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SPECIAL TERMS AND CONDITIONS <br /> <br />DSHS Central Contract Services <br />8030CS County Long-Term Payable (3-28-2017) Page 2 <br />1. Definitions <br />a. “Commingle” is the act of mixing the funds and/or Long -Term Payables for one program with the <br />funds of another program. <br />b. “Documentation of Funds form” (DOF) is a form provided to the County each year by DSHS on <br />which the County records qualifying previous year expenditures from which DSHS can appraise <br />and evaluate the amount of the existing Long -Term Payable or appropriate adjustments. <br />c. “Long-Term Payable” means funds provided by DSHS to the County in anticipation of specific client <br />services provided by the County. The County shall not be allowed to retain any overage <br />of the Long-Term Payable funds if the County does not actually provide the anticipated services <br />during the given timeframe. Long-Term Payable funds are to be reconciled by April 30 of each <br />year and any funds not fully utilized shall be refunded to DSHS by May 31 of each year. <br />2. Purpose <br />a. It is the purpose of this Agreement to specify the procedure by which DSHS will assess and, if <br />necessary, adjust the Long-Term Payable it provides to the County. <br />b. Funds to support contracts for the following DSHS programs may be included in a Long -Term <br />Payable: Developmental Disabilities Administration (DDA) and/or Aging and Long-Term Support <br />Administration (ALTSA). <br />3. Statement of Work <br />a. County Responsibilities <br />(1) The County shall submit to DSHS, on forms provided by DSHS and by a date determined by <br />DSHS, a completed Documentation of Funds form (DOF) from which DSHS shall assess <br />whether or not an adjustment to the amount of the Long -Term Payable provided to the County is <br />warranted. <br />(2) The County shall exclude all amounts related to its Prepaid Inpatient Health Plan expenditures <br />from its DOF. <br />(3) The County shall repay to DSHS all of the Long -Term Payable funds received from DSHS that <br />exceed the amount that DSHS determines is warranted. Repayment requirements shall be <br />based upon DSHS assessment of the most recent annual DOF submitted by the County to <br />DSHS. Any Long-Term Payable funds not fully utilized by the County, as determined by DSHS <br />through the DOF process, shall be refunded to DSHS by May 31 of each year. <br />(4) The County shall only utilize Long -Term Payable funds for the DSHS program or service for <br />which the funds were originally designated. Long -Term Payable funds may not be commingled <br />between or among programs or services. <br />(5) Any interest the County earns on the Long -Term Payable funds shall only be utilized for the <br />DSHS programs or services for which the funds were originally designated. Long -Term Payable <br />interest shall not be used for programs or services unrelated to the client services anticipated by <br />this Agreement. <br />(6) The County shall record the Long -Term Payables in its financial records.