HomeMy WebLinkAboutHCA Amendment 32 (K763)M1g[ M1�7�'•_ [�y�
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
07/28/2017
Fund/Department
116 -Public Health
Contract/Grant Information
Agenda Date
Contract /Grant Agency: Health Care Authority Amendment 2(K763)
Period Begin Date: 07/01/2017 1 1Period End Date: 12/31/17
Total Grant/Contract Amount: $4750.00
Grant/Contract Number:
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 $4750.00.
Recommendation for Board of Health and Board of Health Review on
Department Head Signature: _ , Administrator Date:_
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM:
Signature of Prosecutor's Office Date
Signature of Auditor's Office Date
Signature of Board of Health member
Date
Financial Information
Total Amount $4750.00 State Funds $2375.00 Federal Funds $2375.00
Percentage County Funds Matching Funds $ CFDA#93.778 f
Grant/Contract Review Page 1
In -Kind $
Explain
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? I Yes ❑ attach budget form
New Division Created?
Revenue Code
116-612.24.1.333.93.778 - $2375.00
116-612.24.1.334.06.901- $2375.00
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
No ❑X Why not
Included in 2017 budget
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes❑ No ❑
County Departments Impacted
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
.... ._....
Reviewer Date
Grant/Contract Review Page 2
Auditor
Facilities Maintenance
Information Services
Human Resource
Prosecutor
Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
.... ._....
Reviewer Date
Grant/Contract Review Page 2
Washington State
Health Care uthority
CONTRACT AMENDMENT HCA Contract No.: K763
ABCD Dental Services
Amendment No.: 02
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
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 $4,750.
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 HCA'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
Contractor must submit properly itemized invoices to include the following information, as
applicable:
HCA Contract number; K763-03
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, Al and A2. ABCD Quarterly Outreach & Case Management Report, is hereby
replaced in its entirety with Exhibit A3.
6. Exhibit B, B1 and B2. Community Outreach and Coordination of Care Report, is hereby
replaced in its entirety with Exhibit B3.
7. Exhibit D, D1 and D2. Budget Tool, is hereby replaced in its entirety with Exhibit D3.
8. HCA contact is Janice Tadeo, Dental Program Administrator at Janice.tadeo(ahca_wa.qov
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
DATE SIGNED
HCA SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
HCA Contract NoX763-02 Page 2 of 12
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 A3, 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 D3, 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 caregiver's 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 NoX763-02 Page 3 of 12
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: htt s:lffortress.wa. ov/hcal lfindaprovider/
(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 B3, 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 C1 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
(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 A3, ABCD Quarterly Outreach & Case Management Report for the specific
quarter
(b) Exhibit B3, Community Outreach and Coordination of Care Report
(c) Exhibit C1, List of ABCD Dental Providers
(d) Exhibit D3, Budget Tool, as applicable to the requirements contained in Exhibit A3
(e) Exhibit E, End of Year Summary Report, as applicable to the requirements contained in
Exhibit A3.
(2) Reports and billing must be submitted no later than January 31, 2018, unless otherwise
mutually agreed by both parties.
HCA Contract NoX763-02 Page 6 of 12
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