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Home My WebLink AboutAmend No 1Washington State AaQ HCA CONTRACT NUMBER: Health Care uthority 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. TM010056 / SP020155 Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (OBA) 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 Ellensbura., 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 .u 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 Olympia, WA 98504 HCA CONTACT TELEPHONE HCA CONTACT FAX HCA CONTACT E-MAIL ADDRESS (360)725-377 4 Sarah. Mariani®hca. wa.aov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? I 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: 181 Additional Exhibits (specify): Exhbit B This Contract Amendment, including all Exhibits and other documents incorporated by reference, conta ins all of the terms and conditions agreed upon by the parties as changes to th e 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. c~~ PRINTED NAME AND TITLE DATE SIGNED Tr,~t:,kn Ul)n/:), PJ! !UlnA1uifra6 !,' 2-ln/1°1 ~CASl(ATiURE ~?J ~1-~ PRINTED NAME AND TITLE DATE IS;{r2'°[q ( /./4.A;,. ') Jim Gayton, HCA Contracts Administrator ~ I I 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 Kittitas County name associated with its unique entity identifier); (ii) Subrecipient's unique entity identifier; (DUNS) 010202547 (iii) Federal Award Identification Number (FAIN); SM010056 (iv) Federal Award Date (see §200.39 Federal 04/17/2015 award date); (v) Subaward Period of Performance Start and 4/1/18 to 6/30/19 End Date; (vi) Amount of Federal Funds Obligateq by this -$2,956 action; (vii) Total Amount of Federal Funds Obligated to $86,145 the subrecipient; (xiii) Total Amount of the Federal Award; FY14 $37,271,989 FY15 $37,296,186 FY16 $38,042,110 (ix) Federal award project description, as required Substance Abuse Prevention and Treatment Block to be responsive to the Federal Funding Grant Accountability and Transparency Act (FFATA); (x) Name of Federal awarding agency, pass-SAMHSA, through entity, and contact information for Washington State DSHS, awarding official, Chris Imhoff, Director PO Box 45330 Olympia , WA 98504-5330 lmhofc@dshs.wa.gov (xi) CFDA Number and Name; the pass-through 93.959 entity must identify the dollar amount made available under each Federal award and the CFDA number at time of disbursement; (xii) Identification of whether the award is R&D; and [8J Yes D 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 Page2 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) AWARD AND REVENUES 2017-2019 Biennium CONTRACTOR NAME CONTRACT NUMBER COUNTY Kittitas County Public Health 1863-28733 Kittitas The above named Contractor is hereby awarded the following amounts for the purposes listed. REVENUE SOURCE TYP AWARD AMOUNTS CODE: SFV18 SFY19 333.99.59 5ABG Prevention (7.1.17-6.30.19) s 17,548 $ 68,597 334.04.tiX GF-State-Admin (for SABG Prevention) $ 1,261 $ S,9&S SFY 18 /7.1.17-6.30.18) $ 1,261 SFY 19 /7.1.18-6.31>-19) $ £965 334.04.6>< Dedicated ~.arlJuana A~counl-Funcl 315-Sti!_te $ 7,614 $ 23,UO SFY 18 /7.1.17-6.30.18) $ 7,614 SFY 19 (7.1.18-6.30-19) $ 23,120 333.92.43 PFS-Total $ 21,Gl4 $ 12,318 Year4 FFY16 /7.1.17-9.29.17) $ 9,296 Year S FFY17 (9.30.17-9.29.18) $ 12,318 s 12,318 333.37.88 STR-Total $ $ FFY17 (8.15.17-4.30.18) $ FFY18 /5.1.18-4.30.19) $ -$ Total Federal Funds $ 39,162 $ 80,915 Total State Funds $ 8,!17 5 $ 29,085 I TOTAL ALL AWARDS s-48;G~7 $ 110,000 Federal CFDA: SABG-Substance Abuse Block Grant -CFDA 93.959 Substance Abuse and Mental Health Services Adm,lnlstratlon (SAMHSA) SABG Prevenrlon: fun<{;ng perl od ls!: -7.1.17-6.30 .19 Funds may be used in SFY 18 or SFY 19; up to the Total 17-19 Biennium award, as indicated above. GF-State-Admln (for SABG Prevention}: Fundlng·pe rl odls): :1.U7-6_,~0 .1_8 a_nd 7.1,1.8-6 .30 .1!1 Funds must be used only in the SFY in which the_y are a_warded, as indicated above. Dedicated Morl/u1I110 _A_~count-~und _315_ State: Funding period{Sc): 7.1.17-6.30.18 and 7.1.18-6.30.19 F_unds must be u_s~d c,nly in the SFY in which they are _awarded, ~-s _in~Jcated above._ PFS-Partnershlps for Success-CFDA 93,243 Substance Abuse and Mental Health Services Administration (SAMHSA) PFS: -·~c•t 4 f.undlnp.! 7.1.17-9.29 .17 _'fyr S fll.!).2UJ&;.,. _ ,!1 ,30.17-!l.~9_'.18 funds must be used_ in !h_e FFY in_ ~hich_they are awa_r~ed, as indicated above. Beginning 9._30.17, funds for Vear S may be used in SFY 18 or SFY 19, until 9.29.18._ Exhibit B Total 17-19 Biennium $ 86,145 $ 7,226 30,734 $ 33,932 $ $ U0,077 $ 37,960 $ J.S S,!)37 1 STR •State Targeted Hesponse to th~ Opioid Crisls-CfoA,3.788Sutistance)lb11se and Menial Hcallh SvvlCA1JAdm .n1sm1llon (SAMHSA) STR: 8.15.17-4.30.18 . -·-. , 5.1.18-4.30 .19 ~1.mds rnust_be use_d !~ the FfY in w_hich they are a:,,;i_rded, as i_ndlcated abovl!_. Beginning 5.1.18, funds for FFY18 may be used in SFY 18 or SFY 19, u_ntil 4._30.19 . HCA Contract Services 7024PF HCA Custom Contract Amendment (5-2-2018) Page4 All other terms and conditions of this Contract remain in full force and effect. HCA Contract Services Page5 7024PF HCA Custom Contract Amendment (5-2-2018) Kittitas County Review Form Grants & Contract Agreement Today's Date Agenda Date 2 / Jq I I c, 01/09/18 Fund/Department 116-Public Health Contract/Grant Information Contract /Grant Agency: Health Care Authority Contract Amendment for Prevention Services with KCPHD (DBHR) Period Begin Date: 01/01/2019 I I Period End Date: 06/30/2019 Total Grant/Contract Amount: $158,037.00 (SABG & General Fund program amounts adjusted) Grant/Contract Number: Contract/Grant Summary: The purpose of this amendment is to continue the coordination and implementation of prevention programs and strategies designed to prevent or delay the misuse and abuse of alcohol, marijuana, tobacco, and other drugs, increase mental health promotion, and prevent suicide. Program target populations and focus area are dependent on funding source and specific funded exhibits. I Recommendation for Board of Health and Board of Health Review on Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment: APP D AS TO FO RM : ffice Date Signature of Board of Health member Date Financial Information Total Amount$ 0.00 State Funds$ 2,956.00 (+) Federal Funds$ 2,956.00 (-) Percentage County Funds Matching Funds$ CFDA# 93.959 (SABG) Grant/Contract Review I 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 D attach budget form No []I 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.Gx 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 Approved Date: Prosecutor Review I Has the Prosecutor reviewed this agreement? I Yes • No D County Departments Impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer Submitted I Signature : Department: I Date: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application I Reviewer I Date Grant/Contract Review I Page 2 Grant/Contract Review Page 3