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Home My WebLink About031615_ca04e. 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHeal'th.org Consent Agenda March 3, 2015 JEFFE ' RSON COUNTY vp .00ARD OF COUNTY COMMISSIONERM TO: Board of County Commissioners Philip Morley, County Administrator FROM: lean Baldwin, Director Susan Parke, Financial Operations Coordinator DATE: SUBJECT: Agenda Item – Long-term Payables; July 1, 2015 —tune 30, 2016 STATEMENT OF _1SSYE: Jefferson County Public Health requests Board approval of the Long-term Payables; July 1, 2015 - June 30, 2016; AIVALYS SPSTRATEG ALS PRO"S and COWS: The contract advances funds, in anticipation of the actual) approval of those plans filed by the Contractor (JCPH) with DSHS for the Division of Developmental Disabilities, (DDD) and Substance Abuse prevention, 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. FISCAL IMPACT CciST BENEFIT ANALYSIS: This contract has no fiscal impact. RE JCPH management request approval of Long-Term Payables; July 1, 2015 — June 30, 2016. WED Y: ilip Morle nty Administ ator Date (_()rnrT)urRy Health DeveloprneWol Dsabilifie5 360-385--9400 360-385-9401 {f) Always working for a safer and healthier community Erivironrnenfa9 Health Water Qualify 360-385-9444 (f) 360-379-4487 C J, In M"gjo,f Star' A] P Fc f–h71$--program Agreeme Social and Health Servi conjunction with a Cour which is incorporated b _5_sHS ADMINISTRAT9C7N Executive Administratic DSHS CONTACT NAME AN Donna Corcoran Financial Coordinator DSHS CONTACT (360)(364-5769 COUNTY NAME Jefferson county COUNTY CONTACT NAME Susan Parke COURTY CONTACT TEL.E 360) 385-9400 COUNTY �A S U �BR (iF-�H �E AGREEMENT? l No 07/0112015 — The terms and condil understanding betwe d I or otherwise, regardi understand this Coni U on signature b U COUNTY _T S I N TU _(S 0 W-TYSIGNATURE SIGNA DSHS Cpjntv@B Contract ServIce-1 8030CS County Long-Term Payable (1,27-15) rot to form only AS tefferson CO, Prosec is Office David David Alvarez, Chic Civil DPA Page 1 DSHS Agreement Number COUNTY 1563-32718 PROGRAM AGREEMENT Long-Term Payable ,)t is by and . between the State of Washington Department of Administration or Division ces (DSHS) and the County identified below, and is issued in Agreement Number DSHS Agreement On General Terms and Conditions, Ity and county Agreement Number reference. SH S D'V'S' ON D DSHS DIVISION DSHS INDEX NUMBER DSHS INDEX DSHS CONTRACT CODE Services S Financial Services a a 1 223 1223 8030CS-63 )n L D TI T LE T ADDRESS DSHS CONTACT ADDRESS 0 I gto St SE 1115 Washington St 01 m Ia WA 98504 )NE FAX DSHS CONTACT FAX DSFIS CONTACT E-MAIL 360 _5 (36 )664-5775 n)riQh-- w;A corcodIr COUNTY "'T ........ COUNTY ADDRESS 615 Sheridan St Port Townsend WA 98368- PHONE COUNTY CONTACT FAX PHONE COUNTY CONTACT E-MAIL (360) 385-9401 sparke@co.jefferson.wa.us =CIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS TART DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT 06130/2016 Based on Annual Review this Contract are an integration and representation of the final, entire and exclusive ions of Superseding and merging all previous agreements, writings, and communications, oral en the parties -ig the subject matter of this Contract. The parties signing below represent that they have read and ract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED PRINTED NAME AND TITLE DATE SIGNED Andrea Goff, Contracts Consultant DSHS Cpjntv@B Contract ServIce-1 8030CS County Long-Term Payable (1,27-15) rot to form only AS tefferson CO, Prosec is Office David David Alvarez, Chic Civil DPA Page 1 SPECIAL TERMS AND CONDITIONS Definitions a. ,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 timeframe. 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. d. ,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 XIX Medicaid program in accordance with WAC 338 - 865 -0300, 1 Purpose 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: Behavioral Health and Service Integration Administration (BHSIA) - Mental Health (MH) and /or Alcohol and Substance Abuse (ASA); Developmental Disabilities Administration (DDA); Aging and Long -Term Support Administration (ALTSA); and /or Children's Administration (CA) operated during the term of this Agreement. 3 Statement of Work a. County Responsibilities (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 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 -Term 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. (5) Any interest the County earns on the Long -Term Payable funds shall only be utilized for the DSHS central contract Services Page 2 8030CS county Long -Term Payable (1- 27 -15) SPECIAL TERMS AND CONDITIONS DSHS programs or services for which the funds were originally designated. Long-Term 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 8030CS County Long-Term Payabte (1-27-15) Page 3