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Home My WebLink About050916_ca05615 Sheridan Street ` Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org Public lig Consent Agenda April 7, 2016 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Veronica Shaw, Deputy Director Susan Parke, Financial Operations Coordinator DATE: ,s I 2 -CO / SUBJECT: Agenda Item – Long-term Payables A-1; July 1, 2016-3une 30, 2017 STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of the Long-term Payables A-1; July 1, 2016 - June 30, 2017; ANALYSIS/ST ATEGIC GOALS PRO"S and CON'S: This contract advances funds in anticipation of the actual approval of spending 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. This amendment changes the contact -_ name to David Erickson, and extends the contract by one vear. FISCAL IMPACT COST BENEFIT ANALYSIS: This contract has no fiscal impact. This contract represents a method by which DSHS approves JCPH spending plans for monies received by the Developmental Disabilities and Substance Abuse programs. RECOMMENDATION: JCPH management request approval of Long -Term Payables A-1; July 1, 2016 – June 30, 2017. P EV I D Y ,, Philip Morley, a o kAdtinistrator Date Community Health Developmental Disabilities 360-385-9400 360-385-9401 (f) Environmental Health Water Quality 360-385-9444 (f) 360-379-4487 COUNTY PROGRAM or INTERLOCAL 'AX&14 T.T i ,�`"' LONG-TERM PAYABLE AGREEMENT AMENDMENT This Amendment is between the State of Washington Department of Social and Health Services (DSHS) and the Contractor identified below,. NAME Jefferson Co 615 Sheridan St Port Townsend, WA 98368 - CONTRACTOR CONTACT Susan Parke DSHS ADMINISTRATION Executive Administration DSHS CONTACT NAMEANCA TIT'(. David Erickson Financial Coordinator DSHS CONTACT TELEPHONE 03601664-5757 07/01/2016 $0.00 Jefferson Cout2t WASHINGTON UNIFORP IDENTIFIER (UBI) 161-001-169 „ONTRACTOR TELEPRo CONTRACTOR FP 360 385-9400 360) 385-9401 DSHS DIVISION Financial Services DSHS CONTACT ADDRESS PO Box 45842 Olympia, WA 98504-5842 DSHS CON'T'ACT FAX (360)664-5775 FOR PURPOSES OF THIS COW RACT? CFDA CONTRACT END DATE 06/30/2017 AMOUNT OF INCREASE OR DECREASE. N/A DSHS CONTRACT NUMBER; 1563-32718 Amendment No. 01 Program Oontraot Numuer' Click here to enter text. Contractor Contract Number as (UbA) INESS F DSHS IND x 1223 CONTRACT G sparke2co DSHS CONTRACT C( 8030CS-63 DSHS CONTACT E. -M, erickdd(c-Ddshs,wa. ADDRESS efferson.wa.us Based on Annual Review, aNu.110W.— ., ......................... CHANGE OR CORRECT PERIOD OF PERFORMANCE ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this Amendment by reference: D' Additional Exhibits s eoi This Amendment, including ali Exhibits 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. r�:r��r't=TOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED S SIGNATURE Angela Williams, Contract Manager DSHS Central Contract Services _ Approftd mW t0 /I DSHS Central Contract Services Page 1 o. ecutCrks Ice 6046 LF Long -Term Payable Amendment (3-13-14) David Alvarez, Chief Civt PA 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, 2016, to June 30, 2017, as stated on Page One of this Amendment. 2. DSHS revises the DSHS Contact Name and Contact Address to David Erickson as stated on Page One of this Amendment. All other terms and conditions of this Agreement remain in full force and effect. DSHS Central Contract Services Page 2 6046 LF Long -Term Payable Amendment (3-13-14) DSHS Agreement Number COUNTY 1563-32718 tA PROGRAM AGREEMENT Long -Term Payable —This -T�ro—ram Agreement is by and between the State of Washington Department of Administration or Division Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number conjunction with a County and DSHS Agreement On General Terms and Conditions, County Agreement Number which is incorporated by reference. —ffS —HS �b "MI _N -1 �T �R-f f 6-N . ..... —_ DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Executive Administration Financial Services A D D R E 1223 8030CS-63 S 3, WFIZT N A M E A N D J I TL E Donna Corcoran 1115 Washington St SE Financial Coordinator _9�1n)pia WA 04 . ....... .. . . .. . .... DSHS CONTACT FAX ---TbSHS CONTACT -MAIL �ONIAE� 36 ffl4-577�_ corcodl@C �dshs. Qi- 0166 �Isnsy�� ,ov �-5769 ------- - COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend WA 98368- [-_C_OUNfYTCOJNT[ACf NAME Susan Parke . ......... FC�_�_iNTYCONTAC,f 111:i[,lz'P[10NE COUNlYCONTACTFAX COUNTY CON rAC l E-MAIL 59). 385-9400 385_P401 rke co�L,�ffersqn wa us _L3L _i�(R T -Y A j�F__ _qF _T 'RAM 'IS �S 1-JiL7 R1 [p�iff ]' -CTP DURPOSES ()F 1HIS PRO(S CFDA Ek AGREEMENT? No __ — �tS—TAiifD—Afff----J,—PR-0-G-R—AM—AGR-E-EMEN--rEN-D'UA—T-E--M,6 PROGRAM AGREEME Based on Annual Review LNT AMOUNT 07/01/2015 06/30/2016 . ..... . The terms 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 I upon sm nature by DSHS. — --- - - -ED NAME(S) AND TITLE(S) DATE(S) SIGNED 6'(j �NT Y S K; N A ll U R E(S) PIRW VO 3// 69115— ""PRINTED NAME AW, TITLE DATE SIGNED Andrea Goff, Contracts Consultant L)SIqS Central Contract Seivicus 8()3()C,I,S County Long Tema Payable (1-27-15) 4 proved to form on�y Vk , 0 1,'11, " 31-�:I(S fferson Co. Prosec 8 0 ice tj A 1� Civil DPA David Alvarez, Chic I= 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 -Terra 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..Terrn Payable funds if the County does not actually provide the anticipated services during the given timeframe. Long -Terni Payataie 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 (Bl iSIA) to administer mental health services for people who are eligible for the Title XIX Medicaid program in accordance with WAC 388-805-0300. 2.. 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 (A.LTSA); and/or Children's Administration (CA) operated during the term of this Agreement. 3. Statement of Work a. County Responsibilities (1) The County shall subs! -crit to DSHS, on forms provided by DSIdS and by a date determined by DSHS, a completed Documentation of Funds Forrn (DFF) frorn 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 DS1 tS Central Contract Services vices Page 2 8030CS County Long-Taim 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 Di~i= 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. & 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. [)SI IS Central Contract services Page 3 8030(v;S County Long -Term Pzqable (1-27-15)