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Home My WebLink About042715_ca09_ xln Pubfic HealWl 615 Sheridan Street Port Townsend, WA 98368 www. JeffersonCountyPublicHealth.org Consent Agenda March 16, 2015 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM.- Jean Baldwin, Director Julia Da kin, Public Health Supervisor w% DATE: SUBJECT: A ienda Item – DBHR DSHS A -11; March 15, 2015 —June 30, 2015 STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of the DBHR Amendment #11; March 15, 2015 - June 30, 2015; ANALYSIS/ STRATEGIC GOALS /PRO'S and CON'S: DSHS, Division of Behavioral Health and Recovery, Behavioral Health and Service Integration, Amendment #11 modifies the list of Contractor's regarding Prevention and /or Treatment Services, and Rate Plan by adding additional counties to the list of eliminated counties. DBHR A10, which was signed by the BOCC 1/12/2015, had previously eliminated JCPH. As well, the amendment deletes Section #9 and replaces it with language that clarifies the uses of DBHR funding in regards to reimbursement of insurance co -pays and deductible fees, and the maintenance of documentations associated with CJTA allowable reimbursements; however, JCPH does not participate in CJTA reimbursements. Essentially the only statement that applies to JCPH in this amendment is the final statement which adds Jefferson County's DUNS number to the contract. FISCAL IMPACT /COST BENEFIT ANALYSIS: This contract has no fiscal impact. RECOMMENDATION: JCPH management request approval of DBHR Amendment 11; March 15, 2015 — June 30, 201, REVIEWED BY: P Date Community Health Environmental Health Developmental Disabilities Water Quality 360 - 385 -9400 360 - 385 -9444 360- 385 -9401 (f) Always working for a safer and healthier community (f) 360 - 379 -4487 DSHS Central Contract Services 1611 CS County Program Agreement Amendment (6 -12 -2014) Approved as 01111y. ,,r� 4 David Alvarez, rChief C lvlll " Page 1 DSHS Agreement Number j COUNTY PROGRAM AG REEMENT EQ FE11ARTI, TOFCSETH A M E N D M E N T 1163 -27310 RI7 Amendment No. 11 This Program Agreement Amendment is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified below, Agreement Number County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE Behavioral Health and Service Division of Behavioral 1223 1223 Inte ration Health and Recove COCWT AC' - NAM,- AND TITLE DSH'S 'ONTACT ADDRESS Luc IIla Mendoza 45001 0th Ave SE Lace tl WA 98503 - DSHS CC}N "T,A ,I 'T l -Ek HONE DS195 CONTACT FAX DSFIS C bNTACT E »MAIL 360 725 -3760 mendol2 ,dshs.wa. ov COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368- COUNTY FEDERAI.. EMPLOYER IDENTIFICATION COUNTY CONTACT NAME. NUMBER Julia Danskin COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E -MAIL 361 385 -9420 (3601385-9401 °danskin co.'efferson.wa.us IS `I`Ht COUNTY" A SUiBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? 93.959 No AMENDMENT START DATE PROGRAM AGREEMENT END DATE 03/15/2015 06/30/2015 PRIOR MAXIMUM PROGRAM AGREEMENT" AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM PROGRAM AGREEMENT AMOUNT AMOUNT $141,599.00 $0.00 $141,599.00 REASON FOR AMENDMENT; CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO with a check 4 0 r an X the following Exhibits are attached and are EXHIBITS. When the box below Is marked O 9 incorporated into this Program Agreement Amendment by reference: Exhibits s cif Th is Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement Amendment„ and have authorit to enter into this to ram Agreement Amendment. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S)- DATE(S) SIGNED DSHS SIGNATURE PRgNTED NAME AND TITLE DATE SIGNED BHSIA Contracts DSHS Central Contract Services 1611 CS County Program Agreement Amendment (6 -12 -2014) Approved as 01111y. ,,r� 4 David Alvarez, rChief C lvlll " Page 1 This Program Agreement between the State of Washington Department of Social and Health Services (DSHS) and the County is hereby amended as follows: Modify the list of County's /Contractors regarding Prevention and /or T reatment Services as follows; Section 9. Treatment Statement of Work does not apply to the following as of March 15, 2015: Educational Service District 112 Skamania County (Skamania Sherriff's Office) Jefferson County Republic School District Kittitas CCPHS Network Sunnyside School District Mt. Adams School District Tekoa School District Rural Resources Community Action Service Rate Plan does not apply to the following as of March 15, 2015: Educational Service District 112 Skamania County (Skamania Sherriff's Office) Jefferson County Republic School District Kittitas CCPHS Network Sunnyside School District Mt. Adams School District Tekoa School District Rural Resources Community Action Delete Section 9, Treatment, Multiple Payments for the Same Claim /Duplication kk. (2) (c) iii as follows: iii. The County shall not reimburse providers for individual's co- payment or deductible fees using any DBHR funding or SAPT Block grant funds. And replace with the following: iii. With the exception of the CJTA, the County shall not reimburse providers for individual's co- payment or deductible fees using any DBHR funding or SAPT Block grant funds. Effective April 1, 2015 for services starting April 1, 2015, CJTA may be used to reimburse providers' co- payments or deductibles for individuals who meet the following: (A) Are CJTA eligible under RCW 70.96A.350. (B) Have an income level not less than 220% of the federal poverty level. (C) Are not Medicaid eligible. The County shall maintain documentation of CJTA co- payments and deductibles according to guidelines developed by DBHR. Add Section 11: 11. The Contractor's DUNS number is 184826790.. All other terms and conditions of this Contract remain in full force and effect. DSHS Central Contract Services 1611 CS County Program Agreement Amendment (6 -12 -2014) Page 2 COUNTY PROGRAM AGREEMENT IF AMENDMENT This —Program Agreement Amendment men -- dment is by and between the State of Washington Department of Social and Health Services (DSHS) and the County identified below t1 J-RS �AEMNISJT�ATION Behavioral Health and Service lnte ration — - -- DS I IS C 0 IJ —TA . ...... R A M TNT) TT fl E CT Steve Smothers FISFIS DIVISION DSHS INDEX NUMBER Division of Behavioral 1223 Health and Recovery 4500 10th Avenue SE acEA 98503 DSHS CONTACT FAX DSHS ONT��,,f PHONE =(360) 438-8057 (360) 725 -3767 COUNTY NAME COUNTY ADDRESS 615 Sheridan St Jefferson County Port Townsend, WA 08368- C06F"l 17 ::'EDERAL EMPLOYER Di w Flnz :: Fi5w COUNTY CONTACT NAME NUMBER Julia Danskin ]–�OUNTY CONTACT FAX TfF 3160 385-9420 ,,6tj Y GCWFA�r 'HONE (360�) 385-9401 IS THE COUNTY A.,3Ub1KEC1r1E-1AT FOR PURPOSES OF THIS PROGRAM AGREEMENT? Yes -A-MENDWENT STAVT 11/01/2014 Pl:�IOR MAXIMUM FK AMOUNT $141,599-00 DSHS Agreement Number 1163-27310 Amendment No. 10 Administration or Division Agreement Number County Agreement Number TC—S —C c FrTf -P�"w C, —rC 1223 DSHS CONTACT E-MAIL smothsw(@dshs.wa,aov COUNTY CONTACT E-MAIL jdanskin.(fDcoJeffers,on.wa,us CFDA NUMBERS 93.959 PROGRAM AGREEMENT END DATE 06/30/2015 AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMt AMOUNT $0.00 $141.599.00 AGREEMENT Rff-ASON FOR AMENDMENT; CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are incorporated Into this Program Agreement Amendment by reference: 0 Exhibits_(s pe y . . ..... . TWs—Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement Amendment, and have authority to enter into this Pro ram Agreement Amendment, ............. PRINTED NAM :f) AND I LE DATE(S) SIGNED TURE(S) vc 14 G —�/v I I V ..... ................. PRINTED NAME AND 1-1 H-E DATE SIGNED TS-Ti—SSF,, —NAT�U rF I A &,An'Z%44Jy 11vhN Approved as o form Pn1y )2 71 Ll DSHS Central Contract Services 161 1CS County Program Agreement Amendment (6-12-2014) J Mrson Co. Prosecuto Office David Alvarez, Chief tivil DPA Page 1 This Contract between the State of Washington Department of Social and Health Services (DSHS) and the County is hereby amended as follows: The purpose of the amendment is to: revise incorrect Section references contained in the July 20,114 amendment; update the list of Prevention/Treatment County /Contractors; add new definitions; provide clarification language regarding the Service Rate Plans. Modify the list of County's /Contractors regarding Prevention and /or Treatment Services, and Service Rate Plan as follows: Section 8, Prevention Statement of Work does not apply to the following as of November 1, 2014: Beacon of Hope Skamania County (Community Health) Kittitas County Stevens /Ferry County Klickitat County Yakima County Palouse River Counseling Section 9. Treatment Statement of Work does not apply to the following as of November 1, 2014: Educational Service District 112 Skamania County (Skamania Sherriff's Office) Jefferson County Republic School District Kittitas CCPHS Network Sunnyside School District Mt. Adams School District Tekoa School District Section 10. Additional Services applies only to the identified County for the specific Exhibit(s) as of November 1, 2014. County /Contractor Exhibit(s): County /Contractor Exhibit(s): Clark County D Pierce County D Grant County F Snohomish County D King County D, E, G, H Spokane County D Kitsap County E, H Mt. Adams SD I Service Rate Plan does not apply to the following as of November 1, 2014: Educational Service District 112 Skamania County (Skamania Sherriff's Office) Jefferson County Republic School District Kittitas CCPHS Network Sunnyside School District Mt. Adams School District Tekoa School District Amend Section 1, Definitions, Section "w", this was an incorrect Section reference in the July amendment. The correct definition is for Section "z" as follows: z. "IDU and IVDU" means the same population: Injecting Drug User and Intra- venous Drug User. The acronyms may be used interchangeably to refer to a person or patient who has used a needle one or more times to illicitly inject drugs. r7sFis Central Contract services Page 2 1611CS Caunty Program AgreerrientAmendment (6 -12. -2014) Amend Section, 1, Definitions, to add new Section "uu" and "vv" as follows: uu. "SAPT Block Grant" means Substance Abuse Block Grant, SABG, Substance Abuse Prevention and Treatment Block Grant and SAPT are interchangeable. vv. "Miscellaneous" means a category of special projects with prior approval that may not be funded through any other source. Funding for these projects will be provided by State GIA funding. Services must be negotiated and agreed upon in writing between the County and DBHR prior to initiating the project. Correct error in July 2014 amendment, delete Treatment Section of Work, Section 9. cc. (6)(c) iii., Medicaid Rules and Limitations in which an incorrect number was provided. The correct section number for the deleted language is 9. kk. (2)(d)iii. Add New Section 5, Requirements f. (2) (c) as follows: (c) Notice of Federal Block Grant Funding Requirement A portion of the funding for this contract may be from the federally funded Substance Abuse Block Grant (SABG) CFDA# 93.959. The amount allocated will be detailed in the contractor's authorization for service. Contractor will be notified of the amount of SABG expended each calendar year. Funds designated solely for a specific state fiscal year in this contract may be obligated only for work performed in the designated fiscal year,. Correct error in July 2014 amendment, in which language was included in Section 8, Prevention, instead of Section 9, Treatment. This amendment deletes the Prevention Statement of Work Section 8k.( 2) (c) iii. The following is added to Section 9, Treatment, Multiple Payments for the Same Claim /Duplication kk. (2) (c) iii as follows: iii. The County shall not reimburse providers for individual's co- payment or deductible fees using any DBHR funding or SAPT Block grant funds. Replace language from the July Amendment 2014 amendment regarding Service Rate Plans as follows: Section 9. cc. Consideration (4) Reimbursement Rates (4) DSHS shall reimburse the County based upon the Service Rate Plan (SRP), this shall be provided by DBHR to the County and may be updated on a periodic basis. Any changes made to the SRP by DBHR will not be provided by an amendment, but via email, or letter. Exhibit C, Service Rate is deleted as an Exhibit to the Contract. All other terms and conditions of this Contract remain in full force and effect. DSHS Central Contract Services Page 3 161 1CS County Program Agreement Amendment (6 -12 -2014)