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This Program Agreement between the County and the State of Washington Department of Social and Health <br />Services (DSHS) is hereby amended as follows: <br />1. The Total Maximum Gontract Amount is hereby increased in the amount of $263,603, for a new <br />Contract Amount of $1,1 18,442. <br />2. Sectlon 8, Billing and Payment: <br />a. Program Administration: The County will provide program administration and coordination including <br />such activities as planning, budgeting, contracting, monitoring, and evaluation. Monthly claims for <br />administration can be 1112 ol the maximum amount identified in Exhibit B under Administration or <br />for the actual costs incurred in the given month but the total Administration billed will be the lesser <br />of the two. Administration cost reimbursement will not exceed 10% unless the Assistant Secretary <br />of DDA approves a request for an exception under chapter 388-850 WAC. <br />b. Preadmission Screening and Resident Review (PASRR)Administration: The County may billfor <br />administration costs as identified in Exhibit B. Monthly claims for administration cost will be based <br />on the actual PASRR expenditures multiplied by 10%. <br />3. Exhibit B. Program Agreement Budget is hereby replaced with the following Exhibit Bl, Program <br />Agreement Budget, <br />All other terms and conditions of this Program Agreement remain in full force and effect. <br />Exhibit B1 <br />Program Agreement Budget <br />Original Budget X Budget Revision <br />REVENUES <br />DSHS Central Contract Services <br />1769CP Contract Amendment (4-12-23) <br />Fiscal <br />Year Fund Source Orioinal l"tRevision 2nd Revision 3rd Revision <br />2024 State onlv 431,255 563,959 <br />Medicaid 423.584 554.483 <br />TotalRev $854.839 $1.118.442 $$ <br />Fiscal <br />Year Fund Source Oriqinal 1st Revision 2nd Revision 3rd Revision <br />2025 State onlv <br />Medicaid <br />Total Rev $$ <br />Page 2