice price; and
H. Payment terms and any available prompt payment discount.
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5.4. Contractor will return incorrect or incomplete invoices for correction and reissue. The Agreement
number must appear on all invoices, bills of lading, packages, and correspondence relating to
this Agreement.
5.5. Payment will be considered timely if made within thirty (30) calendar days of receipt of properly
completed invoices. Payment will be directly deposited in the bank account or sent to the
address Contractor designated in this Agreement.
5.6. Upon expiration or termination any claims for payment for costs due and payable under this
Agreement that are incurred prior to the expiration date must be submitted by Contractor within
sixty(60) calendar days after the expiration date. There will be no obligation to pay any claims
that are submitted sixty-one (61) or more calendar days after the expiration date("Belated
Claims"). Belated Claims will be paid at HCA's sole discretion, and any such potential payment
is contingent upon the availability of funds.
6. ACCESSIBILITY
6.1. REQUIREMENTS AND STANDARDS. Each information and communication technology(ICT)
product or service furnished under this Contract shall be accessible to and usable by individuals
with disabilities in accordance with the Americans with Disabilities Act(ADA) and other
applicable Federal and State laws and policies, including OCIO Policy 188, et seq. For purposes
of this clause, Contractor shall be considered in compliance with the ADA and other applicable
Federal and State laws if it satisfies the requirements (including exceptions) specified in the
regulations implementing Section 508 of the Rehabilitation Act, including the Web Content
Accessibility Guidelines (WCAG) 2.1 Level AA Success Criteria and Conformance
Requirements (2008), which are incorporated by reference, and the functional performance
criteria.
6.2. DOCUMENTATION. Contractor shall maintain and retain, subject to review by HCA, full
documentation of the measures taken to ensure compliance with the applicable requirements
and functional performance criteria, including records of any testing or simulations conducted.
6.3. REMEDIATION. If the Contractor claims that its products or services satisfy the applicable
requirements and standards specified in this Section and it is later determined by HCA that any
furnished product or service is not in compliance with such requirements and standards, HCA
will promptly inform Contractor in writing of noncompliance. Contractor shall, at no additional
cost to HCA, repair or replace the non-compliant products or services within the period specified
by HCA. If the repair or replacement is not completed within the specified time, HCA may cancel
the contract, delivery, task order, or work order, or purchase line item without termination
liabilities or have any necessary changes made or repairs performed by employees of HCA or
by another contractor, and Contractor shall reimburse HCA for any expenses incurred thereby.
6.4. INDEMNIFICATION. Contractor agrees to indemnify and hold harmless HCA from any claim
arising out of failure to comply with the aforesaid requirements.
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8. AGREEMENT CHANGES, MODIFICATIONS AND AMENDMENTS
This Agreement may be amended by mutual agreement of the parties. Such amendments are not
binding unless they are in writing and signed by an Authorized Representative of each party.
9. SUBCONTRACTING
Neither the Contractor nor any Subcontractor shall enter into subcontracts for any of the work
contemplated under this Agreement without obtaining HCA's prior written approval. HCA shall have
no responsibility for any action of any such Subcontractors.
10. ASSIGNMENT
The work to be provided under this Agreement, and any claim arising thereunder, is not assignable
or delegable by either party in whole or in part, without the express prior written consent of the other
party, which consent will not be unreasonably withheld.
11. CONTRACT MANAGEMENT
The Contract Manager for each of the parties, named on the face of this Contract, will be responsible
for and will be the contact person for all communications and billings regarding the performance of
this Agreement. Either party must notify the other party within thirty (30) days of change of Contract
Management. Changes in Contract Management shall require an amendment.
12. DISALLOWED COSTS
The Contractor is responsible for any audit exceptions or disallowed costs incurred by its own
organization or that of its Subcontractors.
13. DISPUTES
In the event that a dispute arises under this Agreement, it will be determined by a dispute board in
the following manner: Each party to this Agreement will appoint one member to the dispute board.
The members so appointed will jointly appoint an additional member to the dispute board. The
dispute board will review the facts, Agreement terms and applicable statutes and rules and make a
determination of the dispute. The dispute board will thereafter decide the dispute with the majority
prevailing. The determination of the dispute board will be final and binding on the parties hereto. As
an alternative to this process, either of the parties may request intervention by the Governor, as
provided by RCW 43.17.330, in which event the Governor's process will control.
14. GOVERNANCE
This Agreement is entered into pursuant to and under the authority granted by the laws of the state of
Washington and any applicable federal laws. The provisions of this Agreement will be construed to
conform to those laws.
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In the event of an inconsistency in the terms of this Agreement, or between its terms and any
applicable statute or rule, the inconsistency will be resolved by giving precedence in the following
order:
A. Applicable Federal and State of Washington statutes and regulations;
B. Attachment 1: Statement of Work; and
C. Any other provisions of the agreement, including materials incorporated by reference.
15. INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the performance of this Agreement will
not be considered for any purpose to be employees or agents of the other party.
16. RECORDS MAINTENANCE
16.1. The parties to this Agreement will each maintain books, records, documents and other evidence
which sufficiently and properly reflect all direct and indirect costs expended by either party in the
performance of the services described herein. These records will be subject to inspection,
review or audit by personnel of both parties, other personnel duly authorized by either party, the
Office of the State Auditor, and federal officials so authorized by law. All books, records,
documents, and other material relevant to this Agreement will be retained for six years after
expiration and the Office of the State Auditor, federal auditors, and any persons duly authorized
by the parties will have full access and the right to examine any of these materials during this
period.
16.2. Records and other documents, in any medium, furnished by one party to this Agreement to the
other party, will remain the property of the furnishing party, unless otherwise agreed. The
receiving party will not disclose or make available this material to any third parties without first
giving notice to the furnishing party and giving it a reasonable opportunity to respond. Each party
will use reasonable security procedures and protections to assure that records and documents
provided by the other party are not erroneously disclosed to third parties.
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18. TREATMENT OF ASSETS
18.1. Ownership
HCA shall retain title to all property furnished by HCA to Contractor under this contract. Title to
all property furnished by the Contractor, for the cost of which the Contractor is entitled to
reimbursement as a direct item of cost under this contract, excluding intellectual property
provided by the Contractor, shall pass to and vest in HCA upon delivery of such property by the
Contractor. Title to other property, the cost of which is reimbursable to the Contractor under this
Contract, shall pass to and vest in HCA upon (i) issuance for use of such property in the
performance of this Contract, (ii) commencement of use of such property in the performance of
this Contract, or(iii) reimbursement of the cost thereof by HCA, in whole or in part, whichever
occurs first.
18.2. Use of Property
Any property furnished to Contractor shall, unless otherwise provided herein, or approved in
writing by the HCA Contract Manager, be used only for the performance of and subject to the
terms of this Contract. Contractor's use of the equipment shall be subject to HCA's security,
administrative and other requirements.
18.3. Damage to Property
Contractor shall continuously protect and be responsible for any loss, destruction, or damage to
property which results from or is caused by Contractor's acts or omissions. Contractor shall be
liable to HCA for costs of repair or replacement for property or equipment that has been lost,
destroyed or damaged by Contractor or Contractor's employees, agents or subcontractors. Cost
of replacement shall be the current market value of the property and equipment on the date of
the loss as determined by HCA.
18.4. Notice of Damage
Upon the loss of, destruction of, or damage to any of the property, Contractor shall notify the
HCA Contract Manager thereof within one(1) Business Day and shall take all reasonable steps
to protect that property from further damage.
18.5. Surrender of Property
Contractor will ensure that the property will be returned to HCA in like condition to that in which it
was furnished to Contractor, reasonable wear and tear excepted. Contractor shall surrender to
HCA all property upon the earlier of expiration or termination of this Contract.
19. RIGHTS IN DATA
Unless otherwise provided, data which originates from this Agreement will be"works for hire" as
defined by the U.S. Copyright Act of 1976 and will be owned by HCA. Data will include, but not be
limited to, reports, documents, pamphlets, advertisements, books, magazines, surveys, studies,
computer programs, films, tapes and/or sound reproductions. Ownership includes the right to
copyright, patent, register and the ability to transfer these rights.
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20. CONFIDENTIALITY
Each party agrees not to divulge, publish or otherwise make known to unauthorized persons
confidential information accessed under this Agreement. Contractor agrees that all materials
containing confidential information received pursuant to this Agreement, including, but not limited to
information derived from or containing patient records, claimant file and medical case management
report information, relations with HCA's clients and its employees, and any other information which
may be classified as confidential, shall not be disclosed to other persons without HCA's written
consent except as may be required by law.
21. SEVERABILITY
If any provision of this Agreement or any provision of any document incorporated by reference will be
held invalid, such invalidity will not affect the other provisions of this Agreement, which can be given
effect without the invalid provision if such remainder conforms to the requirements of applicable law
and the fundamental purpose of this agreement, and to this end the provisions of this Agreement are
declared to be severable.
22. FUNDING AVAILABILITY
HCA's ability to make payments is contingent on funding availability. In the event funding from state,
federal, or other sources is withdrawn, reduced, or limited in any way after the effective date and
prior to completion or expiration date of this Agreement, HCA, at its sole discretion, may elect to
terminate the Agreement, in whole or part, or to renegotiate the Agreement subject to new funding
limitations and conditions. HCA may also elect to suspend performance of the Agreement until HCA
determines the funding insufficiency is resolved. HCA may exercise any of these options with no
notification restrictions.
23. TERMINATION
Either party may terminate this Agreement upon 30-days' prior written notification to the other parry. If
this Agreement is so terminated, the parties will be liable only for performance rendered or costs
incurred in accordance with the terms of this Agreement prior to the effective date of termination.
24. TERMINATION FOR CAUSE
If for any cause, either party does not fulfill in a timely and proper manner its obligations under this
Agreement, or if either party violates any of these terms and conditions, the aggrieved party will give
the other party written notice of such failure or violation. The responsible party will be given the
opportunity to correct the violation or failure within 30 days. If failure or violation is not corrected, this
Agreement may be terminated immediately by written notice of the aggrieved party to the other.
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26. WAIVER
A failure by either party to exercise its rights under this Agreement will not preclude that party from
subsequent exercise of such rights and will not constitute a waiver of any other rights under this
Agreement unless stated to be such in a writing signed by an Authorized Representative of the party
and attached to the original Agreement.
27. ALL WRITINGS CONTAINED HEREIN
This Agreement contains all the terms and conditions agreed upon by the parties. No other
understandings, oral or otherwise, regarding the subject matter of this Agreement will be deemed to
exist or to bind any of the parties hereto.
28. SURVIVORSHIP
The terms, conditions and warranties contained in this Agreement that by their sense and context are
intended to survive the completion of the performance, expiration or termination of this Agreement
shall so survive. In addition, the terms of the sections titled Rights in Data, Confidentiality, Disputes
and Records Maintenance shall survive the termination of this Agreement.
Attachments
Attachment 1: Statement of Work
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ATTACHMENT 1: STATEMENT OF WORK
1. Purpose
Expand the operational capabilities of an existing LEAD Program that adheres to the Core
Principles of LEAD as noted in Substitute Senate Bill (SSB) 5380 and Revised Code of
Washington (RCW) 71.24.589.
2. Definitions
2.1 Division of Behavioral Health and Recovery or DBHR - A Division within the Health Care
Authority that provides funding, training, and technical assistance to community-based
providers for prevention, intervention, treatment, and recovery support services to people
in need.
2.2 Individual —A person who may be eligible for LEAD services.
2.3 Law Enforcement Assisted Diversion, LEAD or Program - A registered trademark
referring to the LEAD Program developed by the Seattle King County Policy Coordinating
Group. The LEAD Program is managed by the Purpose Dignity Action (PDA) and is
recognized as an evidence-based practice in the Washington Medicaid Waiver Toolkit
and falls under the Office of Justice Programs standards for evidence-based practices.
2.4 LEAD Support Bureau, National Support Bureau, or NSB—A project of the Purpose
Dignity Action (PDA). The LEAD NSB will be providing strategic guidance and technical
assistance to the pilot sites developing LEAD Programs under this Agreement, including
providing guidance on implementation with a commitment to the LEAD Programs core
principles. Lead Support Bureau —An organization that provides technical support for
implementation of LEAD programs with fidelity to the LEAD core principles.
2.5 PDA (Purpose.Dignity.Action) —The parent organization supporting the LEAD Support
Bureau as one of multiple public advocacy programs in Washington State. Formerly
known as the Public Defenders Association prior to 2013, and will provide technical
assistance for the LEAD site selection, implementation, and evaluation.
2.6 Recovery Navigator Program - RCW 71.24.115 outlines the scope of activities for the
Recovery Navigator Program as a pre-arrest diversion program operated by the regional
behavioral health administrative service organizations in Washington State.
3. HCA Responsibilities
3.1 Provide a Contract Manager to monitor all expanded operations under the LEAD
Program; and
3.2 Provide timely responses to all inquiries from the Contractor.
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Attachment 1
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
4. Work Expectations
5.1 Program Facilitation
5.1.1 Update the existing LEAD Program Site Evaluation Plan to incorporate the
additional operational capacity available through the expansion funding, with
the intent of yielding results that include but are not limited to:
a. Reduction in arrests, time spent in custody, and/or recidivism for the
LEAD Program participants;
b. Increased access to and utilization of non-emergency community
behavioral health and/or substance use services;
C. Reduction in the utilization of emergency services;
d. Increased resilience, stability, and well-being for LEAD Program
participants; and
e. Reduction in cost for the justice system in comparison to processing
cases as usual through the justice system.
5.1.2 Continue providing intensive case management services.
5.1.3 Continue providing intensive case management services and ensure that any
new staff hired through the expansion funding are trained on all applicable case
management practices.
5.2 The Contractor's LEAD Program Manager shall continue to provide logistical
coordination, support, and record-keeping to the local LEAD Policy Coordinating Group
(PCG) and Operational Workgroup (OWG), and shall incorporate additional reporting
related to the expanded operational capacity created through this expansion as required.
5.3 Maintain employees and/or contract clinical support positions, to include, but not limited
to the following:
5.3.1 Outreach Coordinator;
5.3.2 Clinical Supervisor, and
5.3.3 Case Manager.
5.4 Provide referrals to local community agencies for intensive case management services,
including but not limited to the following:
5.4.1 Substance Use Disorder;
5.4.2 Mental health, and
5.4.3 Behavioral health assessment and treatment.
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Attachment 1
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
5. Transportation. Contractor shall monitor, track and report on anticipated and actual
transportation activities in accordance with Section 6, Deliverable Table, and Attachment 7,
Transportation Assessment Reports.
6. Deliverables Table
6.1 Contractor shall provide reports in accordance with Attachments, due dates and rates in
the table below.
6.1.1 HCA Contract Manager will provide templates to Contractor within ten (10)
business days after Contract execution.
6.1.2 HCA Contract Manager will provide updated templates, as needed.
6.1.3 Contractor shall use the current template and format to fulfill reporting
deliverables.
6.2 Contractor shall transmit all reports via the Wa-Tech Managed File Transfer (MFT)
portal.
6.3 Table
# Description Rate Due Date Amount
SFY2024
1 Budget and Staffing Plan $60,000 per plan June 30, 2024 $60,000
(Attachment 2) x 1 plan
2 Narrative Report $50,000 per report $50,000
(Attachment 3) x 1 report
Subtotal SFY2024 Expenses $110,000
SFY2026
1 Monthly LEAD Implementation $14,500 per month July 2024-May $174,000
Reports—Staffing x12 months 2025: 1511 of each
(Attachment 4) month, following
the month of
2 Monthly LEAD Implementation service. $174,000
Reports— Flex Funds
( June 2025: With
Attachment 5)
final invoice.
3 Transportation Assessment $31,000 for Report 1, August 30, 2024 $33,000
Reports (Attachment 6) $2,000 for Report 2 May 30, 2025
4 End of Year Report $22,000 per report With final invoice $22,000
(Attachment 5) X 1 report
Subtotal SFY2025 Expenses $405,000
Total Maximum Compensation for deliverables completed
through June 30, 2025 $515,000
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Attachment 1
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 2: BUDGET AND STAFFING PLAN
1. Purpose.
1.1. A narrative plan for budget and staffing needs and activities Contractor plans to start on
or after July 1, 2024.
1.2. Restatement and/or adjustment of informal proposed plans previously submitted,
adjusted to reflect plans on what the Contractor plans to do with the funding.
1.3. Timeline projection of milestones, to be monitored and matched through Attachment 4,
Monthly LEAD Implementation Reports—Staffing, and Attachment 5, Monthly LEAD
Implementation Reports— Flex Funds.
2. Format:
Word document for narrative descriptions, with use of Excel as needed to support budget
spreadsheet needs.
3. Components
3.1. Demonstrating intended goals for expanding program capability.
3.2. Further outlining the need for the ()(1) Behavioral Health Specialist positions requested
in the budget proposal and the projected impact on alleviating caseload capacity issues.
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Attachment 2
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 3: NARRATIVE REPORT
1. Purpose:
1.1. Prior to June 30, 2024 - Narrative report that provides a description of the program and
maps out identified needs and how they will be addressed starting July 1, 2024.
1.2. Restatement and/or adjustment of informal proposals and mission statements previously
submitted, explaining why additional funds are needed and what is anticipated to be
gained by this expansion.
1.3. Could include history, challenges encountered/anticipated, expansion goals, etc.
2. Format:
Word document
3. Components:
3.1. Detail the hiring timeline for adding program staff.
3.2. Describe the impact of new staff on reporting and workflow management systems.
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Attachment 3
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 4: MONTHLY LEAD IMPLEMENTATION REPORTS—STAFFING
1. Purpose: Track and document over time the progress made in staffing and expansion
implementation.
2. Format:
Word document. HCA Contract Manager will work with Contractor to create a template to
provide clarification and examples.
3. Components
3.1. Narrative of participant success stories related to expansion staffing.
3.2. Narrative description of any success stories or outreach engagement activities
performed by staff funded through grant expansion.
3.3. Anticipated performance report impacts to the site evaluation plan.
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Attachment 4
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 5: MONTHLY LEAD IMPLEMENTATION REPORTS—FLEX FUNDS
1. Purpose: Report and document activities, highlighting expansion activities demonstrating novel
successes or unique situations for use of funds to solve problems.
2. Format:
Word Document. HCA Contract Manager will work with Contractor to create a template to
provide clarification and examples.
3. Components
3.1. Narrative participant success stories related to use of expansion related flex funds.
3.2. Narrative description of successful outcomes from use of program flex funds.
3.3. Demonstration of any utilization requests that might be considered unique or noteworthy,
to support education and training for other diversion programs.
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Attachment 5
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 6: END OF YEAR REPORT
1. Purpose. Demonstrate the LEAD program outcomes and progress made through the end of
the first full year of operation.
2. Format.
Word document narrative and Excel spreadsheet as needed for any budget expression.
3. LEAD Program evaluation metrics. Narrative description of lessons learned and program
outcomes, summaries of metrics met, challenges encountered, and transition plans for
activities after July 1, 2025.
4. Budget. Compare original budget to actual expenditures, and narrative of lessons learned,
new needs, risk assessment, etc.
Due June 15, 2025
Washington State Page 17 of 19 LEAD Services
Health Care Authority HCA IAA K7592
Attachment 6
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
ATTACHMENT 7: TRANSPORTATION ASSESSMENT REPORT
1 . Purpose: Monitor, track and respond to LEAD program transportation needs.
2. Format:
2.1. Report 1, Word document.
2.2. Report 2, Word document with table or Word document for narrative and Excel
document for the spreadsheet.
3. Components:
3.1. Report 1 - Transportation Plan.
3.1.1 . Narrative on how the funds will be spent to support transportation of
clients to services within the purpose of this Contract, and how
supporting transportation needs will bridge current gaps in the provision
of LEAD services.
3.1.2. The report shall include proposed transportation plans for the
purchase(s) of any vehicles, bus passes, train tickets, Uber fees, parking
fees or passes or other transportation related costs that are expected for
the intended purpose of this contract.
3.1 .3. If a vehicle(s) is purchased related to the Contractor's Transportation
Plan or this Contract, the Contractor is solely responsible for ownership,
any associated legal responsibilities, and use of the vehicle(s).
3.2. Report 2 — Transportation Results Summary.
3.2.1 . Narrative summary of results including, but not limited to:
3.2.1.1. Lessons learned;
3.2.1.2. Transportation components of populations served;
3.2.1.3. Explanations for variances and/or unanticipated events.
3.2.2. Spreadsheet that shows the average totals for each category where
service was provided.
3.2.2.1 . Example spreadsheet.
# Expense Type Average Rates Average Expenses
per Month per Month
1 Mileage 250 miles
Washington State Page 18 of 19 LEAD Services
Health Care Authority HCA IAA K7592
Attachment 7
DocuSign Envelope ID:A3AA89F5-9AD1-4AOA-84B9-A985022CD804
# Expense Type Average Rates Average Expenses
per Month per Month
2 Vehicle Fuel/Charging $175
3 Social Services 63 appts
Appointments
3.2.2.2. Components, to include, but not limited to, the following, where
applicable:
a. Vehicle loan/lease/rental payments;
b. Vehicle fuel/charging;
c. Bus/ferry passes;
d. Train tickets;
e. Uber/Lyft/Taxi fees;
f. Parking;
g. Mileage;
h. Number of transportation appointments;
i. Aggregate of types of appointments:
i. Social services;
ii. Medical — evaluation;
iii. Medical — treatment;
iv. Court;
V. Probation;
vi. Crisis services;
vii. Outreach;
viii. Basic needs.
j. Whether or not the items purchased are for distribution to
or use by staff or provided directly to Individuals being
served;
k. Other related expenses, as applicable.
Washington State Page 19 of 19 LEAD Services
Health Care Authority HCA IAA K7592
Attachment 7