HomeMy WebLinkAboutDSHS 1563-43842 No.01I DSHS CONTRACT NUMBER:
CONTRACT AMENDMENT 1563-43842 ~~.,~."'." OEI'~R.T . £NT OF
Amendment No. soc l~Uv1~}TH 01
I
This Contract Amendment is between the State of Washington Department of Program Contract Number
Social -and Health Services (DSHS) and the Contractor itleritifiedoelow. Click -here·to enter text .
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as (DBA)
Kittitas County
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
IDENTIFIER (UBI)
507 North Nanum Street Suite 102
EliensburQ, WA 98926-192-002-673 1225
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Dave Wilson (509) 925-9821 (509) 837-7700 davew@meritresources .org
DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE
Behavioral Health and Service Integration Division of Behavioral Health 1647CS-63
and Recovery
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Melinda Trujillo Sky Valley CSO
Program Manager 19705 SR 2
Monroe, WA 98272
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
(360)805-8362 (360) 794-1334 melinda. trujillo_@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
10101/2015 03/31/2016
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$219,646.00 $0 .00 $219,646 .00
REASON FOR AMENDMENT;
CHANGE OR CORRECT CONTRACT TERMS OR SOW, SEE PAGE TWO
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference :
~ Additional Exhibits (specify): Exhibit B: Awards and Revenues
This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms
and conditions agreed upon by the parties as changes to the original Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or
bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing
below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
~NATUR E _/;)
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DSHS SIGNATURE
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DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
PRINTED NAME AND TITLE DATE SIGNED
i.I
Obie O'Brien, Chairman Board Commissioners 21/~/Zo/f...,
~INTL NAME AND T ITLE ~~~~~~ D1J~~/1.
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This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1. Section 1. Definitions Specific to Special Terms is amended by adding the following two (2) terms.
Recovery Care P lan (R CP): An individualized planjhat sets specific goals and outcomes for an
individual's or their family 's needs based on individual assessment that considers 1) the needs of
the individual and/or their families; 2) the extent to which there are recovery support services, health
and human services, housing services, and 3) the extent of available resources.
Re covery Sup po rt Servi ces (RSS): A broad range of nonclinical services that assist individuals and
families to initiate, stabilize, and maintain long -term recovery from sUbstance use.
2. Section 5. Reciprocity is amended by removing the phrase "and distance standards" from the first
sentence.
3. Section 6. Requirements subsection g .(3). is amended by removing "R34" from the first sentence.
4. Section 8: Statement of Work is amended as follows :
a. Subsection k.(1 ).(b). is amended to read "Women who are postpartum during the first year after
pregnancy completion regardless of the outcome of the pregnancy or placement of children ."
b. A new subsection "aa." Is added to read
aa. RCP must demonstrate shared decision-making between the individual and the RSS provider.
The plan must also document progress and a final interview regarding service impact on their
recovery goal at the time of program discharge.
c. A new subsection "bb" Is added to read
bb . RSS Services may be delivered through a variety of community and faith-based groups,
treatment providers, schools, and other specialized services. Services may be provided by a
single entity or a consortium of health and human service providers. These services may
include:
(1) Housing assistance services such as identifying housing options, contacting prospective
landlords, assisting with housing or housing subsidy applications .
(2) Recovery support such as transportation to and from treatment, employment services and
job training, relapse prevention, child care, family/marriage education, self-help and support
groups , life skills , spiritual and faith-based support, education, and parent education.
(3) RSS does NOT include rent , home repairs, clothing, dental or medical costs, hygiene items,
electronics, or anything that is for personal use.
d . Subsection w .(1). and w(3) The terms "drug court funding" and "State Drug Court funds" is deleted .
e. Subsection w(3).(b). ii. Is deleted in its entirety.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 2
5. Section 9. Transition of SeNices is amended as follows :
a. Subsections 9.a.(3) through 9.a .(10)are deleted and replaced with the following .
(3) For each transitioning client in care January 1, 2016 or entering care after January 1,
2016, and witl1 proper rel~ase in accord~nce with CFR 4 2 Part 2, Su b part C, 2.31
"Fo r m of W ritten Cons en t", provide the receiving SHO with current treatment
information including:
(a)What seNices are being provided,
(b)planned treatment end date,
(c) SeNice provider information,
(d) Treatment location
(e) Administrative records
(4) Participate in the development of individual Client Transition Plans.
(5) Document collection of proper release in TARGET.
(6) Other activities as requested by DSHS .
b. DSHS is responsible for payment of all seNices delivered up to but not including the date of
implementation.
6. Section 11. Consideration is amended by adding the following new subsection.
g. Incentive Research Project
DSHS has received a grant from Brandeis University to participate in an incentive awards
project to improve performance in "treatment engagement" for Outpatient and Intensive
Outpatient treatment agencies (including qualified subcontractors) and detox facilit ies. The
project will run from October 1, 2013 through December 31, 2015.
(1) Funding for incentive award payments is provided by DSHS.
(a) These funds are pooled and not reflected in the Awards and Revenues (A&R)
attachment.
(b) The earned incentive award payments $hall be passed through to the subcontracted
providers or directly to the agency providing seNices that are identified by DSHS as a
quarterly awardee.
(2) DSHS will notify you in writing and/or bye-mail of the status of your subcontractors as to :
(a) If any of your providers have achieved an incentive award payment and the amount
awarded
(b) Provide a separate A-19 for billing purposes that will cover only the incentive payments.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
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(3) Send the separate A-19 for the project to Amanda Lewis at lewisae@dshs.wa .gov or
designee who will review and forward valid A-19s for payment.
7. Section 12. Billing and Payment for Statement of Work
a. Subsection t-<3). the term ~'JdrygJ~ou rt" is deleted.
b. Subsection f.(3).(a) the term "and no more than 10% of the Drug Court" is deleted.
c. Subsection f.(3).(b). is deleted in its entirety.
d. Subsection j.(3).(c).vii is amended by replacing the reference (x.) with (ix.)
8. Exhibit B: Awards and Revenues is deleted and replaced with the new attached Exhibit B: Awards and
Revenues
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
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