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Home My WebLink AboutWashington State Department of Social & Health Services, Amendment No. 3 -120516fir, C" 6 DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Page 1 DSHS Agreement Number COUNTY PROGRAM AGREEMENT 1563-42479 Department of Social 7 nv 'Neaith Services AMENDMENT Amendment No. tra„Sfarr Prevention Services 03 ing rives 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 SP020155 / T1010056 County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE Behavioral Health Division of Behavioral 1223 1223 Administration Health and Recover DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Lucilla Mendoza 4500 10th Ave SE Lacey, WA 98503- DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL (360)725-3760 Click here to enter text. mendol2@dshs.wa. ov COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368 - COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Denise Banker COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL 360 385-9400 1 (360) 385-9401 dbanker@co.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? 93.959 Yes AMENDMENT START DATE PROGRAM AGREEMENT END DATE 09/30/2016 06/30/2017 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE" TOTAL MAXIMUM PROGRAM AGREEMENT AMOUNT AMOUNT $173,559.00 $40,941.00 $21.4,500;00 REASON FOR AMENDMENT; CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEEPAGE 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: ❑ Exhibits (specify): This 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. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED DSHS SIGNATURE RITINTEDAAME AND,.T4TLE�'�b�� DATE SIGNED Z')Contracts 6 DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Page 1 This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS) is hereby amended as follows: 1. Amend the maximum contract consideration to add $40,941, therefore increasing the maximum consideration from $173,559 to $214,500. The Awards and Revenues (A&R) is attached as Exhibit B. 2. Amend Section 1. Definitions aa. by deleting and replacing with the following: aa. "Performance-based Prevention System" or "PBPS" or its replacement means the management information system maintained by DSHS that collects planning, demographic, and prevention service data. 3. Amend Section 1. Definitions by adding the following definition: ff. "Regular annual schedule" means consistent, reliable services with a pattern of implementation intervals throughout the year. 4. Amend Section 4. Performance Work Statement a.(1) and (2) is deleted and replaced in its entirety with the following: (1) Provision of CPWI services in accordance with the CPWI Community Coalition Guide located on the Athena Forum website http://www.theathenaforum.org/cpwi community coalition guide updated august 2015 rvsd 10 12 15 which outlines the minimal standards to participate in the CPWI. County/Contractor shall plan to reach the ideal benchmarks related to the community coalition's efforts and staffing with the Dedicated Marijuana Funding. (2) Contractor shall ensure that a regular annual schedule of direct prevention services for the public dissemination is established. (a) Regular annual schedule shall take into account items including, but not limited to: implementation times that maximize participation and service outcomes; local needs and gaps; leveraged resources; and, other locally identified factors that influence service delivery throughout the year. (b) Regular annual schedule and community dissemination plan shall be identified within SFY 2017 as part of the CPWI Strategic Plan Update and submitted to Contract Manager or designee by June 15, 2017 for DSHS review. 5. Amend Section 4. Performance Work Statement e. by adding (3) as follows: (3) If special circumstances arise and Contractor is unable to enter the data by the reporting deadline(s), the Contractor shall ensure any requests for extensions to reporting deadlines are requested in writing and sent directly to the PSM via email five (5) working days before the report due date. The maximum extension request permitted is ten (10) working days. (a) Monthly Invoices submitted with active data entry extensions will be denied and may be re- submitted by Contractor once data for the month(s) in question is complete. (b) Contractors with three (3) or more consecutive months of data entry extensions or late reporting or four (4) or more program data entry extensions or late reporting within a six (6) month period shall be required to submit a Corrective Action Plan to DSHS. DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Page 2 Extensions granted due to PBPS technical issues will be excluded from this count. All other terms and conditions of this Program Agreement remain in full force and effect. DSHS Central Contracts and Legal Services 1644CS County Program Agreement Amendment (10-28-2015) Page 3 AWARD AND REVENUES 2015-2017 Biennium CONTRACTOR NAME Jefferson County CONTRACT NUMBER 1563-42479 COUNTY Jefferson The above named Contractor is hereby awarded the following amounts for the purposes listed. REVENUE SOURCE TYPE OF SERVICE CODE: 333.99.59 SABG Prevention Exhibit B AWARD AMOUNTS Biennial Total 15-17 SFY 16 SFY 17 Funds Biennium $30,098 $30,598 $60,696 334.04.6X GF -State- Admin (for SABG Prevention) $2,617 $2,617 $5,234 Total State Funds $19,981 $25,981 $0 $45,962 334.04.6X Dedicated Marijuana Account -Fund 315 -State $17,364 $23,364 $40,728 TOTAL ALL AWARDS $104,000 $110,500 $0 $214,500 333.92.43 PFS -Total $53,921 $53,921 $0 $107,842 _ Year 2 FFY14 (7.1.15-9.29.15) $13,480 $13,480 Year 3 FFY15 (9.30.15-9.29.16) $40,441 $13,480 $53,921 Year 4 FFY16 (9.30.16-6.30.17) $40,441 Total Federal Funds $84,019 $84,519 $0 $168,538 Total State Funds $19,981 $25,981 $0 $45,962 TOTAL ALL AWARDS $104,000 $110,500 $0 $214,500 Federal CFDA: SABG-Substance Abuse Block Grant -CFDA 93.959 Substance Abuse and Mental Health Services Administration (SAMHSA) PFS -Partnership for Success-CFDA 93.243 Substance Abuse and Mental Health Services Administration (SAMHSA) 2015-17 Jefferson Amend #3 615 Sheridan Street Port Townsend, WA 98368 P,6tk6on www.JeffersonCountyPublicHealth.org C"t Public Heealt Consent Agenda November 1, 2016 SA -15-07-A-3 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Julia Danskin, Public Health Manager DATE:/ �') (.Q SUBJECT: Agenda Item — Agency Agreement — Division of Behavioral Health and Recovery with DSHS A-3, September 30, 2016 — June 30, 2017; Additional $40,941 for a total of $214,500 STATEMENT OF ISSUE: Jefferson County Public Health is requesting Board approval of the Agency Agreement — Division of Behavioral Health and Recovery (DBHR) with DSHS, September 30, 2016 — June 30, 2017; Additional $40,941 for a total of $214,500. ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S: This ongoing contract with DBHR provides Federal and State funding through Substance Abuse Block Grant (SABG) CFDA 93.959, Partnership for Success CFDA 93.243 to coordinate and implement prevention programs designed to prevent or delay the misuse and abuse of alcohol, marijuana, tobacco, and other drugs among youth up to age 18 and adults ages 18-25. The DBHR contract funds Community Prevention and Wellness Initiatives and Community Coalition activities including coordination, prevention, and training based on evidence -based practices as identified in the Excellence in Prevention Strategies List. This amendment to the current contract, 1563-42479, increases the funding to SABG Prevention by $500 and increases the funding to the PFS -Total by $40,441, for a total of $40,941. FISCAL IMPACT/COST BENEFIT ANALYSIS: This contract is fully funded through Federal Substance Abuse Block Grant, CFDA 93.959 and Partnership for Success CFDA 93.243, and the state's general fund and increases by $40,941 the amount of funding for a total of $214,500. RECOMMENDATION: JCPH management request approval of the Agency Agreement — Division of Behavioral Health and Recovery with DSHS A-3 which increases the amount by $40,941, September 30, 2016 — June 30, 2017; for a total of $214,500. REVIE Phili orley, Calan Administrator Date Community alth 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 <V 615 Sheridan Street Port Townsend, WA 98368 -%j oson www.JeffersonCountyPublicHealth.org is Hea CONTRACT REVIEW FORM CONTRACT WITH: Department of Social and Health Services SA -15-07-A3 NOV 0 3 20116 CONTRACT FOR: Div. Of Behavioral Health and Recovery for TERM: 9/30/2016 - 06/30/2017 Substance Abuse Prevention #1563 -42479 - Amendment #3 COUNTY DEPARTMENT: Jefferson County Public Health I For More Information Contact: Julia Danskin Contact Phone #: X420 RETURN TO: Jenny Matter RETURN BY: ASAP -- AMOUNT: Additional $40,941 for a total of PROCESS: $214,500 Revenue: Expenditure: Matching Funds Required: Source(s) of Matching Funds: Step 1 REVIEW BY Review by: Date Revie APPROVED FORM Comments: ❑ Exempt from Bid Process ❑ Consultant Selection Process ❑ Cooperative Purchase ❑ Competitive Sealed Bid ❑ Small Work Roster ❑ Vendor List Bid ❑ RFP or RFQ ❑X Other: Continuation of services rned for revision (See Comments) Step 2: REVIEW BY PROSECUTING AMANFN Review by: �y Date Reviewed: APPROVED AS TO FORM ❑ Returne for re Ision (See Comments) Con o ments: (This form to stay with contract throughout the contract review process) 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