HomeMy WebLinkAboutDSHS Advance FundsCOUNTY
PROGRAM AGREEMENT
Working Advance Long-Term Payable
This Program Agreement ',s by and betWeen the State of Washington Department of
Social and Health Services (DSHS) and the County identified below , and is issued in
conjunction with a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference .
DSHS Ag reement Number
1763-88849
Administration or Division
Agreement Number
County Agreement Number
DSHS ADMINISTRATION
Executive Administration
DSHS 'DIVISIQN DSHS INDEX NUMBER DSHS CONTRACT CODE
Operation Support and 1225 8030CS-63
DSHS CONTACT NAME AND TITLE
Angela Williams
Contracts Supervisor
Services Division
. DSHS CONTACT ADDRESS --
1115 S Washjngton St
Olympia WA 98504-5811
OSHS COtiiTACTTELEPHQNE
(360) 664~6046 I DSHS CONTACT FAX
(360) 664-6184
I DSHS CONTACTE.·MAiL
J williah@~shs.wa.gov
COlJ~NAME
Kittitas County
JUdy Pless -
'COUNTY AODRESS
County Auditors Office
205 West 5th Ave County Courthouse Ste 105
Eilensburg WA 98926
· COUNTY OElNT/(CTTElEP.HONE I C9~TY C,€!NTACT FAX
· (509) 962-7502 (SP9 962-7687 I COUliIlY,CONTACiE-MAIL
·iiJ~y.pJE$S@co.k.jttitas .wa.lJs
· IS THECOUNTY A SUBRECIPIENT F·OR PURP0$ESOF THIS PROGRAM
AGREEMENT?
No _
. CFDA NUMBERS
PROGRAM AGREEMENT START DATE I PROGRAM AGREEMENT ENcrOATE Mf\XlMUM PROGRAM AGREEMENT AMOUNT
07/01 /2017 _ 06/3U/,2018 Bas~d on Annual Review
The terms ariC! conaitions jjf this C.ontract are an integration and representation of the final, entire and exclusive
understanding between the parties supersed ing and merging all previous agreements , writings, and communications, oral
or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and
understand this Contract, and have th e authority to execute this Contract. This Contract shall be binding on DSHS only
upon signature bY ,DSHS.
PRINTED NAME({),AND TlTLE($) DATE(S) SIGNED
J../ /1£//7
PRINTED NAME AND TITLE DAlE SIGNED
4-/ "Z4} )1-
DS~G!lATURE -__
(~ Angie Williams, Contract Manager
DSHS C.entral Contracts and LeQa l Services
DSHS Central Contract Services
8030CS county Long-Term Payable (3·28-2017) Page 1
SPECIAL TERMS AND CONDITIONS
1. Definitions
a. "Commingle" is the act of mixing the funds and/or Long-Term Payables for one program with the
funds of another program.
b. "Documentation of Funds form" (DOF) is a form provided to the County each year by DSHS on
which the County records qualifying previous year expenditures from which OSHS can appraise
and evaluate the amount of the existing Long-Term Payable or appropriate adjustments.
c. "Long-Term Payable" means funds provided by DSHS to the County in anticipation of specific client
services provided by the County. The County shall not be allowed to retain any overage
of the Long-Term Payable funds if the County does not actually provide the anticipated services
during the given timeframe. Long-Term Payable funds are to be reconciled by April 30 of each
year and any funds not fully utilized shall be refunded to DSHS by May 31 of each year.
2. Purpose
a . It is the purpose of this Agreement to specify the procedure by which DSHS will assess and , if
necessary, adjust the Long-Term Payable it provides to the County.
b. Funds to support contracts for the following DSHS programs may be included in a Long-Term
Payable: Developmental Disabilities Administration (DDA) and/or Aging and Long-Term Support
Administration (AL TSA).
3. Statement of Work
a. County Responsibilities
(1) The County s hall su bmit to DSHS, on forms provided by DS HS and by a date determine d by
DSHS, a com pleted Do cume·ntation of Funds form (OOF) f rom which DSHS shall assess
whether or not an adjustment to the amount of the Long-Term Payable provided to the County is
warranted.
(2) The County shall exclude all amounts related to its Prepaid Inpatient Health Plan expenditures
from its DO F.
(3) The County shall repay to OSHS all of the Long-Term Payable funds received from DSHS that
exceed the amount that DSHS determines is warranted. Repayment requirements shall be
based upon DSHS assessment of the most recent annual DOF submitted by the County to
DSHS. Any long-Term Payable funds not fully utilized by the County , as determined by DSHS
through the OOF process, shall be refunded to OSHS by May 31 of each year.
(4) The County shall only utilize long-Term Payable funds for the DSHS program or service for
which the funds were originally deSignated. Long-Term Payable funds may not be commingled
between or among programs or services .
(5) Any Interest the County earns on the Long-Term Payable funds shall only be utilized for the
DSHS programs or services for which the funds were originally designated. Long-Term Payable
interest shall not be used for programs or services unrelated to the client services anticipated by
this Agreement.
(6) The County shall record the Long-Term Payables in its financial records.
DSHS Central Contract Services
8030CS County Long-Term Payable (3·28-2017) Page 2
SPECIAL TERMS AND CONDITIONS
b. DSHS Responsibilities
(1) DSHS shall assess the DOF submitted by the County to determine if, during the term ofthis
Agreement, any adjustment to the original two month Long-Term Payable provided to the
County is warranted.
(2) Adjustment may include DSHS request for repayment by County of any Long-Term Payable
amounts previously paid to County that are in excess of the amount currently warranted.
4. Termination
In the event that this Agreement, or a program contract listed in 2.b. above, is terminated prior to
completion, DSHS shall take all available steps to recover any Long-Term Payable determined to be an
overpayment and the County shall fully cooperate during the recovery process.
DSHS Central Contract Services
8030CS County Long-Term Payable (3-28-2017) Page 3