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HomeMy WebLinkAboutHealth Care Authority Amendment (K763)Kittitas County Review Form Grants & Contract Agreement Today's Date 07/10/2017 Fund/Department 116 -Public Health Contract/Grant Information r.,�A•7i 5... U,� ,Fa Stt m rrn'.�s r nrrr� 4-11 () U C., j Agenda Date Contract /Grant Agency: Health Care Authority Amendment 2(K763) Period Begin Date: 07/01/2017 Total Grant/Contract Amount: $5075 Grant/Contract Number: Period End Date: 12/31/17 Contract/Grant Summary: The purpose of the Health Care Authority (HCA) contract outlines the Statement of Work for the Kittitas County Public Health Department to assist the HCA to reduce dental decay and improve oral health in those Medicaid -eligible children birth to six years by increasing the utilization of dental services among the population in Washington. The Health Care Authority Amendment 2 extends the period of performance, replaces the Statement of Work, and increases the total maximum consideration by $5075. Recommendation for Board of Health and Board of Health Review on Department Head Signature: Administrator Date: Kattitas County Prosecutor, Auditor, and �Board of Health Review and Comment: APPROVED AS TO FORM: lt�17&h 1;7- rr' Signatu of Prosecutor' ffice Date gnat u77 Signat r of ditor's Office Date Signature of Board of Health member Date Financial Information Grant/Contract Review Page 1 In -Kind $ Is Equipment being purchased?Who owns equipment? New Personnel being hired? Contact HR hiring — reporting requirements Future impacts or liability to Kittitas County: Budget Intormation Budget Amendment Needed? Yes E]attach budget form New Division Created? Revenue Code Pass Throuith Information No ❑ Why not Agency to Pass Through Amount to Pass Through $ Sub -Contract Approved Date: Prosecutor Review Has the Prosecutor reviewed this agreement? Yes ❑ No County Departments Impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted Signature: Department: Assignment OT TracKing Intormation Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Date: Reviewer Date Grant/Contract Review Page 2 DocuSign Envelope ID: 984F2903-5D63-4284-B7A2-A54B6EAAA057 Washington State CONTRACT HCA Contract No.: K763 {. Health Care .� utharity AMENDMENT Amendment No.: 02 ARCD Dental Services THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority and the party whose name appears below, and is effective as of the date set forth below. CONTRACTOR NAME CONTRACTOR doing business as (DBA) Kittitas County Public Health Department CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER (UBI) 507 North Nanum Street, Suite 102, Ellensburg, WA 98926 WHEREAS, HCA and Contractor previously entered into a Contract for increased utilization of dental services early in life, improved oral health, and Apple Health/Medicaid cost savings and; WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section titled Period of Performance, and; NOW THEREFORE, the parties agree that the Contract is amended as follows. 1. Section 3. Special Terms and Conditions. Statement of Work. Changes to Section 3 Statement of work is hereby replaced in its entirety with Attachment 1, 2. Section 4. Special Terms and Conditions. Consideration. The maximum consideration is hereby increased by $5075. 3. Section 5. Special Terms and Conditions. Term. The period of performance is hereby extended from July 1, 2017 through December 31, 2017. 4. Section 6. Special Terms and Conditions. Billing and Payment (a) and (b). Contractor must submit accurate invoices to the following address for all amounts to be paid by HCA via e-mail to: Acctspay@hca.wa.gov. Include the HCA Contract number in the subject line of the email. Invoices must describe and document to FICA's satisfaction a description of the work performed, the progress of the project, and fees. If expenses are invoiced, invoices must provide a detailed breakdown of each type. Any single expense in the amount of $50.00 or more must be accompanied by a receipt in order to receive reimbursement. All invoices will be reviewed and must be approved by the Contract Manager or his/her designee prior to payment. HCA Contract No. K763-02 Page 1 of 12 DocuSign Envelope ID: 984F2903-5D63-4284-67A2-A54B6EAAA057 Contractor must submit properly itemized invoices to include the following information, as applicable: HCA Contract number K763-02; Contractor name, address, phone number; Description of Services; Date(s) of delivery; Net invoice price for each item; Applicable taxes; Total invoice price; and Payment terms and any available prompt payment discount. HCA will return incorrect or incomplete invoices to the Contractor for correction and reissue. The Contract Number must appear on all invoices, bills of lading, packages, and correspondence relating to this Contract. 5. Exhibit A. ABCD Quarterly Outreach & Case Management Report, is hereby replaced in its entirety with Exhibit A2. 6. Exhibit B. Community Outreach and Coordination of Care Report, is hereby replaced in its entirety with Exhibit B-2 7. Exhibit D. Budget Tool, is hereby replaced in its entirety with Exhibit D-2. 8. HCA contact is Janice Tadeo, Dental Program Administrator at Janice.tadeo@hca.wa.gov. 9. This Amendment shall be effective July 1, 2017 ("Effective Date"). 10. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the Contract. 11. All other terms and conditions of the Contract remain unchanged and in full force and effect. The parties signing below warrant that they have read and understand this Amendment and have authority to execute the Amendment. This Amendment will be binding on HCA only upon signature by HCA. CONTRACTOR SIGNATURE PRINTED NAME,AND TITLE T I DATE SIGNED HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED HCA Contract No. K763-02 Page 2 of 12 DocuSign Envelope ID: 984F2903-5D63-4284-67A2-A54B6EAAA057 Attachment 1 Statement of Work The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: a. In accordance with deadlines in Exhibit A2, ABCD Outreach and Case Management Report, develop and implement an ABCD action plan in accordance with the ABCD program principles and submit corresponding budget, using Exhibit D2, Budget Tool. The ABCD program principles are outlined below. (1) Provide outreach and recruitment of Apple Health/Medicaid-eligible children age's birth to six (6), in collaboration with other organizations, including, but not limited to: (a) Contact no less than ten (10%) of client list provided by HCA to the Contractor; HCA shall email the Contractor's contact name identified on page 1. A list that shall include the following data elements: Client ID, name, address and telephone number of clients who have not gone to the dentist, as well the caregivers name and preferred spoken language. HCA shall securely transmit client information and the Contractor shall be responsible to notify the Dental Program Manager within five (5) business days prior to the beginning of the quarter if they have not received this information. Provide outreach by attending county health fairs, working with the smile mobile, visiting WIC offices, Headstart facilities, work with early learning coalition and visit day cares. (2) Convene Health Coalition/ABCD Steering committee or participate in a Coalition or Steering Committee focused on health care, access or early learning with ABCD as a quarterly agenda item. Provide care coordination, including: (a) Providing family orientation; including but not limited to sharing information about the value of a child going to the dentist, what activities will occur in the dentist's office; (b) Connecting families with an ABCD certified dentist who accepts Apple Health/Medicaid, and providing information including, but not limited to, names and referrals to dentists, sharing information about interpreters and transportation benefits, and following up after an appointment, if appropriate; (c) Assisting in scheduling dental appointments for eligible children and council on the importance of keeping the appointment; (d) Identify and address family barriers to accessing oral health care; and (e) Invite the ABCD program manager with Washington Dental Service Foundation and the Health Care Authority, Dental program administrator. (3) Coordinate with the local ABCD Dental Champion(s) to: (a) Identify and recruit dental providers who will take Apple Health/Medicaid clients through HCA Contract No. K763-02 Page 3 of 12 DocuSign Envelope ID: 984F2903-5D63-4284-B7A2-A54B6EAAA057 the ABCD Program; (b) Maintain a list of active ABCD providers who accept Apple Health/Medicaid clients birth to six (6) years and monitor provider availability to accept new clients birth to six (6) years into their practice; (c) Verify that the dental provider information contained in the HCA website is accurate for those providers working in the county or counties in which the Contractor provides services; Contractor shall review provider information available on the HCA "Find a Provider" website which shall be accessed to identify the ABCD provider names in the counties where the Contractor provides services. The Find a Provider website address is: https.1/fortress.wa.gov/hca/plfindgprgvider/ (A) Contractor shall generate a list(s) of ABCD providers in their county(ies) from the aforementioned website. (B) Contractor shall confirm that providers on the list generated from the HCA website are accepting new Apple Health/Medicaid clients. (C) Contractor shall use Exhibit B1, List of ABCD Dental Providers, to provide the HCA Dental Program Manager a list of providers who should be added as a dental provider for Apple Health/Medicaid eligible children. (D) Contractor shall use Exhibit C, to provide the HCA Provider Enrollment Unit the names of providers who should be removed or added to the "Find a Provider" list each quarter. (d) Support current ABCD providers by communicating program changes and policy updates through in-person meetings and written communication; (e) Provide or assist in providing new ABCD provider trainings as needed; (f) Assure certification process is completed; (g) Provide Apple Health/Medicaid billing training assistance to ABCD offices/or arrange for billing assistance; (h) Update dental society (or local dentists/study clubs in counties without a society) on the ABCD Program and encourage their continued recruitment of new Apple Health/Medicaid providers; (i) Support the Dental Champion(s) participation in meetings and activities necessary to effectively conduct Apple Health/Medicaid provider outreach, recruitment and training, including financial support of attendance in development day. (4) As appropriate, identify and recruit primary care medical providers to participate in Apple Health/Medicaid, secure their training in preventive oral health techniques and build their role in referring Apple Health/Medicaid-eligible children to the ABCD Program. This may include oral health education, fluoride treatments, etc. HCA Contract No. K763-02 Page 4 of 12 DocuSign Envelope ID: 984F2903-5D63-4284-B7A2-A54B6EAAA057 (5) Participate in statewide ABCD Coordinators group meetings to remain current with ABCD policies, practices and opportunities. (6) Identify an ABCD coordinator within the contracting organization who will develop and maintain a desk manual that outlines the expected ABCD contractual deliverables and how the contractor meets each deliverable. The coordinator will utilize this manual to fulfill the contractual requirements. If the contractor's coordinator leaves the contractor is responsible to notify the Health Care Authority within two weeks, of the coordinators departure or as soon as possible and share the contractor's developed work plan that outlines how the expected contract deliverables will be met. The contractor will share with HCA the contact information of the newly hired or appointed coordinator and coordinate with HCA to assure a smooth transition of the expected contracted work deliverables. b. Each quarter complete and submit via email; (1) Community Outreach and Coordination of Care summary, which shall include (a) Exhibit A2, ABCD Quarterly Outreach & Case Management Report for the specific quarter (b) Exhibit B2, Community Outreach and Coordination of Care Report (c) Exhibit C, List of ABCD Dental Providers (d) Exhibit D2, Budget Tool, as applicable to the requirements contained in Exhibit A (e) Exhibit E, End of Year Summary Report, as applicable to the requirements contained in Exhibit A2. (2) Reports and billing must be submitted no later than January 31, 2018, unless otherwise mutually agreed by both parties. 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