HomeMy WebLinkAbout112017_ca03615 Sheridan Street
Port Townsend, WA 98368
www.JeffersonCountyPublicHealth.org
Public Healt Consent Agenda
November 1, 2017
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, Developmental Disabilities Coordinator
DATE: I I'x�?01
SUBJECT: Agenda Item — Amendment No. 1 with Department of Social and
Health Services for Developmental Disabilities Administration, (DDA);
July 1, 2017 — June 30, 2018; additional $5,342 for a total of $297,272
STATEMENT OF ISSUE:
Jefferson County Public Health, Developmental Disabilities Division, is requesting Board approval of
amendment No. 1 with Department of Social and Health Services for Developmental Disabilities
Administration, (DDA); July 1, 2017 — June 30, 2018; additional $5,342 for a total of $297,272
ANALYSIS STRATEGIC GOALS PRO'S and CON'S:
This amendment adds funding for the continuation of services with DSHS for services to clients with
developmental disabilities in Jefferson County. The developmental disabilities program services provide
educational opportunities for life-long learning and training to a specific workforce that allows interactions,
equal opportunity, and integrated participation with non -disabled community members.
FISCAL IMPACT COST BENEFIT ANALYSIS:
This is a contract with the Department of Social and Health Services and includes both State and Waiver
revenue. This revenue will be used to support programs in the Developmental Disabilities Programs. There
is no impact to the general fund.
RECOMMENDATION:
JCPH management request approval of t amendment No. 1 with Department of Social and Health
Services for Developmental Disabilities Administration, (DDA); July 1, 2017 — June 30, 2018; additional
$5,342 for a total of $297,272
REVIEWED BY:
l�3 l7
Philip Morley, County inistratar� 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
r DSHS CONTRACT NUMBER:
CONTRACT AMENDMENT 1763-96185
Wnahi !orc Smlr
sacin`Rr �srr ; DDA Count Services
y Amendment No. 01
i
This Contract Amendment is between the State of Washington Department of Program Contract Number
Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Jefferson County
Jefferson CountyDD_A County Services
CONTRACTOR ADDRESS
WASHINGTON UNIFORM BUSINESS
DSHS INDEX NUMBER
IDENTIFIER (UBI)
615 Sheridan St
Port Townsend, WA 98368-
161-001-169
1223
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
Anna McEnr
360 385-9410 360 385-0073
amcene co.'efferson.wa.us
DSHS ADMINISTRATION
DSHS DIVISION DSHS CONTRACT CODE
Developmental Disabilities Admin
Division of Developmental 1769CS-63
Disabilities
DSHS CONTACT ADDRESS
DSHS CONTACT NAME AND TITLE
Wendi Winchel
PO BOX 45315
Business Manager
Olympia, WA 9850_4-5315
_Regional
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL ADDRESS
_360) 725-42641.(360)586-6502
winchwa@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
07/01/2017 06/30/2018
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$291,930.00 $5,342.00 $297,272.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT MAXIMUM CONTRACT AMOUNT
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference:
® Additional Exhibits (specifyi : Exhibit B1 -Program Agreement Budget
This Contract 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 Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or
bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing
below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
CONTRACTOR SIGNATURE
PRIN E NAME AND TIT
Vct:.1,1-J01_7 i1.e.C.I na,
DATE SIGNED
50 -�C (Zn Court 4 60mmi S'lW IV
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Melissa Diebert. Contracts Manager
e
c�!ea�
-• C�._ Date:
Philip C. Hunsucker, Chief Civ I Deputy Prosecuting Attomey
Jefferson County Prosecuting Attorney's Office
DSHS Central Contract Services Page 1
6024PF Contract Amendment (3-31-06)
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
A. Contract maximum amount is increased by $5,342 for a new contract maximum total of $297,272.
B. Exhibit B, Program Agreement Budget, is revised and replaced by Exhibit B-1, Program Agreement
Budget, which is attached hereto and incorporated herein.
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services Page 2
6024PF Contract Amendment (3-31-06)
Exhibit B1
Program Agreement Budget
Original Budget XXX Budget Revision
REVENUES
Fiscal
Year
Fund Source
Ori inal1St
Revision
2nd Revision
3rd Revision
2018
State only
$155,562
$158,421
$18,175
Waiver
Waiver
Local
Local
Medicaid Match to Local
Medicaid Match to Local
$15,809
Total Rev. $
$
Total Rev.
$291,930
$297,272
$
$
$121,920
$121,920
$243,84
0
Fiscal
Year
Fund Source Original
1 st Revision
2nd Revision
3rd Revision
2019
State
OTHER CONSUMER SUPPORTS
(CMIS/AWA Code 31, 32, 41, 92,
93,94)
$9,996
$8,179
$18,175
Waiver
Local
Medicaid Match to Local
$15,809
Total Rev. $
$
$
$
MEDICAID CLIENTS
$121,920
$121,920
COUNTY FY 18 SPENDING PLAN
DSHS Central Contract Services Page 3
6024PF Contract Amendment (3-31-06)
Planned
Local PASRR
Funds Funds
Expenditures
Medicaid
State Funds Funds TOTAL
ADMINISTRATION (CMIS/AWA
BARS 11)
$10,696
$8,752
$19,448
OTHER CONSUMER SUPPORTS
(CMIS/AWA Code 31, 32, 41, 92,
93,94)
$9,996
$8,179
$18,175
CONSUMER SUPPORT
STATE -ONLY
Child Development
$15,809
$15,809
MEDICAID CLIENTS
$121,920
$121,920
$243,84
0
ROADS to COMMUNITY LIVING
66,
TOTAL
$158,421
$138,851
$297,272
DSHS Central Contract Services Page 3
6024PF Contract Amendment (3-31-06)