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Home My WebLink About040918_ca08t; C��rson Public Idea tli 615 Sheridan Street Port Townsend, WA 98368 www.JeffersonCountyPublicHealth.org JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Vicki Kirkpatrick, Director Yuko Umeda, Public Health Nurse DATE: q/ q l z-ot g Consent Agenda March 21, 2018 SUBJECT: Agenda Item — Amendment No. 1 — Early Intervention Program (EIP) #1763-15936 with Department of Social and Health Services; April 1, 2018- - September 30, 2018 STATEMENT OF ISSUE: Jefferson County Public Health is requesting Board approval of Amendment No. 1 to the Agreement for the Early Intervention Program (EIP) #1763-15936 with Department of Social and Health Services; April 1, 2018 — September 30, 2018 ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S: Jefferson County Public Health has contracted with Department of Social & Health Services, Division of Children & Family Services, to provide Early Intervention Services since 1990. The agreement provides services to families referred by Children's Administration, Child Protective Services, for public health nurse interventions. The purpose of this amendment is to make changes to the: 1) Special Terms and Conditions, Section 1: Definitions, 2) Exhibit B Statement of Work, Section 3: Client Eligibility and Referral for Services, and 3) Exhibit B Statement of Work, Section 10: Reports. FISCAL. IMPACTICOST BENEFIT ANALYSIS: There is no change in funding. RECOMMENDATION: JCPH management request approval of Amendment No. 1 to the Agreement for the Early Intervention Program (EIP) #1763-15936 with Department of Social and Health Services; April 1, 2018 — September 30, 2018 REVIEWED BY: f Philip Morley, Cou Ad'ministra or Community Health . Developmental Disabilities 360-385-9400 360-385-9401 (f) Date Always working for a safer and healthier community Environmental Health Water Quality 360-385-9444 (f) 360-379-4487 DSHS Agreement Number IV 1 0 A SIJ10. COUNTY PROGRAM AGREEMENT 1763-15936 117 � Department of Social I &HealthServices AMENDMENT Amendment No. 01 Transforming lives Early Intervention Program (EIP) 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 0603 - County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER Childrens Administration Division of Children and 1223 Family Services DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Dianne Thompson 1 1949 So State St MS N2730 IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM AGREEMENT? No AMENDMENT START DATE PROGRAM AGREEMENT END DATE 04/01/2018 09/30/2018 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE AMOUNT $4,025.00 $0.00 REASON FOR AMENDMENT: See Page 2 CCS CONTRACT 1223 CONTACT E-MAIL 3di(@dshs.wa.gov COUNTY CONTACT E-MAIL yumeda co.jefferson.wa.us CFDA NUMBERS TOTAL MAXIMUM PROGRAM AGREEMEN AMOUNT $4.025.00 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 (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 Program Agreement Amendment. COUNTY SIGNATURE(S) I PRINTED NAME(S) AND TITLE(S) 1 DA -I F"; ,) SIGNED DSHS SIGNATURE �roxe �a' t form: Date: Philip C. Hunsucker, Chief Civil Deputy Prosesting ttorney Jefferson County Prosecuting Attorney's Office torney PRINTED NAME AND TITLE Dianne E. Thompson, Contracts Manager DSHS Central Contracts and Legal Services 2048CS EIP County Amendment (02-22-2018) Page 1 SIGNED Tacoma, WA 98405- DSHS CONTACT TELEPHONE DSHS CONTACT FAX (253) 983-6266 2531983-6433 COUNTY NAME COUNTY ADDRESS Jefferson County 615 Sheridan St Port Townsend, WA 98368 - COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Yuko Umeda COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX (360) 385-9416 1 (360) 385-9401 IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM AGREEMENT? No AMENDMENT START DATE PROGRAM AGREEMENT END DATE 04/01/2018 09/30/2018 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE AMOUNT $4,025.00 $0.00 REASON FOR AMENDMENT: See Page 2 CCS CONTRACT 1223 CONTACT E-MAIL 3di(@dshs.wa.gov COUNTY CONTACT E-MAIL yumeda co.jefferson.wa.us CFDA NUMBERS TOTAL MAXIMUM PROGRAM AGREEMEN AMOUNT $4.025.00 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 (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 Program Agreement Amendment. COUNTY SIGNATURE(S) I PRINTED NAME(S) AND TITLE(S) 1 DA -I F"; ,) SIGNED DSHS SIGNATURE �roxe �a' t form: Date: Philip C. Hunsucker, Chief Civil Deputy Prosesting ttorney Jefferson County Prosecuting Attorney's Office torney PRINTED NAME AND TITLE Dianne E. Thompson, Contracts Manager DSHS Central Contracts and Legal Services 2048CS EIP County Amendment (02-22-2018) Page 1 SIGNED This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS) is hereby amended as follows: Purpose: The purpose of this Contract Amendment is to make changes to the Special Terms and Conditions, and Exhibit B Statement of Work. The Special Terms and Conditions, Section 1. Definitions is amended as follows: a. "CFWS" definition is deleted in its entirety. b. The following definition is added to Section 1.: "Apple Health Core Connections" means the Medicaid health provider for all children placed with Children's Administration. Exhibit B — Statement of Work is amended as follows: a. Section 3, Client Eligibility and Referral for Services is amended as follows: (1) Subsections a. Eligibility (1) (c) and (h) are deleted. (2) Subsection b. Referrals (1) (c) is added as follows: (c) If a child moves from receiving services in their own home during an CPS case to an out of home placement with CA, the Contractor shall coordinate and transfer all treatment plans and activities to Apple Health Core Connections Coordinated Care within ten (10) days of the child's placement. (3) Subsection b. Referrals (2) (c) is deleted in its entirety and replaced with the following: (c) If a child moves from receiving services in their own home during an FVS case to an out of home placement with CA, the Contractor shall coordinate and transfer all treatment plans and activities to Apple Health Core Connections Coordinated Care within ten (10) days of the child's placement. (4) Subsection b. Referrals (3): Open Child and Famil, Weifare Services CFWS Cases is deleted in its entirety. b. Section 10, Reports, deleted in its entirety and replaced with the following: a. Written reports must be submitted by secure email to the DSHS contacts identified below. The DSHS Secure E-mail User Guide is available at: http://www.dshs.wa,clov/ca/partners/intro.asp b. Monthly service summary, a summary of services provided to a family sent to the assigned CA worker., in a format provided by CA. c. The Contractor shall submit the following monthly reports, in a format prescribed by CA as instructed below, unless specified differently in the regional protocol: DSHS Central Contracts and Legal Services 2048CS EIP County Amendment (02-22-2018) Page 2 EIP Contractor Reports 1. EIP Monthly Report 2. EIP Monthly Service Report 3. Ninety (90) Day Review 4. Exit Summary 5. Annual (Contract period) roll -up report to include: a. # of referrals b. # of unduplicated children served c. # of unduplicated families (cases) served d. # of families (cases) exited from EIP for: (1) # of families -Provider unable to make contact (2) # of families -Provider determined family does not need EIP (3) # of families - Family refused services (4) # of families -Family was referred to another program within CA (5) # of families - Service were completed DSHS Central Contracts and Legal Services 2048CS EIP County Amendment (02-22-2018) Submit to: 1 electronic copy to the EIP CA regional liaison Name: Laneta Able Email: laneta.able@dshs.wa.gov 1 electronic copy to the EIP CA headquarters liaison Tim Kelly, In -Home Services Program Manager ti m. kel IvCadsh s.wa. q ov 1 electronic copy to the assigned CA Social Service Specialist 1 copy of each to the assigned CA Social Service Specialist 1 electronic copy to the EIP CA regional liaison (as above) 1 electronic copy to the EIP headquarters liaison (as above) Due Date By the 15th of the month for services provided in the previous month. By the 15th of the month for services provided in the previous month. By the 15th of the month for services provided in the previous month. By the 15th of July each year of the contract. Page 3 (6) # of families - Provider referred EIP case back to CPS as higher risk (7) # of families — re- referral and accepted for investigation e. # of cases with another CPS referral received while family was participating in EIP f. # of families enrolled in community resource and referral services g. # of families enrolled in Family Engagement Services h. Of total # of families, what % improved KBS scores in caretaking and parenting over time d. DSHS may stop payment to the Contractor if reports required under this Contract are delinquent or incomplete. e. Additional Data. DSHS may request additional measurable service and outcome data for services provided. In the event DSHS so requests, DSHS commits to work with the Contractor to develop data elements. If so requested, the Contractor agrees to provide data collection in a manner prescribed by DSHS. All other terms and conditions of this Program Agreement remain in full force and effect. DSHS Central Contracts and Legal Services 2048CS EIP County Amendment (02-22-2018) Page 4