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DSHS Program Agreement Amendment
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2022-07-19 10:00 AM - Commissioners' Agenda
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DSHS Program Agreement Amendment
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Last modified
11/30/2022 8:10:18 AM
Creation date
11/30/2022 8:10:11 AM
Metadata
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Template:
Meeting
Date
7/19/2022
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Fully Executed Version
Supplemental fields
Item
Request to Approve an Amendment to the Program Agreement between the State of Washington Department of Social & Health Services Developmental Disabilities Administration and Kittitas County
Order
5
Placement
Consent Agenda
Row ID
91496
Type
Agreement
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Exhibit B1 <br />Program Agreement Budget <br />Original Budget X Budget Revision <br />REVENUES <br />FY22 <br />TOTAL <br />DSHS Central Contract Services <br />1 769CP Contract Amendment (12-10-21) <br />Fiscal <br />Year Fund Source Oriqinal l.tRevision 2nd Revision 3rd Revision <br />2022 State onlv 316,726 <br />Medicaid 313.916 <br />TotalRev $630,642 $$$ <br />Fiscal <br />Year Fund Source Original lstRevision 2nd Revision 3'd Revision <br />2023 State only 316,726 <br />Medicaid 313,916 <br />TotalRev $630,642 $$$ <br />Job Foundation <br />Funds PASRR <br />Funds State Funds <br />Medicaid <br />Funds TOTAL <br />ADMINISTRATION <br />(cMrs/AWA BARS 11) <br />336 <br />22494 1 8405 4',| <br />OTHER CONSUMER <br />SUPPORTS <br />(CMIS/AWA Code 31, <br />32,41,92.93.94) <br />336 <br />21023 38.559CONSUMER <br />SUP <br />STATE-ONLY <br />Child Development <br />MEDICAID CLIENTS 4800 550.848 <br />ROADS to <br />COMMUNITY LIV]NG <br />64263'l 541 629 <br />Page 5
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