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Home My WebLink AboutHCA Amendment for Prevention ServicesKittitas County Review Form Grants & Contract Agreement Today's Date 01/09/18 Fund/Department 116 -Public Health Contract/Grant Information Agenda Date Ilk r� I I JAS (117 7� Contract /Grant Agency: Health Care Authority Contract Amendment for Prevention Services with KCPHD (DBHR) Period Begin Date: 01/01/2019 Period End Date: 06/30/2019 Total Grant/Contract Amount: $158,037.00 (SABG & General Fund program amounts adjusted) Grant/Contract Number: Contract/Grant Summary: The purpose of this amendment is to continue the coordination and implementation of prevention programs and strategies designed to prevent or delay the misuse and abuse of alcohol, marijuana, tobacco, and other drugs, increase mental health promotion, and prevent suicide. Program target populations and focus area are dependent on funding source and specific funded exhibits. 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 $ 0.00 State Funds $ 2,956.00 (+) Federal Funds $ 2,956.00 (-) Percentage County Funds Matching Funds $ CFDA# 93.959 (SABG) 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? Yes ❑ attach budget form No EA Why not New Division Created? Fund Neutral Revenue Code 116.612.47 Behavioral Health & Recovery 612.47.1.333.93.959 SABG Substance Abuse Block Grant SFY-19 $71,553 — $2,956 = $68,597 612.47.3.334.04.6x GFS General Fund State Admin SFY-19 $ 3,009 + $2,956 = $ 5,965 Pass Through Information Agency to Pass Through Amount to Pass Through $ Sub -Contract Aanroved 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: Date. Department: Information Reviewer I Date Grant/Contract Review Page 2 Grant/Contract Review Page 3 HCA CONTRACT NUMBER: Washington Statekt-h-Or7i Health Care CONTRACT AMENDMENT 1863-28733 Prevention Services Amendment No. 01 This Contract Amendment is between the State of Washington Health Care Program Contract Number Authority (HCA) and the Contractor identified below. TMO10056 / SP020155 Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (DBA) Kittitas County Kittitas County Health Department CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS ACD INDEX NUMBER 507 North Nanum Street Suite 102 IDENTIFIER (UBI) 1225 192-002-673 Ellensburg, WA 98926-2886 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Kasey Knutson (509) 962-7515 (509) 962-7581 kasey.knutson@co.kittitas.wa.0 s HCA PROGRAM AREA HCA CONTRACT CODE Division of Behavioral Health 1644CS-63 HCA CONTACT NAME AND TITLE HCA CONTACT ADDRESS Sarah Mariani 4500 Tenth Ave SE Program Administrator PO Box 45330 OI m ia, WA 98504 HCA CONTACT TELEPHONE HCA CONTACT FAX HCA CONTACT E-MAIL ADDRESS (360)725-3774 1 1 Sarah.Mariani@hca.wa.gov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS Yes 93.959 AMENDMENT START DATE CONTRACT END DATE 01/01/2019 06/30/2019 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $158,037.00 $0.00 $158,037.00 REASON FOR AMENDMENT; CHANGE OR CORRECT CHOOSE ONE: 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): Exhbit B 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. CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED HCA SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Jim Gayton. HCA Contracts Administrator HCA Contract Services Page 1 7024PF HCA Custom Contract Amendment (5-2-2018) This Contract between the State of Washington Health Care Authority (HCA) and the Contractor is hereby amended as follows: 1. Amend the following by deleting and replacing: Federal Award Identification for Subrecipients (reference 2 CFR 200.331) - Substance Abuse Block Grant (i) Subrecipient name (which must match the name associated with its unique entity identifier); (ii) Subrecipient's unique entity identifier; (DUNS) (iii) Federal Award Identification Number (FAIN); (iv) Federal Award Date (see §200.39 Federal award date); (v) Subaward Period of Performance Start and End Date; (vi) Amount of Federal Funds Obligated by this action; (vii) Total Amount of Federal Funds Obligated to the subrecipient; (xiii) Total Amount of the Federal Award; (ix) Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA); (x) Name of Federal awarding agency, pass- through entity, and contact information for awarding official, (xi) CFDA Number and Name; the pass-through entity must identify the dollar amount made available under each Federal award and the CFDA number at time of disbursement; Kittitas County 010202547 S M010056 04/17/2015 4/1/18 to 6/30/19 -$2,956 $86,145 FY14 $37,271,989 FY15 $37,296,186 FY16 $38,042,110 Substance Abuse Prevention and Treatment Block Grant SAMHSA, Washington State DSHS, Chris Imhoff, Director PO Box 45330 Olympia, WA 98504-5330 ImhofcC�dshs.wa.aov 93.959 (xii) Identification of whether the award is R&D; and ® Yes ❑ No (xiii) Indirect cost rate for the Federal award 5% (including if the de minimis rate is charged per §200.414 Indirect (F&A) costs). HCA Contract Services Page 2 7024PF HCA Custom Contract Amendment (5-2-2018) 2. Amend the Contract Special Terms and Conditions Exhibit B by deleting and replacing with the Exhibit B on the next page: HCA Contract Services Page 3 7024PF HCA Custom Contract Amendment (5-2-2018) Exhibit B AWARD AND REVENUES 2017-2019 Biennium CONTRACTOR NAME Kittitas County Public Health CONTRACTNUMBER 1863-28733 COUNTY Kittitas The above named Contractor is hereby awarded the following amounts for the purposes listed. REVENUESOURCE TYPE OF SERVICE AWARDAMOUNTS CODE: Total 17.19 SFY18 SFY19 Biennium 333.99.59 SABG Prevention (7.1.17-6.30.19) 5 17,548 $ 68,597 $ 86,145 334.04.6X GF -State- Admin (for SABG Prevention) $ 1,261 5 5,965 $ 7,226 SFY 18 (7.1.17-6.30.18) $ 1,261 SFY 19 (7.1.18-6.30-19) 5 5,965 334.04.6X Dedicated Marijuana Account -Fund 315 -State $ 7,614 5 23,120 $ 30,734 SFY 18 (7.1.17-6.30.18) $ 7,614 SFY 19 (7.1.18-6.30-19) 5 23,120 333.92.43 PFS -Total $ 21,614 $ 12,318 5 33,932 Year 4 FFY16 (7.1 17-9.29.17) $ 9,296 Year 5 FFY17 (9.30.17-9 29.18) $ 12,318 $ 12,318 333.37.88 STR-Total $ $ 5 FFY17 (8.15.17-4.30.18) $ - FFY18 (5.1.18-4.30.19) $ - $ Total Federal Funds $ 39,162 $ 80,915 $ 120,077 Total State Funds $ 8,875 $ 29,085 $ 37,960 LOTAL ALL AWARDS$ 48,037 $ 110,000 5 158,037 Federal CFDA: SABG-Substance Abuse Block Grant -CFDA 93.959 Substance Abuse and Mental Health Services Administration (SAMHSA) SABG Prevention: funding pe nod Ls}_ 7 117-6.30.19 Funds may be used in SFY 18 or SFY 19; up to the Total 17-19 Biennium award, as indicated above. GF -State- Admin (for SABG Prevention): FundinK periodWs 7.1.17-6.30.18 and 7.1.18-6.30.19 Funds must be used only in the SFY in which they are awarded, as indicated above. Dedicated Marijuana Account -Fund 315 State: Lundin peri s : 7.1.17-6.30.18 and 7.1.18-6.30 19 Funds must be used only in the SFY in which they are awarded, as indicated above. PFS -Partnerships for Success-CFDA 93.243 Substance Abuse and Mental Health Services Administration (SAMHSA) PFS: Year 4 funding: 7.1.17-9.29 17 Year 5 fundinl[: 9.30.17-9.29.18 Funds must be used in the FFY in which they are awarded, as indicated above. Beginning 9.30 17, funds for Year 5 may be used in SFY 18 or SFY 19 , until 9.29.18. STR -State Targeted Response to the Opioid Crisis-CFDA 93.788 Substance Abuse and Mental Health Services Administration (SAMHSA) STR: FFY17 815.17-4.30.18 FFY18 5-1.18-4.30.19 Funds must be used in the FFY in which they are awarded, as indicated above. Beginning 5.1.18, funds for FFY18 may be used in SFY 18 or SFY 19 , until 4.30.19. HCA Contract Services Page 4 7024PF HCA Custom Contract Amendment (5-2-2018) All other terms and conditions of this Contract remain in full force and effect. HCA Contract Services Page 5 7024PF HCA Custom Contract Amendment (5-2-2018)