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nQiF.: p r <br />Kittitas County <br />Review Form <br />rnr•r rr �.• a •�� r• Yrs. <br />Grants & Contract Agreement <br />Today's Date <br />11/17/2022 PA Camas Request #: <br />Fund/Department <br />116 -Public Health Agenda Date: <br />Contract/Grant Information <br />Contract /Grant Agency: Health Care Authority -Medicaid Admatch Amendment 1 <br />Period Begin Date: January 1, 2021 <br />Total Grant/Contract Amount: Fee for Service <br />Grant/Contract Number: K4649 <br />Period End Date: December 31, 2025 <br />Contract/Grant Summary: <br />The Healthcare Authority Professional Services Contract is established to support Medicaid related <br />outreach and linkage activities performed by Kittitas County Public Health to Washington State residents <br />who live within Kittitas County. <br />Recommendation for Board <br />Department Head Signature: , <br />of Health Review on <br />, Director Date: <br />Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: <br />APPROVED AS TO FORM: <br />Signature of Prosecutor's Office Date <br />Signature of Auditor's Office <br />Date <br />Verification the Contracting Agency is not Suspended/Disbarred: <br />® Agency is not suspended/disbarred ❑ Not Checked (reason) <br />Financial Information <br />Grant/Contract Review Page 1 <br />