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Interlocal Agreement between Mason County and Thurston Mason Behavioral Health Organization - Interlocal Agreement INTERLOCAL AGREEMENT BETWEEN MASON COUNTY - and the THURSTON MASON BEHAVIORAL HEALTH ORGANIZATION This Interlocal Agreement{AGREEMENT) is made and entered into pursuant to-the provisions of Chapter 39.34 RCW lnterlocal Cooperation Act by and between Mason County-(COUNTY)and the Thurston Mason-Behavioral Health Organization (BHO) collectively known as the parties to this AGREEMENT. Purpose: Provide.$275,000 from Sales and Use Tax for Chemical Dependency or Mental Health Services as defined in RCW 82.14.460 to be used to purchase and renovate a building in Mason County to.providebehavioral health diversion services for both inappropriate incarceration of the mentally ill from jail and inappropriate utilization of local hospital emergency department by individuals with behavioral health disorders. Term: The facility will be used for the purpose detailed in BHO's 2016 Community Behavioral Health Beds-Acute and Residential grant application submitted the Washington State Department of Commerce (DOC)for a minimum of ten (10) years. Ownership: The building purchased and renovated will belong to the BHO. Should the BHO become defunct, ownership of the building will be transferred to Mason County. Should-the BHO elect to sell the property after ten (10)years COUNTY reserves the right of first refusal. If the facility is sold BHO will reimburse COUNTY's original$275,000 investment. Administration:COUNTY and BHO have designated the fallowing representatives to serve as the Administrators for this AGREEMENT.The parties agree to provide notification to the other paity of change of designated Administrator. COUNTY: Frank Pinter Support Services Director Mason County 411. N.5th Street Shelton,`WA 98584 Phone: 380-427-9670 Ext. 530 PPinter@co.mason.wa.us BHO: Mark Freedman 412 billy Road NE Olympia,.WA 98506 Phone: 360-867-26.58 E<mail:freedman@cothurston.wa.us thurston.wa.us Notices and Written Communication: Notices and other communication may be conducted via email, U.S. mail,fax, hand-delivery or other generally accepted manner including delivery services. Indemnification: 1: Mutual Indemnity. To the extent of its comparative liability, each party agrees to indemnify, defend and hold the other party, its elected and appointed officials, employees, agents and volunteers, harmless from and against any and all claims, damages,losses and expenses, including but not limited to court costs, attorhey%fees and alternative dispute resolution costs, for any personal injury,.-for any bodily injury, sickness., disease or death and for any damage to ordestruetion of any property (including the loss of use resulting therefrom)-which are alleged_or proven to be caused by an act or omission,negligent or otherwise,of its elected and appointed officials, employees,agents or-volunteers. In the event of any concurrent act or omission of the.parties, each party-shall pay its proportionate share of any damages awarded. The parties agree to maintain a consolidated defense to claims made:against them and to reserve all indemnity claims against each other until after liability to the claimant and.damages, if any, are adjudicated. If any claim is-resolved by voluntary settlement and the parties cannot agree upon apportionment of damages and defense costs,they shall submit apportionment to binding arbitration. 2. Survival of Indemnity Obligations. The parties agree all indemnity obligations shall survive the completion,expiration or termination of this AGREEMENT. Independent Capacity: Employees or agents of each party who are engaged in the performance of this AGREEMENT shall continue-to be employees or agents of that party and shall not be considered for any purpose to be employees or agents of the other party. Assignment and Subcontracting: The performance of all-acti.vhties.contemplated by this AGREEMENT shall be accomplished by BHO. No portion of this AGREEMENT may be assigned or subcontracted to any other individual, firth or entity without the express and prior written approval of COUNTY. Non-Discrimination in Employment: COUNTY's policy is to-provide equal opportunity in all terms, conditions and privileges of employment for all qualified applicants and employees without regard to race, color, creed, religion, national origin,sex,sexual orientation, age, marital status,disability, or veteran status. shall comply with all laws prohibiting discrimination against any employee or applicant for employment on the grounds of race, color,creed, religion,national origin, sex,sexual orientation, age, marital status, disability, or veteran status, except where such constitutes a .bona fide occupational qualification. BHO shall take of itmative action to insure that applicants are employed,and treated during ern.ployment,without regard to their race,.color, creed, religion,national origin, sex; age, marital status,sexual orientation,disability,or veteran status, except where such constitutes a bona fide occupational qualification. Such action shall include, but not be limited to: advertising, hiring, promotions, layoffs orterminations; rate of pay or other forms of cornpensation benefits, selection for training including.apprenticeship, and participation in recreational and educational activities. In all solicitatibris.or advertisements for employees placed by them or on their'behalf, BHO. shall state that all qualified applicants w me ill receive consideration for employment without regard to race,color, religion,sex or national origin. Nun-Discrimination in Customer Services: BHO shall not discriminate on the grounds of race, color, creed, religion, national origin, sex, age, marital status, sexual orientation, disability, or veteran status; or*deny an individual or business any service or benefits under this AGREEMENT; or subject an individual or business to.segregation or separate treatment in any manner related to his/herClts receipt any service or services or other benefits provided under this AGREEMENT; or deny.an individual or business an opportunity to participate in any program provided by this AGREEMENT. Compliance with Applicable;Laws, Rules and Regulations: This AGREEMENT shall be subject to all laws, rules, and regulations of.'the United States of America,the State of-Washington, political subdivisions of the State of Washington and Mason County, BHO also agrees to comply with applicable Federal,State, County or municipal standards for licensing,,certification and operation of facilities and programs; and accreditation and licensing of individuals. Amendments: Either party may request changes-in the AGREEMENT.Any and all agreed amendments,to be valid.and binding upon either party, shall be in writing and signed by both of the parties. Right to Review: This AGREEMENT is subject to review by any Federal, State or COUNTY auditor. COUNTY or its designee shall have-the right to review and monitor the financial and'service components of this program by whatever means are deemed expedient by COUNTY's AGREEMENT Administrator or by CO,UNTY's Auditor's Office. Such review may occur with or without notice and may include, but is not limited to, on-site inspection.by COUNTY agents or employees, inspection of all records or other materials whlch COUNTY deems pertinent to the AGREEMENT and its performance,:and any and all communications with or evaluations by service recipients under this AGREEMENT. BHO shall preserve.and-maintain all financial records and records relating to the:-perflormarice of work,under this AGREEMENT fnr six (6) years after AGREEMENT termination, and shall make them available for such review,within Mason County, State of Washington,.upon request. BHO also agrees to notify the COUNTY's AGREEMENT Administrator in advance of any inspections, audits, or program review by.any individual, agency,ar,governmental unit whose purpose is to review the services provided within the terms of this AGREEMENT. If no advance notice is given to BHO,then BHO agrees to notify the COUNTY's AGREEMENT Administrator as soon as it is practical. Disputes: Differences between.COUNTY and BHO, arising under and by virtue of the AGREEMENT. Documents, shall be brought to the attention of COUNTY at the earliest possible time in order that such matters may be settled or other appropriate action promptly taken. Decisions of COUNTY's Adrministrator shall be final and conclusive. Venue and Choice of In the event that any Iitigation,should arise concerning the construction or interpretation of any Of the terms of this AGREEMENT,the venue of such action of litigation shall be in the courts of the State of Washington in and-for Mason County. Unless otherwise specified herein,this AGREEMENT shall be governed by the laws of Mason County and the State of Washington. Severabllity: If any term or condition of this AGREEMENT or the application thereof to.any persons)or .circumstances is held-invalid, Such invalidity shalt not affect otherterms,conditions or. applications which can be-given effect without the invalid'term,condition or application. To this end, the terms and conditions of this'AGREEMENT are declared severable. Waiver_ Waiver of any breach or condition of this AGREEMENT shall not be deemed a waiver of any prior or subsequent breach. No.term or condition-of this AGREEMENT shall be held to be waived, modified or deleted except by an instrument, in writing, signed by the parties hereto. The failure of COUNTY to insist upon strict performance of any of the covenants of this AGREEMENT, or to exercise any option herein conferred-in any one or more Instances,shall not be construed to be a waiver or relinquishment of any such, or any other covenants or contracts; but the same shall be and remain in full force and effect. Order of precedence: A.Applicable.federal; state and county statutes, regulations, policies, procedures,federal Office of Management and Budget(OMB) circulars and federal and state executive orders. B.AGREEMENT C.Attachment A-2016 Community Behavioral Health Beds-Acute and Residential grant application. Entire Agreement, This written AGREEMENT,comprised of the writings signed or otherwise identified and attached hereto, represents the entire AGREEMENT between the parties and supersedes any prior oral statements,discussions or understandings between the.parties. IN WITNESS WHEREOF,COUNTY and BHO have executed this AGREEMENT as of the date and year last written below. Ti HURSTON MASON, BO.AR.D OF COUNTY COMMISSIONERSBEHAVIORAL.HEALTH ORGANIZATION MASON COUNTY,WASHINGTON Terri Jeffreys, it Dated; . f ` is � (4. Dated: f 15 APPROVED A5 TO FORM: Tirn Whitehead,Chief DPA RESOLUTION NO.. B11016-14 A RESOLUTION OF THE THURSTON-MASON BEHAVIORAL HEALTH ORGANIZATION GOVERNING BOARD ESTABLISHING AN AGREEMENT WITH MASON COUNTY FOR FACILITY PURCHASE WHEREAS,chapter 39.34 RCW permits local governmental entities to make the most efficient use of their powers by enabling them to cooperate with other localities on the basis of mutual advantage; and WHEREAS,Mason County shall provide$275,000 from Sales and Use Tax for Chemical Dependency or Mental Health services as defined in RCW 82.14.460 to be used to purchase and renovate a building in Mason County to provide behavioral health diversion services for mentally ill individuals. WHEREAS,the facility will be used for the purpose detailed in TMBHO's 2016 Community Behavioral Health Beds-Acute and Residential grant application submitted to the Washington State Department of Commerce(DOC)for a minimum of ten(10)years. WHEREAS,the building purchased and renovated will belong to TMBHO. Should TMBHO elect to sell the property after ten(10)years,Mason County reserves the right of first refusal.If the facility is sold,TMBHO will reimburse Mason County the original$275,000 investment. NOW,THEREFORE,in consideration of the promises recited herein and the mutual benefits to be derived and to coordinate their efforts is mutually agreed by the Parties as follows: ADOPTED by the Board of the Thurston-Mason Behavioral Health Organization,at a regular meeting thereof held on the d_(;rK day o r 20 1 Thurston-Mason Behavioral Health ATTEST: Governing Board Tina Gehrig,Cle and H Blake,Chair Approved As To Form: Terri Jeffreys, Jon Tunheim,Prosecuting Attorney _ _absent _ Cathy Wolfe,Commissioner �- Attachment Department of Commerce 2016 Community Behavioral Health Beds - Acute & Residential Grant Application Submission deadline: Thursday, July 28, 2016 at 5:00 p.m. (must be emailed or postmarked) For questions regarding the application and selection process and submission of the application: Bill Cole Department of Commerce P.O. Box 42525 Olympia,WA 98504-2525 (360)725-3005 Bill.cole@commerce.wa.gov For questions regarding Residential Treatment Facility, Hospital licensing, or Construction Review: Julie Tomaro Department of Health (360) 236-2937 NOTE: If you are one of the projects listed in Section 1007(3), (4), or(7) of the 2016 Supplemental Capital Budget, please fill out this application to provide us with the information we will need to write a contract for your project. You do not have to submit this form by July 28, but the sooner you provide us with this information, the sooner we can execute a contract and start reimbursing you for eligible project costs. Application Due Date: Thursday, July 28, 2016 at 5:00 p.m. Please read Section 1007 of the 2016 Supplemental Capital Budget(included at the end of the application) as well as EHB 2212 prior to filling out your information and answering the questions. EHB 2212 can be found at http:/Ilawfilesext le.g wa gov/biennium/2015- 16/Pdf/Bills/Session%20Laws/House/2212.SL.pdf This application is for grants to hospitals or other entities to establish new community hospital inpatient psychiatric beds, free-standing evaluation and treatment facilities, triage facilities, or crisis stabilization facilities with sixteen or fewer beds for the purpose of providing short term detention services through the publicly funded mental health system. Enhanced Services Facilities (ESFs) do not qualify for this grant. Note: The limit of sixteen or fewer beds only applies to crisis stabilization facilities and not to other types of facilities. "Short Term" is defined as 72 hours to 14 days. Grant Limit: Each competitive award is limited to $2.0 million. If you are applying for more than one project you must indicate the priority of the projects. Based on demand, Commerce reserves the right to offer reduced award amounts in order to fully obligate the grant funding. Commerce will notify applicants prior to announcing awards to inform them of a reduced offer. Commerce also reserves the right to prioritize grants to applicants that have not previously received funding through this program. Applicant: Thurston Mason Behavioral Health Organization Contact Name: Mark Freedman Phone: 360-867-2558 Email: freedmm@co.thurston.wa.us Address: 412 Lilly Rd NE City: Olympia WA Zip: 98506 County: Mason State Legislative District of the Project: 22 Congressional District of the Project: 10 Will your project be licensed as a psychiatric hospital (WAC 246-322) or acute care hospital (WAC 246-320)? ❑Yes 9 No Is your facility a critical access hospital? ❑ Yes ❑x No Do you currently have a Certificate of Need for new beds identified in this application (WAC 246- 310)? ❑ Yes FX1 No Would you be exempt from Certificate of Need requirements under EHB 2212 if you receive a grant? 0 Yes 0 No For Certificate of Need questions contact the Certificate of Need Program at the Washington State Department of Health at (360) 236-2955. Funds awarded through this grant process may be contingent on receiving a Certificate of Need, if required for your facility. If a Certificate of Need is required for your facility, please start the application process with the Department of Health as soon as possible. Will your project be licensed as a Residential Treatment Facility (WAC 246-337)? 0 Yes ❑ No 1. List the Managed Care Entity or Entities (MCEs) and contact information of the person(s) you collaborated with to develop this application below. An MCE could include a: Behavioral Health Organization (BHO), Behavioral Health Administrative Services Organization (BH-ASO) or a Managed Care Organization (MCO). MCE(s): Thurston Mason Behavioral Health Organization Click here to enter text. MCE Contact Name: Marls Freedman Click here to enter text. MCE Contact Phone: 360-867-2558 Click here to enter text. MCE Contact Email: freedmm@co.thurston.wa.us Click hereto enter text. MCE(s): Click here to enter text. Click here to enter text. MCE Contact Name: Click here to enter text. Click here to enter text. MCE Contact Phone: Click here to enter text. Click here to enter text. MCE Contact Email: Click here to enter text. Click here to enter text. 2. If the project is not at the location above, where is your project located? Address: 307 W. Cota St City: Shelton WA Zip: 98584 3. Please describe your project, including: a. Whether this project is a stand-alone facility or part of a larger facility; b. Total square footage of the project; c. Number of new community hospital inpatient psychiatric beds; d. Free-standing evaluation and treatment facilities; e. Triage facilities; f. Crisis stabilization facilities; g. Specific use of state grant funds; and h. Total number of beds. Thurston Mason Behavioral Health Organization (TMBHO) is requesting capital funding to purchase and renovate an existing building in Mason County to provide Evaluation and Treatment/Triage services (E&T). The overall plan, to occur in two stages, is to create two treatment units for involuntary behavioral health services for the region served by Thurston Mason BHO with improved geographical access for Mason County individuals. One unit is for involuntary Evaluation and Treatment (E&T) services, and the other for Secure Withdrawal Management (formerly referred to as Detoxification or Detox) services. For the initial phase, TMBHO is requesting funding to purchase and renovate the first floor of a building already identified in Mason County to construct 10 E&T beds. Because the grant funding currently available is insufficient to renovate the complete building for both units, phase will be done at a later date, and will include the complete renovation of the second floor to construct ten secure withdrawal management beds. These two units must operate separately from each other per licensing requirements. Having a two floor building would help facilitate this separation as well as the staging for construction. Requested funding is for the purchase and renovation of the building. Operational services will be funded by TMBHO. This past year, community meetings were held in Mason County to discuss local needs/gaps analysis for diversion services from the criminal justice system and emergency departments for those with a behavioral health disorder. Participants included: County Commissioners, Prosecuting Attorney, Defense Council, Sheriff, service providers, Mason County General Hospital staff and the BHO. While stakeholders identified that E&T beds be built first, they would just as well prioritize secure withdrawal management beds. If the grant funders felt that the overall statewide mix of new facility beds were better served by prioritizing secure withdrawal management beds first for construction, the TMBHO Governing Board and stakeholders would willingly accept that change to the order that this facility be built. As already noted, the proposed project is to renovate an available building located in Mason County to provide behavioral health diversion services for both inappropriate incarceration of the mentally ill from jail and inappropriate utilization of local hospital emergency department by those individuals with a behavioral health disorder. Currently, to access services, citizens in Mason County must travel to Thurston or other counties for acute or diversion services. While Mason County is part of the Thurston Mason Behavioral Health Organization, geographical access to appropriate acute care is lacking. On September 1, 2016, TMBHO will begin operation of a new Triage Facility located in Thurston County. This is a ten bed E&T facility designed for diversion of those with a behavioral health disorder who committed a crime due to their mental illness from incarceration. While these ten beds will have an impact, they are insufficient to meet the needs of the region are geographical distant from Mason County, and as a result,more beds are needed for the region. For effective jail and emergency department diversion, the following conditions are essential 1) immediate access to behavioral health services otherwise called "treatment on demand" is critical The wait time to transport a client to another county by police or emergency transport does not promote effective or humane treatment. 2), the time it takes for law enforcement to transport an individual out of county significantly affects their ability to cover patrol requirements and is not an efficient use of their time. Transportation time for law enforcement must be reduced. 3), there's a great need for law enforcement to have alternatives to jail for individuals 24 hours a day, 7 days a week to ensure community safety. We need to add to law enforcements "tool kit" for an alternative place to jail for those individuals who commit crimes due to their behavioral health disorder. As police have said frequently, Crisis Intervention Training for police is not particularly effective if there is no place to actually bring an acutely ill individual who cannot be left to their own recognizances. This facility will provide 24 hour 7 days a week services through licensed residential beds credentialed for voluntary and involuntary E&T care. Several issues are driving the need for these services and additional beds. 1): At this time there exists only limited access to E&T beds for residents in Mason County through transportation to Thurston County. Since behavioral health integration, access to E&T beds in other BHO's has become extremely restrictive. Additionally, there are no withdrawal management beds in the region. The closest withdrawal management beds that TMBHO has access to are located in Port Angeles. There are no "secure withdrawal management" beds statewide at this time. 2) In order to impact the census at Western State Hospital and reduce the use of emergency rooms for single bed certification TMBHO region needs additional beds just to cover the individuals in need: 3) To impact the use of the Mason County jail for both psychiatric and withdrawal management services, additional beds with the necessary licensing and service levels to facilitate diversion are required. For jail diversion to be effective, police must have easy and close proximity to the appropriate facility. Driving to Thurston County when there are only two sheriff deputies on shift at night is not feasible. TMBHO and the Mason County community are requesting accessible services for their County to provide appropriate care at the right level at the right time. As evidence, Mason County has been conducting an ongoing "Jail Diversion Work Group" to address the issues of over utilization of the jail for inappropriate incarceration of individuals displaying acute behavioral health issues, and inappropriate use of the emergency departments by police and community when no other acute services are available. This issue is now well documented as a national issue, citing more than 40% of those in jails have behavioral health issues. .This community work group was orchestrated by the County Commissioners and includes: Sheriff's Department, Prosecuting Attorney's Office, Defense Counsel, Mason General Hospital, City of Shelton Police, and other service agencies. The outcome was to prioritize the need for an involuntary jail diversion program, withdrawal management services, and mobile crisis outreach teams. TMBHO has already proceeded with the development of a dedicated mobile crisis outreach team tied with intensive case management for Mason County. It's anticipated that services begin September 1, 2016. To assist with these needed services, TMBHO is proposing the renovation of an existing building to create two separate units: 1) first we will create a ten bed evaluation and treatment facility functioning to triage and divert those with an acute behavioral health disorder from jail, hospital emergency room and Western State Hospital diversion.2) as funding becomes available a second unit to function as a secure withdrawal management unit. This unit will provide an additional ten beds for withdrawal management services in a "secure" setting. This secure setting will be similar to an E&T pending completion of the State WACs to fully define these requirements. While the E&T will focus on residents from Mason County depending on availability, they could receive referrals from Thurston or other contiguous counties. The secure withdrawal management unit will be designed as a regional program being the only local resource. The need for additional E&T beds and withdrawal managementbeds are based on historical utilization information including census overflow at WSH, inability to access beds at WSH, number of inmates in Mason County Jail due to their behavioral disorder, prior utilization of detox beds when Providence St. Peter Hospital was operating a unit, and estimated need based on police encounters on the "street" in Mason County. In 2015 TMBHO was on average over census at WSH by three beds. To date, TMBHO has six individuals who are unable to go to WSH due to hospital overall census. This creates a back log and further impacts our community by averaging at least two single bed certification in emergency room settings, unable to place them into any E&T beds. The Sheriff and City of Shelton police chief estimate 40% of individuals incarcerated at the Mason County Jail have a chronic behavioral health problem. Not all of these individuals were incarcerated due to their behavioral health issue but the estimate is that approximately 40 individuals could be diverted each month. This number does not include the individuals waiting in the jail for a forensic evaluation due to incompetence to stand trial. This average is between 10 and 12 inmates. Based on prior history TMBHO's has a treatment demand for detox services is for over 600 individuals per year with an average length of stay of15 days. The facility we are proposing to purchase is the previous PUD facility in Shelton. It has 13,000 square feet on two different floors. Our plan is to utilize the 6,500 square feet on the first floor for E&T beds and supporting services. The second floor, also 6,500 square feet is planned for detox services. There is an elevator to ensure ADA access for both floors. The estimated cost for purchase is approximately $350,000. Construction renovation is projected at approximately $250 per square foot and additional "soft costs" (please see attached budget for description) at a total with purchase of$2,598,025. TMBHO is requesting $2,000,000 from this grant and will fund the rest of the cost with local funds. The facility shall be a stand-alone facility with regards to any other licensed facility. The new facility will be certified as an E&T facility for ten beds in one unit and later will include a ten bed secure withdrawal management in the second unit, by the Department of Social and Health Services, Division of Behavioral Health and Recovery under RCW 71.05 and WAC 388-865. Policies and procedures will be developed to meet all requirements for Department of Health Licensing as an Adult Residential Rehabilitative Center under WAC 246-337. A DSHS licensed service provider for the E&T will be selected through a procurement process to operate the service programs 4. List any existing licensed facilities that will be part of this project. Include license number and expiration date. The new facility will be certified as an evaluation and treatment facility in one unit and secure withdrawal management in the second unit by the Department of Social and Health Services, Division of Behavioral Health and Recovery under RCW 71.05 and WAC 388-865. The facility shall be a stand alone facility with regards to any other licensed facility. Policies and Procedures will be developed to meet all requirements for Department of Health Licensing as an Adult Residential Rehabilitative Center under WAC 246-337. A licensed service provider for the E&T will be selected to operate the service programs. The facility will be part of the larger TMBHO network of services and providers for the acute behavioral health services for Thurston and Mason Counties. 5. What assessment have you completed that the project would meet gaps in geographical access to short term detention services under Chapter 71.05 RCW in your region? TMBHO has conducted both a community needs and a geographical access assessment to identify gaps in geographical access to short term detention services under Chapter 71.05 in our region. The purpose of the Triage/E&T facility is to serve all clients who either come through the Mason County criminal justice system, emergency care services and/or the Thurston Mason Behavioral Health Organization involuntary commitment and crisis care system who are detainable under RCW 71.05. Additionally, this program would be available as space allows, for detained individuals under RCW 71.05 from the Cascade Pacific Action Alliance, Accountable Communities of Health region. This region is made up of the seven (7) counties: Thurston, Mason, Grays Harbor, Lewis, and Pacific, Cowlitz and Wahkiakum. The purpose of this E&T is to serve as a mental health diversion program from higher levels of restricted care such as Western State Hospital, the emergency room at local hospitals and from incarceration. We are requesting to renovate a facility by which police, other emergency responders, and the community can bring an individual who is 1) in a psychiatric crisis; 2) at a level of acuity where immediate intervention is necessary to stabilize; and/or, 3) having committed or at risk to commit a crime or endanger themselves or others due to a mental health disorder. The intent of this facility is to provide a 24 hour 7 days a week response program where a client can be "held" on an Involuntary Treatment Act commitment for up to seventy-two (72) hours, where both security, safety, and psychiatric needs are provided at the proposed facility. Additionally, a client may be further detained by the Superior Court if a fourteen day detention is required. The target population we are looking to impact are individuals who are engaged by the police or other first responders for an illegal activity or displaying at risk behavior, where either a crime has been committed, is at-risk of being committed, or the individual cannot be left alone without supervision due to their possible behavioral health disorder. This target population will be those individuals who have or are eligible for Medicaid or other public funded health care. Despite Medicaid expansion, E&Ts around the State are serving over 25% individuals who do not have Medicaid and require other public funding sources for services. Overall, these are individuals who have possibly committed a crime due to their behavioral health disorder where jail is not necessary for community safety. Often these individuals are co-disordered, where both psychiatric and substance abuse is at the cause of their behavior. The result is that the Mason County Jail now identifies that forty percent (40%) of their jail population have a major mental health disorder and up to eighty percent (80%) of those are drug involved. Many of these individuals are inmates whom the jail requests forensic evaluations under State Legislation 10.77. Once requested, these evaluations can take several weeks to occur at which time the mentally ill inmate is not being discharged from the jail nor obtaining necessary treatment to help them resulting in extended lengths of stay, far longer than the average inmate. If these individuals who are determined incompetent to stand trial are diverted and provided services in such a facility-as ours, then we will be able to reduce the overall mentally ill population incarcerated to jail. In short, the focus populations for Triage/E&T services are: 1) Acute mentally ill adults who are detainable under RCW 71.05 and reside in Mason Counties (Thurston County and other contiguous Counties are included but priorty is for Mason). 2) This service is for individuals that the police, other emergency first responders and hospital emergency rooms are being asked to serve who are displaying acute behavioral symptoms where immediate intervention is necessary to stabilize and/or c) have committed a crime or endanger themselves or others due to behavioral health disorder; and 4) When an individual is evaluated by a DMHPs to meet involuntarily detention under RCW 71.05 and no other ITA bed is available in order to avoid use of single bed certifications at local hospitals. Geographical Assessment: On a regular basis, TMBHO conducts a geographical study for access to services in our region, for outpatient, inpatient and commitment services. Under contract we try to limit any travel for acute care to 30 minutes. In the case of Thurston and Mason County, we have determined that we could improve care by siting acute services in Mason County. 6. What is your commitment to serve persons who are publicly funded and persons detained under the involuntary treatment act at Chapter 71.05 RCW? As a Behavioral Health Organization, TMBHO mission includes the commitment to serve persons who are publicly funded and persons detained under the Involuntary Treatment Act, Chapter 71.05 RCW. The E&T facility identified for this grant, whole focus is to serve: adults with an acute mental illness, who reside in Thurston and Mason Counties (other contiguous Counties will be served as well), who meet commitment criteria under Chapter 71.05 RCW. Those involved in the Mason County judicial or medical emergency response system will be a priority. Other individuals regionally will be served dependent on available space. This facility will provide services for an involuntary 72 hour commitment as well as those determined by a Superior Court Crisis Commitment Court to be detainable for up to 14 days. The facility will staff 10 licensed beds for these services including: psychiatric care, Designated Mental Health Professionals and the rest of the required staff to meet both Department of Health and Department of Behavioral Health and Recovery requirements. 7. How long will your project maintain the beds or facility and how will you pay for the on-going operation of the project? The on-going cost for the treatment service operation of this facility will be funded though the TMBHO Medicaid and Non-Medicaid budget. TMBHO has an annual operating budget of over$57,000,000. Operating services for the E&T are a Medicaid allowable service and therefore covered by the BHO. This facility will be an asset of the TMBHO and as such, will be maintained to operate as described here for at least ten years or longer based on the continued funding of the TMBHO. 8. What is your commitment to work with local courts and prosecutors to ensure that prosecutors and courts in the area served by the hospital or facility will be available to conduct involuntary commitment hearings and proceedings under Chapter 71.05 RCW? Local Superior Court and the Mason County Prosecutor, Defense Counsel and the Mason County Clerk have already been involved in identifying the need for these services and recognize the impact it will have and acknowledge the requirement for them to conduct involuntary commitment hearings and procedures under Chapter 71.05 RCW. In Thurston and Mason County, TMBHO does fund all elements of these procedures: Superior Court, Prosecutor, Defense Counsel and Clerk, as well as the treatment support of this function. At present, TMBHO funds involuntary commitment court services in two locations in Thurston County-with a third site beginning soon at the new involuntary Triage; when this Mason County facility opens, Crisis Commitment Court will be held at the facility under the venue of Mason County. TMBHO will continue to fund these legal services 9. Please list any local resources, including non-Medicaid operating reserves, and regional fund balances that are not contractually encumbered. Please attach Statements of Commitments for any local funding or partnership sources. Currently, all TMBHO non-Medicaid reserves are encumbered. This includes funding that TMBHO has already encumbered for Long Term Replacement costs and Operations and Maintenance of each Evaluation and Treatment facility. TMBHO will commit from existing non-Medicaid maintenance and operating reserves $500,000 to make up the difference for the request of this grant and the presumptive cost of this project. These funds are available as part of TMBHO's Long Term Operations and Maintenance reserves for current operating TMBHO facilities 10. What is the projected timeline for your project? Project Components Start Date End Date % Completed Design 9/15/16 11/23/16 Click here. Structural Modification or Construction 5/25/17 12/20/17 Click here. Occupancy 2/6/18 11. How much money are you requesting from this grant program? $$2,000,000 12. What is the total project cost? $$2,598,025 Cost Category Budgeted Funds Site Acquisition $350,000 Architecture and Engineering $172,274 Structural Modification or Construction $1,837,140 Capitalized Equipment $0 Construction Management (from external sources only) $75,000 Contingency $Click here to enter text. Total Project Cost $2,598,025 NOTE: Commerce does not pay for in-house labor. What documentation do you have to support the total project cost and timeline? Please include a copy of the relevant budget and timeline information used to develop the information above. Please see attached budget for additional costs such as LEED Certification, not included above and timeline detail. Sec. 1007. 2015 3rd sp.s. c 3 s 1036 (uncodified) is amended to read as follows: FOR THE DEPARTMENT OF COMMERCE Community Behavioral Health Beds-Acute & Residential (92000344) The appropriation in this section is subject to the following conditions and limitations: (1) The appropriation in this section is provided solely for the department of commerce, in collaboration with the department of social and health services,to issue grants to hospitals or other entities to establish new community hospital inpatient psychiatric beds,free-standing evaluation and treatment facilities, enhanced services facilities,triage facilities, or crisis stabilization facilities with sixteen or fewer beds for the purpose of providing short-term detention services through the publicly funded mental health system. Funds may be used for construction and equipment costs associated with establishment of the community hospital inpatient psychiatric beds, free-standing evaluation and treatment facilities, enhanced services facilities,triage facilities, or crisis stabilization facilities.These funds may not be used for operating costs associated with the treatment of patients using these services. The department shall establish criteria for the issuance of grants and priority must be given to those proposals to establish new community hospital inpatient psychiatric beds or free-standing evaluation and treatment facilities.The criteria must include: (a) Evidence that the application was developed in collaboration with one or more regional support networks, as defined in RCW71.24.025; (b) Evidence that the applicant has assessed and would meet gaps in geographical access to short-term detention services under chapter 71.05 RCW in their region; (c) A commitment by applicants to serve persons who are publicly funded and persons detained under the involuntary treatment act under chapter 71.05 RCW; (d) A commitment by the applicant to maintain the beds or facility for at least a ten-year period; (e)The date upon which structural modifications or construction would begin and the anticipated date of completion of the project; (f) A detailed estimate of the costs associated with opening the beds; (g) The applicant's commitment to work with local courts and prosecutors to ensure that prosecutors and courts in the area served by the hospital or facility will be available to conduct involuntary commitment hearings and proceedings under chapter 71.05 RCW; and (h) A lack of local resources, including nonmedicaid operating reserves, and regional fund balances that are not contractually encumbered. (2) To accommodate the emergent need for inpatient psychiatric services,the department of health and the department of commerce, in collaboration with the department of social and health services shall establish a concurrent and expedited process for the purpose of grant applicants meeting any applicable regulatory requirements necessary to operate inpatient psychiatric beds, free-standing evaluation and treatment facilities, enhanced services facilities, triage facilities, or crisis stabilization facilities. (3) The following list is subject to the criteria in subsection (1) of this section: Cascade mental health $3,000,000 ((WeedrneRt)) I(ent recovery center $5,000,000 Parkside conversion to behavioral health beds (( 4-1 0)) 4 000 000 (( )) Central Washington comprehensive mental health $2,000,000 Swedish Ballard psychiatric unit $3,000,000 Substance abuse & mental health facilities $2,000,000 Fairfax behavioral health - Providence health &services facility $1,000 Daybreak Youth Services $1,500,000 (4) Multicare-Franciscan joint venture $5,000,000 (5) State Mental Hospital Diversion Protects $7,552,000 (a)The appropriation in this subsection is provided solely for the department of commerce, in collaboration with the department of social and health services and the health care authority,to issue grants to entities for the development of facilities that provide for the diversion or transition of patients from the state hospitals. (b) Funds may be used for construction and equipment costs directly associated with the - establishment of community hospital inpatient psychiatric beds, free-standing evaluation and treatment facilities, enhanced services facilities, crisis triage centers, and crisis stabilization facilities; secure detoxification facilities and co-occurring treatment facilities; or other transitional facilities that provide for the diversion or transition of state hospital patients.These funds may not be used for operating costs associated with the treatment of patients using these services. (c) The department, in collaboration with the department of social and health services and the health care authority, shall establish criteria for the issuance of grants including but not limited to: (i)A clear demonstration of need; (ii) a commitment to serving persons who are publicly funded; (iii) a commitment to maintain the beds or facility for at least a ten-year period; and (iv) specific performance and outcome measures to ensure greatest benefit to the region. The department may only fund proposals that provide evidence that the application was developed in collaboration with one or more behavioral health organizations as defined in RCW71 24 025 or the health care authority in the case of an application submitted from a region that has become an early adopter of integrated medical and behavioral health services pursuant to RCW71 24 380(5) In awarding these funds,the department must prioritize an equitable distribution for facilities in both rural and urban areas with the greatest demonstrated need. (6) Competitive grants $10,499,000 (7) Clallam county respite center 8847,000 Appropriation: State Building Construction Account—State $44,399,000 Prior Biennia (Expenditures) $0 Future Biennia (Projected Costs) $0 TOTAL (($82,000,000)) $44,399,000