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Home My WebLink AboutWashington State Department of Social & Health Services, (DSHS) Division of Developmental Disabilities - 071221 313(04T 1 1336/ DSHS Agreement Number • •]+—• COUNTY 2163-23571 r PROGRAM AGREEMENT Working Advance Long-Term Payable This Program 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, which is incorporated by reference. County Agreement Number _2163-23571 DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Facilities,Finance and Financial Services 1223 8030CS-63 Analytics Administration DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Rebecca Doane PO Box 45842 Office Chief Olympia WA 98504-5842 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL (360)763-2977 Click here to enter text. rebec ca.doanelj dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County Castle Hill Center 615 Sheridan Port Townsend WA 98368-2476 COUNTY CONTACT NAME Aimee Calahan COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL Click here to enter text. acalahantco.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? No PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT 07/01/2021 06/30/2022 Based on Annual Review 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 shah be binding on DSHS only upon signature by DSHS. COUNTY SIGNATURE(S) PRINTED NAME(S)AND TITLE(S) DATE(S)SIGNED 1(./ r > DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Kerry Lynch,Contract Manager 7/23/2021 DSHS Central Contracts and Legal Services Approved as t only: July 6,2021 Philip C.Hunsucker, Date Chief Civil Deputy Prosecuting Attorney DSHS Central Contract Services 8030CS County Long-Term Payable(3-28-2017) Page 1 SPECIAL TERMS AND CONDITIONS 1. 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" (DOF) 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-Term 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-Term Payable funds if the County does not actually provide the anticipated services during the given timeframe. Long-Term Payable 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. 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: Developmental Disabilities Administration (DDA) and/or Aging and Long-Term Support Administration (ALTSA). 3. Statement of Work a. County Responsibilities (1) The County shall submit to DSHS, on forms provided by DSHS and by a date determined by DSHS, a completed Documentation of Funds form (DOF)from 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 DOF. (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 DOF submitted by the County to DSHS. Any Long-Term Payable funds not fully utilized by the County, as determined by DSHS through the DOF 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 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. DSHS Central Contract Services 8030CS County Long-Term Payable(3-28-2017) Page 2 SPECIAL TERMS AND CONDITIONS b. DSHS Responsibilities (1) DSHS shall assess the DOF 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. (2) 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. 4. 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. DSHS Central Contract Services 8030CS County Long-Term Payable(3-28-2017) Page 3 I4:/— N_ 615 Sheridan Street Port Townsend, WA 98368 .son www.JeffersonCountyPublicHealth.org Consent Agenda Public Healt JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Mark McCauley, Interim County Administrator FROM: Vicki Kirkpatrick, Director Aimee Calahan, Financial Operations Coordinator DATE: jj11111 ( DO I SUBJECT: Agenda Item — Program Agreement with DSHS for Working Advance Long- term Payable; July 1, 2021—June 30, 2022 STATEMENT OF ISSUE: Jefferson County Public Health requests Board approval of the Program Agreement with DSHS for Long-Term Payables; July 1, 2021 - June 30, 2022. ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S: The agreement advances funds, in anticipation of the actual approval of those plans filed by the Contractor (JCPH) with DSHS for the Division of Developmental Disabilities (DDD) program operated during the contract period. This agreement is governed by terms in accordance with the General Terms and Conditions between DSHS and the Contractor. FISCAL IMPACT/COST BENEFIT ANALYSIS: This contract has no fiscal impact. RECOMMENDATION: Jefferson County Public Health requests Board approval of the Program Agreement with DSHS for Long-Term Payables; July 1, 2021 —June 30, 2022. REVIEWED BY: v2 Mark McCauley, I erim County Adminis d�� Date C/ Community Health Environmental Public Health Developmental Disabilities 360-385-9444 360-385-9400 (f) 360-379-4487 360-385-9401 (f) Always working for a safer and healthier community Public Heald; CONTRACT REVIEW FORM CONTRACT WITH: DSHS-FFAA (DSHS No.2163-23571) TRACKING NO.: AD-21-021 (Contractor/Consultant) CONTRACT FOR: Working Advance Long-Term Payable TERM: 7/1/2021 -6/30/2022 COUNTY DEPARTMENT: Jefferson County Public Health For More Information Contact: Aimee Calahan Contact Phone #: x495 RETURN TO: Glenn Gilbert RETURN BY: ASAP (Person in Department) (Date) AMOUNT: $o PROCESS: ❑ Exempt from Bid Process ❑ Consultant Selection Process Revenue ❑ Cooperative Purchase Expenditure ❑ Competitive Sealed Bid Matching funds Required ❑ Small Works Roster Source(s) of Matching Funds ❑ Vendor List Bid ❑ RFP or RFQ Other-State Contract Step 1 : REVIEW BY RISK MANAGEMENT Review by: Date Reviewed: Dectoarlioatipapproved by Risk Managerft ntoirn7$6b2&2i1ion(See Comments) Comments Step 2: REVIEW BY PROSECUTING ATTORNEY Review by: Philip C. Hunsucker Date Reviewed: Chief Civil Deputy Prosecuting Attorney ❑ APPROVED AS TO FORM ❑ Returned for revision(See Comments) Comments Electronically approved as to form by PAO on 7/6/2021. State lanai saga rannnt rhan a Step 3: (If required)DEPARTMENT MAKES REVISIONS& RESUBMITS TO RISK MANAGEMENT AND PROSECUTING ATTORNEY Step 4: CONTRACTOR/CONSULTANT SIGNS APPROPRIATE NUMBER OF ORIGINALS Step 5: SUBMIT TO BOCC FOR APPROVAL Submit original Contract(s),Agenda Request,and Contract Review form. Also,please send 2 copies of just the Contract(s) (with the originals)to the BOCC Office. Place"Sign Here"markers on all places the BOCC needs to sign. MUST be in BOCC Office by 4:30 p.m.TUESDAY for the following Monday's agenda. (This form to stay with contract throughout the contract review process.)