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HomeMy WebLinkAbout041513_ca04„„ ~ Consent Agenda =`,~U`y~ ~~~"`F'~RSO~~T 'I~(]iJ~TT"Y` ~UBLIiC ~FALTH ~'~ - N,SffPhu~Q 69.5 Sherodan Street ~ Port Townsend o 'Washington o 98368 www.jeffersoncauntypu blichealth.org J~FFER~O'N COUNTY B~ARQ +(3~ COUNTY C~]MN'~I5SIfl'NE~tS AGENDA REQUEST TU: Board of Cvun~y Cvta~misslvners Phlllp Morley, Cvu~nty Administra~vr FR(3M: ]can 'Baldwin, director PATE: April 2, 2013 SUB7ECT: Agenda Item -Agency Agreement with C~epartment of 5vcial and Health Services for CHIP~dA `Technology Grant #13f~~-72917; May 3., ZQ13 -August 31., 2.[113; $4,298 STATEMENT QF I55U[E: ]efferson County Public Health requests Board approval of the Agency Agreement with I]epartment of Social and 'Health Services for CI~IPRA Technology Grant #9.363-72917; May 1, 2013 -August 31, 2013; X4,200 ANALYSI515TRATEGIC GflAL511~1~C)''S ai~ttl C(~N`5: ]CPFI applied for and was awarded the CHIPRA Technology Grant in the amaunt of X4,200 to purchase technology equipment (2 laptops and a scanner}. Trained staff will assist families with children apply on-line for premiurr~, free and reduced cost health insurance. The application is available online with the state through the Washington Connection portal.. ]CPhf will use this equipment at the satellite clinics in quilcene and at Chimacum and Port Townsend schools. When the mobile equipment is not needed for the satellite clinics the computers will be available fn the ]CPH main office. This project will increase Internet access to families and teenagers in rural areas and assist therr~ with an on-line healthcare application. FISCAL. IMPACTIC05T !BENEFIT ANAl~Y5I5: This contract funds the purchase of technology equipment for use in assisting families with children apply for health insurance on-line. REC9MMENDATIDN': ]CPH management request approval. of the Agency Agreement with ©epartrr+ent of Social and Health Services for CHIPRA Technology Grant #1363-72917; May f, X01.3 -August 31, 2013; X4,200 ~C /. flip Ma~~ey, , oun Admi ' for Date CDMMI~NITY HEALTH pHgLl~ HEALTH EhIVIRpNMENTAC HEALTH DEVELOPMENTAL DISABILITIES WATER QWALlTY MAIN; (36Q} 385-94QQ !lLYYAYS ~~RRtI~ FAR A SAFER ~~p MAIN: {3b0) 38'5-9444 FAX: [36fl] 385-9401 HEALTHIER COlYUYIUNITY FAX: (360) 379-4487 I75HS Contract #1353-`i2517 pe~artment of Social and i~eaith Services (DSHS~ CIiIPP~ II Grartit ~ Scanning Verification Dvcurnent5 Participation Agreement ~ ~rssist%ng_Agency Jefferson Count dba Jefferson Caunty Public Health This Partic%pativn Agreement acltnowledges the %ntentian of DSIiS and the partner listed below to increase access to DSHS services l,y prc~-riding a laeatran to sufamit an on-I%ne application for CHIP assistance and other public assistance benefits using a computer vvvrlcstatian funded by DSHS, with the intention tv sustain the warlcstation after the life of the grant, This agreement is intended tv provide charity regarding expectat%ans. This Particiipation ,Agreement is between: DSWS, Community Services Division (CS©~ Attentive: Lynette Richardson, email address, RichaLA~dshs.wa,gvv 712 Fear St. SE Olympia, WA 985(?4 Phone: 3~t3~7Z5-48911 fax; 66ts-7~5-49{]4 And: Jefferson County Public hlealth Attention: lean Baldwin email address. jbaldwin~ea.~effersvn.wa.us fi15 Sheridan St PartTawnsend,'IN'A 98368 Phone. 36t1-385~94t}El FA)C: 3611-38a-94tH. ROLES AND RE5PQN5IBILITI1r5: 1. Contractor Obligations a. Have computer and scanner installed and operati©nai by their sch~eduied site visit. Site visit will lac conducted within 5~ days after participation agreement award [date to be scheduled by QSNS~, as detailed in Section 3 below. Page 1 of 4 DSHS Contract t31~~3-~2~t,7 ~. Provide semi-private location where Partnering Agency staff can assist applicants ire completing and submitting the DSHS on-line application for CHIP and upload verification documents. C, kiave staff who assist applicants with the application process sign a DSHS Contractor Nondisclosure of Confidential Information farm to ensure they will not use, publish, transfer, sell or otherwise disclose any confidential information gained by reason of this agreement for any purpose. Partnering Agency is required to keep these signed forms an file for one year beyond the duration of this agreement d. !Maintain working order of the equipment e. Pnsure equipment is available, during peak business hours, to provide client assistance for Ci-IdP applications as defined in the Partnering Agency's Statement of INor'k. f. Provide adequate Internet service and electrical power connectivity fvr semi private workstation {which includes a computer and scanner). g. Allow DSHS andf or Federal representativef s) periodic, on-site visits, h. Register to become a Washington Connection Assisting Agency Register for Secure Access Washington ~SAW~ accounts through DSHS Washington Connection j. Track suiimittals by Bogging into Washington Connection Contractor Assisting Staff's SAW account for each submittal. Provide a monthly Account Summary Report as detailed in Section ~ below, 1f for any reason you are unable to meet the obligations set forth in this participation agreement, notify project coordinator immediately who will determine if the agreement is in default.. Default may result in reirr~bursement to DSHS for equipment funds. i. Inform applicants they are applying for CHIP from DSHS so the applicant can make art inforrr~ed deeision about receiving benefits.. 2. Reporting Requirements The Partnering Agency will provide monthly Account Summary reports for submitted applications, eligibility reviews, change of circumstance, and/or count of uploaded documents. Page 2 of ~ ~5Fi5 Cantraet #1363-72917 3, 11/lanitoring Rectuurerrrents "fhe Partnering Agency wili be avaiiabfe for a site visit conducted within 6~ days of participation agreement award idate to be scheduled} and thereafter by []SHS 'Project Coordinator. ~"he site visit wilt include: training on y+Jashingtr~n Connection, contractor pages, reporting requirements, and deivery of marketing materials 4. ~Si#S rnruil: a. Complete site visit to ensure partnering agency Eras received the approved computer equipment to equip workstation~s~ b. Coiled receipts and signatures to authorise reimbursement, and promptly reimburse Partnering Agency for purchased equipment c. Review Non-'[~usclasure Agreements for signatures d, Provide training to Partnering Agency staff that will assist applueants in the application process e. Have the Project C.acrrdinator respond to inquiries andJor issues received from the Partnering Agency regarding thus praject f. Inform the Partnering Agency of any changes to the on-line application or changes in service delivery that may impact this agreement This Participatian Agreement is entered into between the partnering Agency referenced above and i7SliS Corrdmunity Services Divisian beginning May ~, 21]13 and ending August 33, 2~D13. AP~ROV~r~: Partnering Agency Signature: Printed Marne: Phone ~urrrber: _ Email: E3ate: Ap~31C~~~(~ ~S ~'~) tC9t ® ~~~ I y . 4~ _ _l.: !fJ 1. , JAY,..... ' } ~effet'st~tt ~rZ.. 1?rrr4ec~rttrrt ~ ~ oe Page 3 cf 4 aSH5 Contract #1353-721`7 APPR'C1~fEA: DStiS~CS~ Contracts C3f~4~er Signature: 'printed Fame: Rarnana Bushnell Phone iVumber: 3~0-725-453 Crnail: 8ushnR[t@dshs.wa.go~ €~ate: i=or C35ki5 use oniy: lL~anitar Keyboard CCU Scanner Captc~p Air Card Quantity Purchased installed - Re'rmburserrrent ~tec{uested ~ - F~age 4 of 4