HomeMy WebLinkAboutContract-Grant Health Care Authority -Medicaid Admatch Amendment 1Kittitas County
Review Form
Grants & Contract Agreement
Contract/G ra nt I nformation
Recommendation for Board of Health Review on
Department Head Signature Director Date >t 22
Kittitas county Prosecutor, Auditor, and Board of Health Review and comment:
APP FOR
Signature of P or's Offi Date
Signature of Aud s Office Date
Verification the contracting Agency is not suspended/Disbarred:
Financial lnformation
Today's Date
t1.11712022 PA camas Request #: [1f}l \t
Fund/Department
L16-Public Health Agenda Date
Contract /Grant Agency: Health Care Autho rity-Medicaid Admatch Amendment 1
Period Begin Date:January 1,,2021 Period End Date: December 31,2025
Total Grant/Contract Amount: Fee for Service
Grant/Contract Number: K4649
The Healthcare Authority Professional Services Contract is established to support Medicaid related
outreach and linkage activities performed by Kittitas County Public Health to Washington State residents
Contract/G ra nt Summary:
who live within Kittitas Coun
E Agency is not suspended/disbarred ! Not Checked (reason)
Grant/Contract Review Page 1
TotalAmount $State Funds $Federal Funds S
Percentage County Funds Matching Funds S CFDA#
ln-Kind S
Expla in
ls Equipment being purchased? No Who owns equipment?
New Personnel being hired? No Contact HR hir rtin requirements-re
Future impacts or liability to Kittitas County:
Budget lnformation
Pass Through lnformation
Prosecutor Review
Budget Amendment Needed?Yes I attach budgetform No K Why not
Time extension onlyNew Division Created?
Revenue Code 7L6.6L2.95.333.93.7 7 8
Expense Code rt6.6 12.9s .s rcoL I s2o0 1/5 009 8
Agency to Pass Through
Amount to Pass Through Expense Code
Sub-Contract Approved Date:
Has the Prosecutor reviewed this agreement?Yes No
County De artments lm acted
BOCC Approval Needed?
Assignment of Tracki lnformation
Auditor Facilities Maintenance
lnformation Services Human Resource
Prosecutor Treasurer
Yes I Notr
Staff Mem ber Presenting
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
DocuSign Envelope lD 6A9322O2-7468-44F8-8981-S3Bj D8308834
WHEREAS, HCA and Contractor previously entered into a Contract to support Medicaid related
outreach and linkage activities performed by Local Health Jurisdictions to'certain Washington StateResidents, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 7 to extend the termand add/remove language;
Now THEREFORE, the parties agree the contract is amended as follows:
1. Section 3, Period of Performance, is amended to read:
3. PERIOD OF PERFORMANEE
Subject,o,,,ffiperiodofperformanceofthisContractwillcommenceon
January 1, 2021, and be completed on December 31, 2025, unless terminated sooner or extended
upon written agreement between the parlies.
This Contract may be extended through December 31,2026, at HCA's sole discretion. No change
in terms and conditions will be permitted during these extensions unless specifically agreed to in
writing.
2' Attachment 4, Federal Funding Accountability and Transparency Act Data Collection Form, is
removed from the Contract.
3. Subsection 18.8 is removed from Section 18, Governance, and all remaining subsections within
that Section are renumbered accordingly.
4. Section 26, Federal Funding Accountability & Transparency Act (FFATA), is removed from thecontract and all subsequent sections are renumbered accordingiy.
5' This Amendment will be effective as of the last date of signature shown below ("Effective Date").
6' All capitalized terms not otherwise defined herein have the meaning ascribed to them in the
Contract.
Washington State
Health Care ority
CONTRACT
AMENDMENT
HCA Contract No.: K4649
Amendment No.: 01
TH S A M E N D M E N T TO TH E co N T RACT S b etween t h e W a sh tn gton S tate H e al th Care A u th ority
and the d wh o SE name a ears be low a nd IS effect VE AS of t h e da te set fo rth below
CONTRAGTOR NAME
Kittitas County Health Department
CONTRACTOR doing business as (DBA)
GONTRAGTOR ADDRESS
507 North Nanum Street, Ste #102
Ellensburg, WA 98926
WASHINGTON UNIFOR M BUSINESS IDENTIFIER
(uBr)
HCA Contract No. K4649-01 Page 1 of 2
DocuSign Envelope lD: 6AS322O2-7468-44FB-8981-5381 D8308834
7 ' All other terms and conditions of the Contract remain unchanged and in full force and effect.
The parties signing below warrant that they have read and understand this Amendment and haveauthority to execute the Amendment. This Amendment will be binding on HCA only upon signature oyboth parties.
SIGNATURE NAME AND
Loeffers
Il,frtn Public Health Director
PRINTED TITLE
chelle Amerine
n
DATE SIGNED
12t21t2022
DATE SIGNED
11111t2022
HCA Contract No. K4649-01 Page 2 of 2