HomeMy WebLinkAbout032414_ca07so. Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
,s =K 615 Sheridan Street o Port Townsend o Washington o 98368
www.jeffersoncountypublichealth.org
March 18, 2014
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE:
SU63ECT: Agenda Item — Agency Agreement with the department of Social and
Health Services for Long Term Payable, # 1363 - 73712, Amendment
#1; July 1, 2014 — June 30, 2015; extends contract end date and
changes DSHS contact name /address based on annual review.
STATEMENT OF ISSUE:
Jefferson County Public Health requests Board approval of the Agency Agreement with Department of Social
and Health Service for Long term Payable, #1363 - 73712, Amendment #1; July 1, 2014 — June30, 2015;
extends contract and end date and changes DSHS contact name /address based on annual review.
ANALYSIS/ STRATEGIC GOALS /PRO'S and CON'S:
The contract advances funds in anticipation of the actual approval of those plans filed by the Contractor,
(JCPH) with DSHS for Division of Developmental Disabilities, (DDD) programs operated during the contract
period. This agreement is governed by terms in accordance with the General Terms and Conditions
between DSHS and the Contractor.
This amendment extends the contract term from July 1, 2014 — June 30, 2015. It also changes the DSHS
contact name and Address.
COMMUNITY HEALTH ppgLlC HEALTH ENVIRONMENTAL HEALTH
DEVELOPMENTAL DISABILITIES WATER QUALITY
MAIN: (360) 385 -9400 ALWAYS WORKING FOR A SAFER AND MAIN: (360) 385 -9444
FAX: (360) 385 -9401 HEALTHIER COMMUNITY FAX: (360) 379 -4487
FISCAL IMPACT /COST BENEFIT ANALYSIS:
This contract has no fiscal impact.
RECOMMENDATION:
JCPH request approval of the Agency Agreement with
Payable, #1363 - 73712; July 1, 2014 — June 30, 2015;
REVIEWED BY:
Philip Mor County Ad-rmnist for
Consent Agenda
the Department of Social and Health Services for Long
based on annual review.
<: � Y
Date
COUNTY PROGRAM or INTERLOCAL 1363-73712
LONG-TERM PAYABLE AGREEMENT j Amendment No. 01
AMENDMENT
_7__J�_�_theSt State of Washington Department of Social and Program Contract Number
is be
Health Services (DSHS) and the Contractor identified below, Contractor Contract Number
. _ I
CONTRACTOR NAME CONTRACTOR didng business as (DBA)
Jefferson Count _
E_0_NT�A_ZT5R ADDRESS
WASHINGTON UNIFORM BUTRSS_ DSHS INDEX NUMBER
IDENTIFIER (UBI)
615 Sheridan St
161-001-169
1223
Port Townsend WA 98368-
T0NTRAcTo—RcbNTACT
NTRACTOR"r'ELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRES
Susan Parke
360)_385-94 0 360) 385-9401
1 sparke@co,jefferson,wa,us
DSHS A RATION
DSHS DIVISION
DSHS CONTRACT CODE
Executive Administration.___.—
Financial Services
8030 S -63 . . .... . . . ...... ..
DSHS CONTAU I NIAIVM� AND TITLE
()SHS'EONTACT ADDRESS
1115 Washington St SE
Donna Corcoran
Financial Coordinator__.._._—
I OIV!Dp[a, WA 98504
.............. . .. . .. ..... . ... . ...
DSHS C-&-NTAGfT_ff_LffFFiONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
I
360 664 -5.76
. . . . . . . . . . . . . . . . . . . ........ . - corcodM@dshs,wa.gov
NUMBERS
—TOR KsuBF�E
IS HE CONTRAC
N r FOR _S OF TI ..its CONTRACT? CFDA
... ...... . . . . ..... . .....
No
.–L.. ENDMENT S DATE
I A.
-7
CONTRACT END 6�A_TE�
07/0182014
,W� 5UNT � .
PRIOR �UM CONTRACT �T
06/30/2015
... �MOUW�rOii7lFiCREASEF61� �DECRE�A��E
N/A
TOTAL MAX]MUM CONTRACT AMOUNT
Based on Annual Review
$0,00
1
REASON FOR AMEN DMEN 1,
CHANGE OR CORRECT PERIOD OF PERFORMA.. N. CE . . .........
............
ATTACHMENT5. ; hen the below is marked with an X, the following Exhlbits are attached and are incorporated into
this Amendment by reference:
'Ti: ditional molt'Th Amendment, i�g ill ffxkibits and other documents incorporated by reference, contains all of the terms and
conditions agreed upon by the parties as changes to the original County Program Agreement or Interlocal Agreement, No
other understandings or representations, oral or otherwise, regarding the subject matter of this Amendment shall be
deemed to exist or bind the parties, All other terms and conditions of the original County Program Agreement or Interlocal
Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this
Amendment and have authority to enter into this Amendment, DATE SIGNED
CONTRACTOR SIGNAI URE PRINTED NAME AND TrTLE
TU
DSHS Central Contract Services
6046 LF Long -Term Payable Amendment (3-13-14)
PRINTED NAME AND
Stephen Ssemaala, Contract Manager
DSHS Central Contract Services
Page 1
This Agreement between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
DSHS extends the Agreement End Date twelve months from July 1, 2014, to June 30, 2015, as stated
on Page One of this Amendment.
2. DSHS revises the DSHS Contact Name and Contact Address to Donna Corcoran as stated on Page
One of this Amendment.
All other terms and conditions of this Agreement remain in full force and effect.
DsHc6 Conlract Setviices Page 2
604 6 LF LongJerm Payable Amendment (3-13-14)
DSHS Agreement Number
COUNTY 1363-73712
r F- PROG RAM AGREEMENT
ALTH
FS
7 �&m t
Long-Term Payable
This Program Agreement is by and between the State of Washington Department of Administration or Division
Social and Health Services ( ) and the County identified below, and is issued in Agreement Number
Conjunction with a County and S, S Agreement On General Terms and Conditions, County Agreement Number
which is incorporated by reference.
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER : DSHS CONTRACT CODE
Executive Administration
Joel Emery
Grants & Contracts Mana(
DSHS CONTACT TELEPHONE
360 664-5752
COUNTY NAME
Financial Services 11 1223
DSHS CONTACT ADDRESS
PO Box 45842
Olympia WA 98504-5842
DSHS CONTACT FAX
(360)664-5775
COUNTY ADDRESS
Jefferson County 615 Sheridan St
Port Townsend WA 98368-
Susan Parke
7EO—UNTY CONTACT TELEPHONE COUNTY CONTACT FAX
36!01N 385 -9490 (360) 385-9401
IS THE COUNTY ASUB EC IPI ENT FOR PURPOSES OFT HIS PROGRAM
AGREEMENT?
8030CS-63
DSHS CONTACT E-MAIL
emervia00dshs.vva-Qc
COUNTY CONTACT E-MAIL
sparke@c2l.efferson wa us
DA NUMBERS
No PROGRAM AGREEMENT END DATE -- MAMXIMUMPR GRAM AGREEMENT AMOUNT
rz-r DATE 7 Based on Annual Review
PROGi�AM A(�REEMENT START DATE n6130/2014
0710112013
The teI Ins and conditions of this Contract are an integration and representation of the final, entire and exclusive
understanding between the parties superseding and merging all previous agreements, writings, and communications, oral
or otherwise„ regarding the subject Matter of this Contract. The parties signing below represent that they have read and
understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only
_y Lon s�22Lre jb DSHS. E(S) I ATE —
PRINTED NAME(S) AND TITLE(S) D (S) SIGNED
CO LINTY SIGNATURE
S
PRINTED NAME AND TITLE DATE SIGNED
Angie Williams, Contract Manager
DSHS Central Contract Services
Approved as tz fog only:
wv�
Jeff e r4son Co, Probe"" UMf OffIC0
D�SHS Central Contract Servic)BS Page 1
n
8030CS County Long-Te"' payable (3-13 .2013)
SPECIAL TERMS AND CONDITIA
,Commingle" is the act of mixing the funds and/or Long-Term Payables for one program with the
funds of another program.
b. "Documentation of Funds Form"' (DFF) is a form provided to the County each year by DSHS on
which the County records qualifying previous year expenditures from which DSHS can appraise
and evaluate the amount of the existing Long-Term Payable or appropriate adjustments.
,c. "Long-Term Payable" means funds provided by DSHS to the County in anticipation of specific client
services provided by the County. The County shall not be allowed to retain any overage
of the Long-Term Payable funds if the County does not actually provide the anticipated services
during the given tirneframe. Long-Term Payable funds are to be reconciled by April 30 of each
year and any funds not fully utilized shall be refunded to DSHS by May 31 of each year.
& "Prepaid Inpatient Health Plan" is an entity that contracts with the Behavioral Health and Service
integration Administration (BHSIA) to administer mental health services for people who are eligible
for the Title ;DIY Medicaid program in accordance with WAC 388-865-030&
a. it is the purpose of this Agreement to specify the procedure by which DSHS will assess and, if
necessary, adjust the Long-Term Payable it provides to the County.
b. Funds to support contracts for the following DSHS programs may be included in a Long-Term
Payable: Aging & Disability Services (Developmental Disabilities Administration (DDA), Behavioral
Health and Service Integration Administration (BHSIA), and/or Aging and Long-Term Support
Administration (ALTSA), and/or Children's Administration (CA) operated during the term of this
Agreement.
3. Statement of Work
(1) The County shall submit to DSHS, on forms provided by DSHS and by a date determined by
DSHS, a completed Documentation of Funds Form (DFF) from which DSHS shall assess
whether or not an adjustment to the amount of the Long-Term Payable provided to the County
is warranted,
(2) The County shall exclude all amounts related to its DBHR Prepaid Inpatient Health Plan
expenditures from its DFF,
(3) The County shall repay to DSHS all of the Long-Term Payable funds received from DSHS that
exceed the amount that DSHS determines is warranted, Repayment requirements shall be
based upon DSHS assessment of the most recent annual DFF submitted by the County to
DSHS, Any Long-Terrn Payable funds not fully utilized by the County, as determined by DSHS
through the DFF process, shall be refunded to DSHS by May 31 of each year,
(4) The County shall only utilize Long-Term Payable funds for the DSHS program or service for
which the funds were originally designated. Long-Term Payable funds may not be commingled
between or among programs or services.
Ds iS Central Contract serwces Page 2
8030CS county LongJerrn Payable (3-13 -2013p
SPECIAL TERMS AND CONDITI�ONb
(,5) Any interest the County earns on the Long-Term Payable funds shall only be utilized for the
DSHS programs or services for which the funds were originally designated. Long-Terrn
payable interest shall not be used for programs or services unrelated to the client services
anticipated by this Agreement.
(6) The County shall record the Long-Term Payables in its financial records.
4. DSHS Responsibilities
a. DSHS shall assess the DFF submitted by the County to determine if, during the term of this
Agreement, any adjustment to the original two month Long-Term Payable provided to the County is
warranted.
b, Adjustment may include DSHS request for repayment by County of any Long-Term Payable
amounts previously paid to County that are in excess of the amount currently warranted,
5. Termination
In the event that this Agreement, or a program contract listed in 2,b. above, is terminated prior to
completion, DSHS shall take all available steps to recover any Long-Term Payable determined to be
an overpayment and the County shall fully cooperate during the recovery process.
DSHS Central Contract Services iPage 3
&030CS Cokiinty Long-Term PaYaNe (3..13 - p13j