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DSHS DDD Services Agreement Amendment 2 01.01.2023-06.30.2023
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2023-05-16 10:00 AM - Commissioners' Agenda
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DSHS DDD Services Agreement Amendment 2 01.01.2023-06.30.2023
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Last modified
5/11/2023 12:11:22 PM
Creation date
5/11/2023 12:10:14 PM
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Meeting
Date
5/16/2023
Meeting title
Commissioners' Agenda
Location
Commissioners' Auditorium
Address
205 West 5th Room 109 - Ellensburg
Meeting type
Regular
Meeting document type
Supporting documentation
Supplemental fields
Item
Request to Approve Amendment No. 2 between the Department of Social & Health Services, Division of Developmental Disabilities and Kittitas County
Order
11
Placement
Consent Agenda
Row ID
103113
Type
Contract
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Exhibit B1 <br />Program Agreement Budget <br />Original Budget X Budget Revision <br />REVENUES <br />Fiscal <br />Year Fund Source Original 16*Revision 2nd Revision 3rd Revision <br />2022 State only 316,726 <br />Medicaid 313,916 <br />Total Rev.$630,642 $$$ <br />Fiscal <br />Year Fund Source Original 1st Revision 2nd Revision 3rd Revision <br />2023 State only 316,726 392,273 <br />Medicaid 313,916 328,125 <br />Total Rev.$630,642 $720,398 $$ <br />FY22 <br />Job Foundation <br />Funds PASRR Medicaid <br />Funds State Funds Funds TOTAL <br />ADMINISTRATION 336(CMIS/AWA BARS 11)22494 18405 41,235 <br />OTHER CONSUMER <br />SUPPORTS <br />(CMIS/AWA Code 31,336 <br />32,41,92,93,94)21023 17200 38,559 <br />CONSUMER -r <br />SUPPORT <br />STATE-ONLY <br />Child Development <br />MEDICAID CLIENTS 4800 273024 273024 550,848 <br />ROADS to <br />COMMUNITY LIVING <br />TOTAL 5,472 316,541 308,629 630,642 <br />DSHS Central Contract Services <br />1769CP Contract Amendment (12-10-21)Page 18
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