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Today's Date <br />12/10/2018 <br />Fund/Department <br />116 -Public Health <br />Kittitas County <br />Review Form <br />Grants & Contract Agreement <br />Agenda Date <br />I• ��4 <br />FiFII' I -I' •5ti 1'� t l'!''I 7' <br />Contract/Grant Information <br />Contract /Grant Agency: Washington State Association of Local Public Health Officials and Kittitas County <br />Public Health Department <br />Period Begin Date: 01/01/2019 _ Period End Date: 12/31/2019 <br />Total Grant/Contract Amount: $ Fee for service <br />Grant/Contract Number: <br />Contract/Grant Summary: <br />The Washington State Associate of Local Public Health Officials formalizes the understanding between <br />the Washington State Association of Local Public Health Officials (WSALPHO) and Local Health <br />Jurisdiction Kittitas County Public Health regarding the operation of the Medicaid Administrative <br />Claiming in Washington State. Attached is also the Business Associate Agreement needed to satisfy the <br />Health Insurance and Accountability Act. <br />Recommendation for Board of Health and Board of Health Review on <br />Department Head Signature: <br />Administrator 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 Date <br />Signature of Board of Health member Date <br />L <br />Financial Information <br />Total Amount $ no max <br />Grant/Contract Review <br />State Funds —$ <br />J <br />Federal Funds $ no max <br />Page 1 <br />