HomeMy WebLinkAboutAgreement SH20-025The Kittitas County Sheriff's Office
Health Services Agreement For
The Year 2021
This Agreement is between Kittitas County through Kittitas County Sheriff's Office {hereinafter "sheriff's
Office") and Comprehensive Mental Health {hereinafter the "Provider"} and shall be in effect from the
date signed by both parties until December 31, 202L. The Sheriff or the Provider may terminate this
contract provided that at least thirty {30) days written notice is given in advance of termination.
Exceptions may be made if the Sheriff deems removal is necessary. This contract shall be to provide
Mental Health care within the Kittitas County Jail as outlined below:
Definitions:
A. Practitioner: presumptively a Psychiatric Advanced Registered Nurse Practitioner {P-ARNP) - a
person who holds a current, valid license to practice as such in Washington State as defined in
RCW 71.05.020 and who has prescr'iptive authority. The Provider may substitute another
licensed medical professional whose license status includes prescriptive authority sufficient to
implement and maintain existing prescriptions appropriate to the mental health condition of
inmate patients.
Contract Provisions:
t. The Provider will supply a qualified Practitioner who will provide Mental Health related medical
assessment and treatment to inmates of the Kittitas County Jail according to established
professional protocols and within their licensed capabilities, based on the assessment and
recommendations made by the Mental Health Professional and/or other professionals who have
evaluated the inmate. The Practitioner shall work up to three (3) hours every week, starting the
first week after the effective date of this contract. Provider and the Jail agree that variations
within and deviations from the currently intended schedule that do not change the number of
hours of service provided may be informally agreed upon due to the nature of Jail operations,
weather conditions, and other circumstances beyond the control of the parties. Provider may
delegate appropriate authority to the Practitioner to address such necessary deviations. The on-
duty supervisor shall be the designated point of contact for such communications.
2. Qualified Substitute: Provider may, with advance notice to the Sheriff's Office, if the designated
Practitioner is not available for any reason, provide a substitute for the Practitioner of equal or
greater qualifications. The period of notice shall be as much as reasonably possible, consistent
with the circumstances that require the substitution. lt is the intent of the parties that a specific
substitute be designated and utilized to the greatest extent possible so that continuitv of care is
maintained, and the background investigation referred to in Provision Eleven t11) may be
conducted in a timely manner.
3. After passage of the scheduled time previously agreed upon pursuant to Provision L (one), any
additional time required for patient care shall be charged at an hourly rate desoibed below or
portion thereof in fifteen (15) minute increments as actually provided,
Page 1
4. Each inmate shall have access to MHP services by providing an electronic Request for MHP
Prescription Services. lndigent inmates shall not be denied access to medical care.
5. Payment for prescription medications shall be the responsibility of the inmate receiving the
medication. Medications to sustain life or to prevent life threatening medical problems shall be
permitted. All medications shall be at the expense of the inmate. Those medications for
conditions other than life threatening shall also be at the inmate's expense. The final decision
as to the necessity of any medication pursuant to this provision shall be made by the
Practitioner or the approved substitute.
6. The Practitioner shall be responsible for logging all patients seen and completing the Kittitas
County Jail Medical Services Log as well as individual patient charting, The Practitioner shall
provide medical referral and obtain medical consultation as necessary.
7. The Provider shall provide telephone consultation to Jail Staff regarding emergency inmate
medical needs outside of regular sick call hours, but such telephone consultation shall be limited
to the hours of 8:00am to 9:00pm daily. Such telephone calis may be billed with a five {5)
minute minimum of $2.50 per telephone call as actually provided. There will not be an actual
call schedule, but as available. All other calls shall be referred to the local emergency room for
assistance.
8. The compensation to Provider for these seryices is as follows: $125.00 per hour
ln the event the Practitioner is subpoenaed to court regarding care given at the Kittitas County
Corrections Center the hourly rate shall be paid for actual time spent preparing for court and
testifying. The Practitioner shall be responsible for keeping an accurate and detailed timecard
accounting for all billable time.
The Provider and Sheriff's Office agree that in the event that no inmates have requested to be
seen by the Practitioner, the "sick call" for that day as scheduled pursuant to Provision One (11
of this Agreement may be cancelled by telephone with two {2} hours' notice and that there will
be no charge for that cancelled sick call. For the purposes of this Provision, the Sheriff's Office
official responsible for the determination and cancellation shall be the assigned Corrections
Center Duty Supervisor for the shift during which the sick call is scheduled.
9. Kittitas County shall indemnify and hold harmless the Provider, its agents or employees from and
against all loss or expense, including but not limited to judgments, settlements, reasonable
attorney's fees and costs by reason of any and all claims and demands upon the medical provider
for damages because of personal or bodily injury, including death at any time resulting therefrom,
sustained by any person or persons and on account of damage to property including loss of use
thereof, due to the negligence of Kittitas County, the Kittitas County Sheriffs Office, its elected
officers, employees, volunteers, or other agents except such injury or damage as shall have been
occasioned by the sole negligence or willful misconduct of the Provider, its agents or employees.
Kittitas County has insurance to cover the Provider during such times as the P-ARNP or qualified
substitute is treating inmates of the Kittitas County Jail pursuant ts this agreement. Such
insurance shall not cover patients who were not Kittitas County Jail inmates and that were
PageZ
treated by the Provider outside of the facility
Provider shall defend, indemnify and hold harmless Klttitas County, the Sheriff's Office, its
appointed and elective officers, agents and employees, from and against all loss or expense,
including but not limited to judgments, settlements, reasonable attorney's fees and costs by reason
of any and all claims and demands upon the County, the Sheriffs Office, its elected or appointed
officials, agents or employees for damages because of personal or bodily injury including death at
any time resulting therefrom, sustained by any person or persons and on account of damage to
property including loss of use thereof, whether such injury to persons or damage to property is due
to the negligence of the Provider, its subcontractors, its elected officers, employees or their agents,
except only such injury or damage as shall have been occasioned by the sole negligence of Kittitas
County, the Sheriffs Office, appointed or elected officials, agents or employees. lt is further
provided that no liability shall attach to Kittitas County by reason of entering into this contract,
except as expressly provided herein.
10. The Sheriff's Office, through the Kittitas County Jail, shall maintain basic medical supplies and
items, which shall be used in the treatment of inmates of the facility. Such supplies shall include
prescription forms, over the counter medications, first aid supplies, topical agents and such
other supplies as deemed appropriate by the Provider. The Provider may delegate its role in this
process to the P-ARNP.
11. The Practitioner shall be subject to a Background lnvestigation as determined by the Sheriff; this
may include a polygraph test (see RCW 49.44,120). This will be conducted by whomever the
Sheriff's Office deems qualified to complete. This can be done prior and anytime after the
contract is signed by the Provider. The P-ARNP or qualified substitute may be subject to such
background investigation or any part thereof more than once.
12, ln the event that any litigation 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 Superior Csurt of
the State of Washington in and for the County of Kittitas, This Agreement shall be governed by the
law of the State of Washington.
13. All services pursuant to this Agreement shall be furnished by the Provider as an independent
contractor and nothing herein contained shall be construed to create a relationship of employer-
employee or master-servant, but all payments made hereunder and all services performed shall be
made and performed pursuant to this Agreement by the Provider as an independent contractor.
The Provider acknowledges that the entire compensation for this Agreement is specified in Sections
7 and 8, and that neither the Provider nor Practitioner is entitled to any Kittitas County benefits
including, but not limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other
insurance benefits, or anv other rights or privileges afforded to Kittitas County employees.
Provider will defend, indemnify and hold harmless Kittitas County, the Kittitas County Sheriff's
Office, their officers, agents or employees from any loss or expense, including but not limited to
settlements, judgments, setoffs, attorneys' fees or costs incurred by reason of claims or demands
because of breach ofthe provisions ofthis paragraph.
14. Either party may request changes in the Agreement. Any and all agreed modifications shall be in
Page 3
writing, signed by each of the authorized agents of the parties
15. Except as set forth elsewhere in the Agreement, for all purposes under this Agreement, except
service of process, notice shall be given by the Provider to the Jail Superintendent , Kittitas County
iail , 205 W. 5'h Ave. Suite #J., and to the Kittitas County Commissioners, 205 W 5th Ave, Suite 108,
Ellensburg, WA 98926. Notice to the Provider for all purposes under this Agreement shall be given
to the address or telephone number as the case may be reflected on the signature page. Notice
may be given by delivery or by depositing in the U.S. Mail, first class, postage prepaid.
16. lf any term or condition of this Agreement or the application thereof to any person{s) or
circumstances is held invalid, such invalidity shall not affect other terms, 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.
17. Waiver of any breach or condition of this Agreement shall not be deemed a waiver of any prior or
subsequent breach. No terms or conditions of this Agreement shall be held to be waived, modified
or deleted except by an instrument, in writing, signed by the parties hereto.
18, This written contract, including Exhibit "A", the federally mandated Business Associate Agreemen!
attached hereto and incorporated by reference into this contract, represents the errtire Agreement
between the parties and supersedes any prior oral statements, discussions or understandings
between the parties. As to Exhibit "A", "Providef is the "Business Associate".
19. This Agreement is subject to public disclosure laws. This contract is subjectto review by any
Federal or State auditor, The 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 the
County. Such review may occur with or withoui notice, and may include, but is not limited to, on-
site inspection by County agents or employees, inspection of all records or other materials which
the County deems pertinent to the Agreement and its performance, and any and all
communications with or evaluaticn by service recipients under this Agreement. The Contractor
shall preserve and maintain all financial records and records relating to the performance of work
under this Agreement for 6 years after contract termination, and shall make them availabla for such
review, within Kittitas County, State of Washington, upon request.
Page 4
lN WITNESS WHEREOF, the parties have executed this Agreement this I4Yauv ot
2020.
APPROVED:
BOARD OF COUNW
NSIVE MENTAL HEALTH KITTITAS
, cEo Date Chairm an
Commissioner
COUNTY OF KITTITAS
SHERIFF'S OFFICF
t-
ay Sheriff Date
the
as to Form:
,/iilltll\
N
lll I I l,l,////
Contractor Address
4a2 s. 4th Ave.
Yakima, WA98902
By J-:l'Lqif-
Douglas R. ry{itchell,
Deputy P rosecutin g Attorney
County Contact:
Steve Panattoni
{5oe) 962-7s27
Kittitas County Jail
205 W.5th Ave, Suite L
Ellensburg, WA 98926
Page 5
BUSIN ESs ASSOCIATE/ qUALIFIED SERVICE
ORGAN IZATION AG REEM ENT
This Business Associate/Qualified Service Organization
Agreement ("BA/QSO Agreement") is
between
Comprehensive Healthcare
(Covered Entity)
and
(Kittitas County JailI
(Business Associote)
Exhibit "A"
Page 1 of 8
B.B.A Attachment
Recitals
Covered Entity will make available and/or provide certain Protected Health lnformation and Records (as
defined below) to Business Associate in the course of the parties' relationship.
Business Associate will make available and/or provide certain Protected Health lnformation and Records (as
defined below)to Covered Entity in the course of the parties' relationship.
ln order to protect the privacy of the Protected Health lnformation and to comply with HIPAA and the HIPAA
Regulations (as defined below) as well as the Confidentiality of Substance Use Disorder Patient
Records, 42 C.F.R. Part2; Covered Entity and Business Associate desire to enter into this BA/qSO
Agreement setting forth the terms and conditions of use and disclosure of Protected Health
lnformation.
ln consideration of the mutual promises set forth below, the parties agree as follows:
Article 1: Definitions
1.1 Business Associate. "Business Associate" shall mean (insert name of Business Associate)
L,2 Confidentiality Rule. "Confidentiality Rule" shall mean the Confidential of Substance Use Disorder
Patient Records in 42 CFR Part 2.
1.3 Covered Entitv. "Covered Entity" shall mean Comprehensive Healthcare
I.4 lndividual. "lndividual" shall have the same meaning as the term "individual" in 45 CFR 5 164.501 and
shall include a person who qualifies as a personalrepresentative in accordance with 45 CFR 5
16a,s02(s).
1.5 HIPAA. "HIPAA" means the Health lnsurance Portability & Accountability Act of 1996, P.L. 104-91.
1.6 HIPAA Regulations. "HIPAA Regulations" mean the regulations promulgated under HIPAA by the U.S.
Department of Health and Human Services, including the Privacy Rule.
1.7 Privacv Rule. "Privacy Rule" shall mean the Standards for Privacy of lndividually ldentifiable Health
lnformation in 45 CFR Part 160 and Part 164, Subparts A and E.
Page 2 of 8
B.B.A Attachment
1,8 Protected Health lnformation. "Protected Health lnformation" shall have the same meani ng as the
term "protected health information" in 45 CFR S 164.501, limited to the information created or
received by Business Associate from or on behalf of the Covered Entity. The term Protected Health
lnformation shall also include "Records" as provided herein.
1.9 Records. "Records" shall have the same meaning as the term "records" in 42 CFR 52,11.
1.10 Required Bv [aw. "Required By Law" shall have the same meaning as the term "required by law" in 45
cFR 5 164.s01.
1.11 Secretarv. "Secretary" shall mean the Secretary of the Department of Health and Human Services or
the Secretary's designee.
1.12 General Rule, Capitalized terms not otherwise defined in this BA Agreement shall have the same
meaning as those terms in the Privacy Rule
1,13 Qualified Service Oreanization, "Qualified Service Organization" shall have the same meaning as the
term "Qualified Service Organization" in 42 C.F.R. 5 2.11.
r.14 Substance Abuse Confidentiality Regulations. "Substance Abuse Confidentiality Regulations" shall
mean the regulations promulgated by the U,S. Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration, including the Confidentiality Rule.
A!'tic!g 2: Oblieations and Activities of Eusiness Associate
2.1 Prohibitions. Business Associate agrees to not use or disclose Protected Health lnformation other
than as permitted or required by the BA/qSO Agreement or as required by applicable federal or state
laws and regulations.
2,7 Qualified Service Organization. Business Associate acknowledges that it may also be a Qualified
Service Organization as defined in 42 CFR 2.77 and as such: (i) acknowledges that, to the extent it
receives, stores, processes or otherwise dealswith any information, whether recorded or not, relating
to a patient received or acquired by a federally assisted alcohol or drug program, it is fully bound by
the regulations in 42 CFR Part 2; and (ii) if necessary, will resist in judicial proceedings any efforts to
obtain access to any information, whether recorded or not, relating to a patient received or acquired
by a federally assisted alcohol or drug program, except as permitted by 42 CFR Part 2.
Page 3 of 8
B.B.A Attachment
2.3
2.4
2.5
2.6
Safeeuards. Business Associate agrees to implement and use appropriate safeguards and comply with
Subpart C of 45 CFR Part 164 to prevent use or disclosure of the Protected Health lnformation other
than as provided for by this BA/QSO Agreement. Agrees that, when Business Associate uses, discloses,
or requests Protected Health lnformation, it will limit the use, disclosure, or request to the minimum
necessary. Business Associate acknowledges that in receiving, transmitting, transporting, storing,
processing, or otherwise dealing with any Protected Health lnformation or Records received from the
Covered Entity identifying or otherwise relating to the patients within the Covered Entity, it is fully
bound by the provisions of the federal regulations governing the Confidentiality of Substance Use
Disorder Patient Records,42 C.F.R. Part2; and the Health lnsurance Portability and Accountability Act
(HIPAA), 45 C.F.R. Parts 142, 160, L62, and 164.
M:tieation. Business Associate agrees to mitigate promptly, to the extent practicable, any harmful
effect that is known to Business Associate of a use or disclosure of Protected Health lnformation by
Business Associate in violation of the BA Agreement, the Privacy Rule, Confidentiality Rule or other
applicable federal or state law and regulations.
Reports of lmproper Use or Disclosure. Business Associate agrees to immediately report to Covered
Entity any use or disclosure of the Protected Health lnformation not provided for by this BA Agreement
of which it becomes aware. Business Associate also agrees to immediately report to Covered Entity
about any complaint that the Business Associate receives concerning the handling of Protected Health
Information or compliance with this BA Agreement. Business Associate must notify Covered Entity of
any Breach relatingto Unsecured Protected Health lnformation, which notice shall be in compliance
with the requirements of the HITECH Act and shall be given to Covered Entity at its designated address
for receiving such notices, as soon as practicable and without unreasonable delay, and in no case later
no later than five (5) business days after such breach is discovered by Business Associate. Such notice
shall include, to the extent possible, the identification of each individual whose Unsecured Protected
Health lnformation has been, or is reasonably believed by Business Associate to have been breached,
along with other available information that Covered Entity may be required to include in its
notification to the individual. Notice to Covered Entity may be given by email, return receipt requested
or certified mail, return receipt requested. lf Business Associate learns subsequent to its initial
notification to Covered Entity of any additional information that Covered Entity may need for its
required notification to individuals, Business Associate shall promptly notify Covered Entity of such
information in the same manner as specified above.
Disgloi-lrJgs to Aeents and Subcontractors. ln accordance with 45 CFR 164.502{e}(1}(ii), 164.308(b}{2),
and 42 CFR Part 2 if applicable, ensure that any subcontractors that create, receive, maintain, or
transmit Protected Health lnformation on behalf of the business associate agree to the same
restrictions, conditions, and requirements that apply to the business associate with respect to such
information;
Page 4 of 8
B.B.A Attachment
2.7
2.8
2,9
2.10
2.rt
Aqjssg, To enable the Covered Entity to fulfill its obligations under the Privacy Rule, Business
Associate agrees to make Protected Health lnformation in Designated Record Sets that are maintained
by Business Associates or its agents or subcontractors available to Covered Entity for inspection and
copying within ten (10) days of a request by Covered Entity. lf an lndividual requests inspection and
copying of Protected Health lnformation directly from Business Associate or its agents or
subcontractors, Business Associate shall notify the Covered Entity in writing within five (5) business
days of receipt of the request, and shall defer to, and comply with, Covered Entity's direction in a
timely manner regarding the response to the lndividual regarding the request for inspection and
copying.
Amendmen!, To enable the Covered Entity to fulfill its obligations under the Privacy Rule, Business
Associate agrees to make any amendment(s)to Protected Health lnformation in a Designated Record
Set that are maintained by Business Associate or its agents or subcontractors that the Covered Entity
directs or agrees to pursuant to 45 CFR $ 164 within ten {10) days of a request by Covered Entity. lf an
lndividual requests amendment of Protected Health lnformation directly from Business Associate or its
agents or subcontractors, Business Associate shall notify the Covered Entity in writing within five (5)
business days of receipt of the request, and shall defer to, and comply with, Covered Entity's direction
in a timely manner regarding the response to the lndividual regarding the request for amendment.
F.ederal Goverrgn.ent OffiCials. Business Associate agrees to make internal practices, books, and
records, including policies and procedures and Protected Health lnformation, relating to the use and
disclosure of Protected Health lnformation received from, or created or received by Business Associate
on behalf of, Covered Entity available to the Secretary as designated by the Secretary, for purposes of
the Secretary determining Covered Entity's compliance with the Privacy Rule. Business Associate shall
notify Covered Entity regarding any Protected Health lnformation that Business Associate provides to
the Secretary concurrently with providing such Protected Health lnformation to the Secretary, and
upon Covered Entity's request, shall provide Covered Entity with a duplicate copy of such Protected
Health Information.
Documefrtati?ll of Disclosure.L Business Associate agrees to implement a process for documenting
such disclosures of Protected Health lnformation and information related to such disclosures as would
be required for Covered Entity to respond to a request by an lndividual for an accounting of disclosures
of Protected Health lnformation in accordance with 45 CFR $ 164,528,
Accountins of Disclosure$ Business Associate agrees to provide to Covered Entity the information
collected in accordance with Section 2.9 of this BA Agreement within ten (10) days of the Covered
Entity's request in order to permit Covered Entity to respond to a request by an lndividual for an
accounting of disclosures of Protected Health lnformation in accordance with 45 CFR 5 164.528. lf an
individual requests an accounting directly from Eusiness Associate or its agents or subcontractors,
Buslness Associate must notify Covered Entity in writing within five (5) business days of the request,
and shall defer to, and comply in a timely manner with, Covered Entity's direction regarding the
response to the lndividual regarding the request for an accounting.
Page 5 of 8
B.B.A Attachment
3.1
3.2
3.3
4.t
4.2
4.3
4.4
5.1
Article 3: Permitted Uses and Disclosures bv Business Associate
Specific Purposes. Business associate may only use or dlsclose protected health information as
required or permitted by law.
legal Responsibilities. Except as otherwise limited in this Agreement, Business Associate may use
Protected Health lnformation for the proper management and administration of the business associate
or to carry out the legal responsibilities of the business associate.
Reportine Law Violations. Business Associate may use Protected Health Information to report
violations of law to appropriate Federal and State authorities, consistent with 5 164.502(jX1).
Article 4: Obligations of Covered Entitv
Notice of Privacv Practices. Covered Entity shall notify Business Associate of any limitation(s) in its
notice of privacy practices of Covered Entity in accordance with 45 CFR I 164.520, to the extent that
such limitation may affect Business Associate's use or disclosure of Protected Health lnformation.
lndividual Permission. Covered Entity shall notify Business Associate of any changes in, or revocation
of, permission by lndlvidual to use or disclose Protected Health lnformation, to the extent that such
changes may affect Business Associate's use or disclosure of Protected Health lnformation.
Restrictions, Covered Entity shall notify Business Associate of any restriction to the use or disclosure
of Protected Health lnformation that Covered Entity has agreed to in accordance with 45 CFR $
t64522 and 42 CFR Part 2 , to the extent that such restriction may affect Business Associate's use or
disclosure of Protected Health lnformation.
Prohibited Requgsts. Covered Entity shall not request Business Associate to use or disclose Protected
Health lnformation in any manner that would not be permissible under the Privacy Rule or
Confidentiality Rule if done by Covered Entity.
Article 5: Term and Termination
Term. The Term of this BA Agreement shall be effective as of the date signed, and shall terminate
when allof the Protected Health lnformation provided by Covered Entity to Business Associate, or
created or received by Business Associate on behalf of Covered Entity, is destroyed or returned to
Covered Entity, or, if it is infeasible to return or destroy Protected Health lnformation, protections are
extended to such information, in accordance with the termination provisions in this Section.
Page 5 of 8
B.B.A Attachment
5.2 Termination for Cause. Upon Covered Entity's knowledge of a material breach by Business Associate,
Covered Entity shall either:
A. Provide an opportunity for Business Associate to cure the breach or end the violation, and
terminate this Agreement if Business Associate does not cure the breach or end the violation
within the time specified by Covered Entity;
B. lmmediately terminate this Agreement if Business Associate has breached a materialterm of
this Agreement and cure is not possible; or
C. lf neither termination nor cure is feasible, Covered Entity shall report the violation to the
Secretary,
5.3 Effect of Termination.
A. Except as provided in paragraph (B) of this section, upon termination of this Agreement, for
any reason, Business Associate shall return or destroy all Protected Health lnformation
received from Covered Entity or created or received by Business Associate on behalf of
Covered tntity, This provision shall apply to Protected Health lnformation that is in the
possession ofsubcontractors or agents of Business Associate. Business Associate shall retain
no copies of the Protected Health lnformation.
B. ln the event that Business Associate determines that returning or destroying the Protected
Health lnformation is infeasible, Business Associate shall provide to Covered Entity notification
of the conditions that make return or destruction infeasible. Business Associate shall
thereafter extend the protections of this Agreement to such Protected Health lnformation and
limit further uses and disclosures of such Protected Health lnformation to those purposes that
make the return or destruction infeasible, for so long as Business Associate maintains such
Protected Health lnformation.
5.4 Survival. The respective rights and obligations of Business Associate under this Article 5 shall survive
the termination of this BA Agreement.
Article 6: Miscellaneous
6.1 Resulatorv References. A reference in this Agreement to a section in the Privacy Rule means the
section as in effect or as amended,
Page 7 of I
B.B.A Attachment
6.2
5.3
6.4
6.5
Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time
to time as is necessary for Covered Entity to comply with the requirements of the Privacy Rule and the
Health lnsurance Portability and Accountability Act of 1996, Pub, L, No. 104-191 and the
Confidentiality Rule.
lnterpretation. Any ambiguity in this Agreement shall be resolved to permit Covered Entity to comply
with the Privacy Rule.
State Law. ln addition to HIPAA and the HIPAA Regulations, Business Associate shall comply with all
applicable state and federal privacy and security laws.
Nqtiqgs, Under the terms of this BA Agreement, either party shall be deemed as being given notice, if
delivered personally, or if mailed by first class United States mail, postage prepaid, and addressed as
follows:
lf to Covered Entitv:
Comprehensive Healthcare
PO Box 959
Yakima, WA 98907
The parties mutually agree as of the date above to this agreement.
t4,,L#L.d'
aly,CEO Date Clay rs, Sheriff
ensive Healthcare Sherifl Kittitas County
lf to Business Associate:
Kittitas County Jail
205 West 5'h Ave, Suite 1
Ellensburg, WA 98926
Date
Com
Page 8 of 8
B.B.A Attachment
Kittitas County
Review Form
Grants & Contract Agreement
Contract/G ra nt I nformation
Financial lnformation
Budget lnformation
Pass Through lnformation
Agency to Pass Through NA
Amount to Pass Through s
Sub-Contract Approved Date
Today's Date
January 1.2,202I
Agenda Date
Janua 19 202r
Fund/Department
30 / Sheriff
Contract /Grant Agency: Com prehensive Healthcare
Period Begin Date: Upon Signature Period End Date: 1,2/3t/202I
Total Grant/Contract Amount: Sl"25/hour
Grant/Contract Number: SH20-025
Contract/G rant Summary: This agreement is between the Kittitas County Sheriff's Office and
Comprehensive Healthcare, previously and commonly referred to as Comprehensive Mental Health. The
provider will supply a qualified practitioner to provide mental health related medical assessment and
treatment to inmates at the Kittitas County Jail.
Total Amount -S15,000 expected
to this vendor
State Funds S0 Federal Funds S0
Percentage County Funds IOO%Matching Funds S0 CFDA# NA
ln-Kind S0
Explain
ls Equipment being purchased? NO Who owns equipment?
New Personnel being hired? NO Contact HR hiring - reporting requirements
Future impacts or liability to Kittitas County: None
Budget Amendment Needed?Yes ! attach budget form No E Why not - already in budget
New Division Created? NO
Revenue Code NA
Expense Code 001-3007s4113 Medical Services
Grant/Contract Review Page 1
Prosecutor Review
Has the Prosecutor reviewed this agreement?Yes Eruo CAMAS# sos22
County Departments lm acted
Submitted
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
signature: qa". 1t7t<tttt Date: I -t r-, t
Department: Shdriff
Assignment of Tracki lnformation
Auditor's Office
Human Resource
Prosecutor's Office 1 C-- &u7\ 47 ,ftd*r
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2