HomeMy WebLinkAboutDSHS AgreementCOUNTY
PROGRAM AGREEMENT
Working Advance Long-Term Payable
DSHS Agreement Number
2163-23580
This Progra m Ag reeme nt ts by and between the State of Was hington Department of
Social and Health S ervices (DSHS)and the Co unty ide ntified below and issued tn
conjunction with a County and DSHS Agreement On Genera Terms and Conditions,
wh ic h IS I ncorporated by reference.
Administration or Division
Agreement Number
County Agreement Number
DSHS ADMINISTRATION
Facilities, Finance and
Analytics Adm inistration
DSHS DIVISION
Financial Services
DSHS INDEX NUMEER
1225
DSHS CONTMCT CODE
8030cs-63
DSHS CONTACT NAME AND TITLE
Rebecca Doane
Office Chief
DSHS CONTACT ADDRESS
PO Box 45842
-lQlympia WA 98504-5842
DSHS FAX DSHS CONTACT E-MAIL
763-2977 Click to enter text
NAME COUNTY
Kittitas County
Kittitas County County Auditors Office
205 West 5th Ave County Courthouse Ste 105
EI wA 98926
co
J Pless
CONTACT COUNTY ACT E-MAIL
962-7502 kittitas.wa.us
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM
AGREEMENT?
No
CFOA NUMBERS
PROGRAM AGREEMENT START DATE
07t01t2021
PROGRAM AGREEMENT END DATE
06BAl2A22
MAXIMUM PROGRAM AGREEMENT AMOUNT
Based on Annual Review
The terms and con ditions of this Contract are an integration and re presentation of the final,enti re nd exclusive
understand tng between the parties superseding and merg tng all prevrous agreements,writings and comm unications,oralorothenruise,regarding the subject matter of th is Contract.The parties sig ning below represent that they have read and
understand this Contract,nd have the uthority to execute this Co ntract.This Contract shall be bi nding o n DSH S only
nature
AND TITLE(S)SIGNED
Brett Wachsmith, Chairman
Board of County Commissioners iuly 6,2021
DSHS SIGNATURE PRINTED NAME AND TITLE
Kerra Lynch, Contract Manager
DSHS Central Contracts and Leoal Services
DATE SIGNED
7t19t2021
DSHS Central Contract Services
8030CS County Long-Term Payable (3-28-2017)
Current Working Advance $54,000
Page !
SPECIAL TERMS AND CONDITIONS
1. Definitions
2.
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 DSHS 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.
Purpose
a. lt 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 (ALTSA).
3. Statement of Work
a. CountyResponsibilities
(1) The County shall submit to DSHS, on forms provided by DSHS and by a date determined by
DSHS, a completed Documentation of Funds form (DOF) from 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 allamounts related to its Prepaid lnpatient Health Plan expenditures
from its DOF.
(3) The County shall repay to DSHS 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 DoF process, shall be refunded to DSHS by May 31 of each year.
(a) 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)Page2
4.
SPECIAL TERMS AND CONDITIONS
b. DSHSResponsibilities
(1) DSHS shall assess the DOF submifted by the County to determine if, during the term of this
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.
Termination
ln the event that this Agreement, or a program contract listed in 2.b. above, is terminated prior to
completion, DSHS shalltake all available steps to recover any Long-Term Payable determined to be an
overpayment and the county shallfully cooperate during the recovery process.
DSHS Central Contract Seruices
8030CS County Long-Term Payable (3-28-2017)Page 3