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Today's Date <br />02/15/2018 <br />Fund/Department <br />116-Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date 3/ & J /0 <br />Contract/Grant Information <br />Contract /Grant Agency: Washington State Association of Local Public Health Officials and Kittitas County <br />Public Health Department <br />Period Begin Date: January 1, 2017 l J Period End Date: December 31,2018 <br />Total Grant/Contract Amount: $2,000.00 (approximately) <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The purpose ofthis AGREEMENT is to facilitate the operation of a statewide Random Moment Time <br />Survey that complies with the requirements of the LHJs' Cost Allocation Plan approved by the Centers <br />for Medicare and Medicaid Services (MAC), and the MAC contract between HCA and each participating <br />LHJ. The Agreement will also assist in oversight activities of the Health Care Authority (HCA) working <br />with the LHJ MAC Steering Committee to provide coordination and program compliance among <br />participating LHJs. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: ~ , Administrator Date : 3t I) U C; <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APP ROVED AS TO FORM: <br />Date <br />Date <br />Signature of Board of Health member Date <br />Grant/Contract Review Page 1