Kittitas County DDA County Services Amendment 3

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This Contract between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: 1. The Total Maximum Contract Amount is hereby increased in the amount of $801,577 for a new Contract Amount of $1,628,424. 2. The Program Agreement end date is extended to June 30, 2019. 3. Special Terms and Conditions, Section 8, Billing and Payment is amended as follows: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDA as costs incurred by the program for: Program Administration : The County will provide program administration and may bill for administrative costs up to the identified amount in Exhibit B. Administrative costs reimbursement will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer Support services unless millage has been declared or the Assistant Secretary of DDA approves a request for an exception under Chapter 388-850 WAC. Monthly claims for administrative costs will be for allowable expenditures incurred or 1/12 of the maximum Administration amount identified in Exhibit B, or the lessor of the two. 4. Exhibit B. Program Agreement Budget is hereby replaced with the following Budget Revision: All other terms and conditions of this Contract remain in full force and effect. EXHIBIT B Program Agreement Budget ❑ Original Budget X Budget Revision REVENUES Fiscal f Year Fund Source Original 1 St Revision 2"d Revision 2018 State Only 413,416 421,051 Waiver Local ............. _ Medicaid Match to Local Total Rev. $820,341 $835,289 $826,847 3rd Revision Fiscal Year Fund Source Original 1st Revision 2nd Revision 3rd Revision 2019 State Only 408,462 Waiver Local Medicaid Match to Local Total Rev. $801,577 DSHS Central Contract Services Page 2 6024PF Contract Amendment (1-26-2018)