Laserfiche WebLink
DocuSign Envelope ID: 262ABA18-5354-4F41-9508-9B13CBACBA6D <br />Washington State <br />Health Care <br />uthoriry <br />INTERAGENCY <br />for <br />AGREEMENT <br />MEDICAID ADMINISTRATIVE HCA Contract Number: K4649 <br />CLAIMING <br />THIS AGREEMENT is made by and between Washington State Health Care Authority (HCA) and Kittitas County Health <br />Department, (Contractor), pursuant to the authority granted by Chapter 39.34 RCW. <br />CONTRACTOR NAME CONTRACTOR DOING BUSINESS AS (DBA) <br />Kittitas County Health Department <br />CONTRACTOR ADDRESS I Street j Citv State Zip Code <br />507 North Nanum Street, Suite #102 Ellensburg WA 98926 <br />CONTRACTOR CONTRACT CONTRACTOR TELEPHONE CONTRACTOR E-MAIL ADDRESS <br />Candi Blackford 1 (509) 933 8203 1 candi.blackford@co.kittitas.wa. <br />HCA PROGRAM <br />Medicaid Administrative Claiming (MAC) <br />HCA DIVISION/SECTION <br />Medicaid Programs Operations & Integrity / <br />Community Services <br />HCA CONTRACT MANAGER ADDRESS <br />HCA CONTRACT MANAPER NAME AND TITLE <br />Jon Brogger, <br />Health Care Authority <br />626 8th Avenue SE <br />Medical Assistance Program Specialist <br />DTE <br />oncuSignea by! <br />PO Box 45530 <br />11/3/2020 <br />Olympia, WA 98504-5530 <br />HCA CONTRACT MANAGER TELEPHONE <br />HCA CONTRACT MANAGER E-MAIL ADDRESS <br />(360) 725-1647 <br />jon.brogger@hca.wa.gov <br />CONTRACT START DATE CONTRACT END DATE TOTAL MAXIMUM CONTRACT AMOUNT <br />January 1, 2021 December 31, 2022 No Maximum <br />PURPOSE OF CONTRACT: <br />The purpose of this Contract is to support Medicaid related outreach and linkage activities performed by Local Health <br />Jurisdictions (LHJ) to Washington State residents who live within its jurisdiction. These activities assist residents who <br />have no or inadequate medical coverage, and includes explaining the benefits of the Medicaid program, assisting them <br />in the Medicaid application and renewal processes, and linking them to Medicaid covered services. This Agreement <br />provides a process for partially reimbursing the Contractor for allowable and reasonable expenses associated with the <br />time its staff spend performing Medicaid Administrative Claiming (MAC) activities. <br />The parties signing below warrant that they have read and understand this Contract, and have authority to <br />execute this Contract. This Contract will be binding on HCA only upon signature by HCA. <br />CONTRACTOR )GNATURE <br />PRINTED NAME AND TITLE <br />DATE <br />HCA <br />HCA S{GNATU E V <br />15RINTED AME AND TITLE <br />DTE <br />oncuSignea by! <br />Annette schuffenhauer <br />11/3/2020 <br />chief Legal officer <br />7 tF 17Fc W774E7 <br />Washington State Page 1 of 53 HCA IAA K4649 <br />Health Care Authority Revised 10/2020 <br />