HomeMy WebLinkAboutJ - Fully ExecutedDocusign Envelope lD:'|D7E1DA7 4976-48gD-9EFO-BEDFgFE584EB
VVashington State i1 --)
Health Care KuthoritY
GONTRACT
AMENDMENT
HCA Contract No.: K746 ,l
Amendment No.: 02
AMENDMENT TO THE co NTRACT is betwee n the Was h ington State Health Care Autho rity and the party
TH ts
set forth belowwhosenameappearsbelowandtseffecttveasofthedate
CONTRACTOR NAME
Kittitas County Health Department
CONTRACTOR doing bus iness as (DBA)
GONTRACTOR A DDRESS
507 N Nanum St., Suite 102
Ellensburg, WA 98926
CONTRACTOR CO NTRACT MANAGER
Name: Nea Alfaro
Email: nea.alfaro@co. kittitas.wa. us
AMENDMENT START DATE
July 1 ,2026
AMENDMENT END DATE
June 30, 2028
CONTRACT END DATE
June 30, 2028
Prior Maximum Co ntract Amount
$35,876.00
Amount of lncrease
$25,376.00
TotalMaximum Compensation
$61,252.00
ryHEREAS, HcA and contractor previously entered into a contract for providing "Access to Baby and child
oentistry" services to detect and prevent eirty childhood dental decay, and;
WHEREAS, HCA and contractor wish to amend the contract pursuant to section 4-4 - Amendments to extend
the Contract Term and increase Maximum Compensation;
NOW THEREFORE, the parties agree the Contract is amended as follows:
1. Section 3.2- Term,subsection 3.2.1 is amended to extend the term for two years and shall now read as
follows:
3.2.1 The initial term of the Contract will commence on July 1, 2024, and continue through June 30'
2028, unless terminated sooner as provided herein'
2. Section 3.3 - compensation,subsection 3.3.1 is amended to increase the maximum compensation and
shall now read as follows:
3.3.1 The parties have determined the cost of accomplishing the work herein will not exceed
$61,252.00, inclusive of all feeS, taxes, and expenses. compensation for satisfactory performance
of the work will not exceed this amount unless the parties agree to a higher amount through an
amendment.
3. ln Attachment 1: stafem ent of work, is hereby amended and replaced in its entirety with a new
Attachment 18, Statement of Work, and is att-ached hereto and incorporated herein'
4. A new Attachment S: ABCD Action Plan, is hereby incorporated and attached hereto'
5. Attachment S: Data Sharing Agreement, is hereby renumbered to be Attachment 6, and any reference
throughout the Contract to tne Oata Sharing Agreement shall be updated to reference the new
attachment number.
HCA Contract No. K7461-2
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6
iavson.diaz@hca.wa.oov'
7. This Amendment will be effective as of July 1,2026 ("Effective Date")'
g. All capitalized terms not otherwise defined herein have the meaning ascribed to them in the contract'
g. 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 have authority to
execute the Amendment. This nmenomeni *iir o" binding on HCA only upon signature by both parties'
F2EF7 1-E93FBC4W
Any reference on the contract for HCA Clinical Dental Program Manager Pixie Needham and email
address pixie.needham@hca.wa.sov, sn"ir no* be replacJd with Jaysbn Diaz and the email address
DATE SIGNED
412212026Chelsey Loeffers
Public Health Director
signed by;
DATE SIGNED
3t2712026
PnltneO t'tnUE AND TITLE
Andria Howerton
Contracts Admin istratorHCA DeputY-L^S^^,2
D@uSigned bY:
HCA Contract No. K7461-2
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ATTACHMENT 1B: STATEMENT OF WORK
The contractor shall provide the services and staff, and otherwise do allthings necessary for or incidental
to the performance of work, as set forth below:
1. Contractor ResPonsibilities
ln accordance with deadlines in Attachme nt 2, ABCD Quarterty community and Provider outreach and
case Management Report, develop and implement an ABCD action plan in accordance with the ABCD
program principles and submit corresponding budget, using Attachment 4, ABCD Yearly Budget lool' The
ABCD program principles are outlined below'
A. provide Outreach and linkage of Apple Health/Medicaid-eligible Clients, ages birth to six (6), and
ages six (6) to thirteen (13) who are clients of the Developmental Disabilities Community Services
(DDCS) with an emphasis on groups with low utilization and high risk of dental disease such as
children residing in rural communities, children of color, children aged zero (0) to two (2) and other
eligible but underserved children in the service area, through collaboration with other organizations,
including, but not limited to:
i. Attending Outreach and marketing events and activities such as health fairs, use of social
media (i.e., Facebook, lnstagram, Constant Contact, etc.) to perform targeted Outreach
activities that effectively connect with families of eligible children;
ii. smileMobile (sponsored by the Arcora Foundation) locations (a mobile dental clinic providing
dentalservicestochildren,pregnantwomen,andothers);
iii. Women, lnfants, and Children (WlC) offices (a federal assistance program of the Food and
Nutrition Services of the United States Department of Agriculture);
iv. Head Start and Early Head Start facilities (a federal program that promotes the school
readiness of children under five from low-income families);
v. Early Learning Regional Coalitions that are a not-for-profit alliance of employers and
communitysubsidizedbefore-andafter-schoolchildcare;
vi.DayCarefacilitiesthroughoutthestateofWashington;
vii. Community health workers or regional networks to gain resources, community connections on
Outreach efforts for eligible children of color and children ages 0-2; and
viii. Local Children with Special Health Care Needs (CSHCN) program, local Developmental
Disabilities Community Services (DDCS) office and/or other organizations who work with
children with disabilities to find methods and resources on how to identify eligible children for
Outreach work.
B. Provide care coordination, including but not limited to:
i. Family Orientation such as sharing information about the value of an infant, toddler, or young
child going to the dentist, what activities to expect at the dentist's office, and the importance of
oral health care at home and the importance of keeping an appointment;
HCA Contract No. K7461-2 Page 3 of 14
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ii. connecting families with an ABCD certified dental providers who accepts Apple
Health/Medicaid, and providing information including, but not limited to, names and referrals to
dentists, sharing information about interpreters and transportation benefits, and assist in
scheduling "ppointr"nts
for eligible children and following up after an appointment, if
aPProPriate; and
iii. Maintain an up-to-date website with the correct ABCD logo, program eligibility information, and
directions and a URL link to Dentistlink'org'
c. collaborate with the Dentistlink team to align the Dentistlink toolwith local program's referral
processes to ensure AB6D clients have a variety of complementary avenues for referral and linkage
to ABCD Providers.
D. coordinate provider relationship management and program communication with DentistLink to
support participating dental practices and maintain accurate program information'
E. Contact each practice initially and periodically to update participating-ABCD dentist roster and collect
the following information:
i. Capacity and frequency for accepting ABCD clients;
ii. Availability of language and translation services;
iii. Changes in participation status (e.g., temporarily not accepting new ABCD clients' increased
availabilitY);
iv. practice capability of serving children with disabilities and special health care needs, such as
providing accessibility accommodation and equipment being available (e.g' wheelchair accessible
operatories, sensory friendly rooms, sedation services, adaptive dental chairs' behavioral
suPPorts);
v. Availability of General Anesthesia (GA); and
vi. Ensure timely communication of any changes to participating practices to
abcdproqram@arcorafoundation' orq'
F. ldentify and address family barriers to accessing oral health care.
G. Bi-annually convene or participate in a county-wide or regional oral Health Coalition, ABCD Steering
Committee, or other groups with focuses on health care, access or early learning in order to build
awareness of the ABCD program and solicit input on process improvements'
H. lnvite Champion(s) to participate in the meeting with the ABCD state managing director, the Arcora
Foundation, andihe Health bare Authority dental program administrator'
l. continuously coordinate with the local ABCD Dental champion(s) to:
i. ldentify and recruit dental providers to accept and provide care to Apple Health/Medicaid
clients zero (0) to six (6) years through the ABCD Program;
ii. Maintain a public facing list of active ABCD dental who accept Apple Health/Medicaid
clients zero (0) to six (6) years, ages six (6) to thirteen (13) who are clients of the
Developmental Disabilities Community Services (DDCS) and monitor provider availability to
HCA Contract No. K7461-2
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accept new client's zero (0) to six (6) years into their practice;
iii. Support current ABCD providers by communicating program changes and policy updates
through in-person meetings and written communication;
iv. plan and implement, in coordination with the UW School of Dentistry, timely ABCD provider
trainings (phase l, ll, lll and refreshertraining) leading to certification of providers and
onboarding of their staff;
V.EnsureproviderABCDcertificationprocessiscompleted;
vi. provide or arrange for, timely Apple Health/Medicaid billing training assistance to ABCD office
staff and providers, as needed;
vii. At minimum, annualry update dental society (or local dentists/study clubs in counties without a
society) on the ABCD program and support their continued participation in the program and
encourage recruitment of new Apple Health/Medicaid providers;
viii. Support the Dental Champion(s) participation in meetings and activities necessary to
effectively conduct Apple Health/Medicaid provider Outreach, recruitment and training,
including financial support of attendance (travel, lodging, etc') in ABCD Champion
Development DaY;
ix. Participate in the annual statewide ABCD Champion Development Day to remain current with
new clinical practices and opportunities. Meet, network, and share knowledge with other
champions regarding program roadblocks and successes; and
x. Extend invitation(s) to ABCD Dental Champion(s) to attend the annualABCD Champion
Development DaY.
Provide ABcD Champion(s) travel reimbursement, if any, to attend ABCD Champion Development
Day, is included in the total compensation.
Partner with the MouthMatters program to expand primary care medical providers' participation in
Apple Health/Medicaid as ABCD-certified providers and support integrated referral pathways to
ensure Apple Health/Medicaid-eligible children are connected early and consistently to the ABCD
Program.
participate in all three (3) statewide ABCD Coordinators group meetings to remain current with
ABCD policies, practices, and opportunities. Programs which do not meet this annual contract
requirement will be subject to Contract review by HCA and potentially, to loss of this Contract'
ldentify an ABCD Coordinator within the contracting organization who shall develop and maintain a
desk manual that ouilines the expected ABCD contractual deliverables and how the Contractor
meets each deliverable. The Coordinator shall utilize this manual to fulfillthe contractual
requirements and to orient new lead staff within the organization to the ABCD program'
lf the Contractor's Coordinator vacates the position, the Contractor must:
i. Notify the Health Care Authority within two (2) weeks of the coordinator's departure;
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ii. Share the Contractor's developed work plan that outlines how the expected Contract
deliverables will be met;
iii. Include the HCA and the state Managing Partner, Arcora Foundation, in the hiring process
to find a new coordinator;
iv. Share with HCA the contact information of the newly hired or appointed Coordinator;
coordinate with HCA to assure a smooth transition of the expected contracted work
deliverables, including participation in program orientation with HCA and other state partners,
and;
ABCD Coordinator new hire must reasonably meet the expectations as identified in
Exhibit D ABCD Coordinator Pertormance Expectations and Abilities of the ABCD
Toolkit for coordinators, as provided by Arcora Foundation (https://abcd-
dental. orq/resources/abcdtoolkiV).
O. lf the Contractor determines that it can no longer serve as the ABCD Contractor, Contractor must:
i. Give reasonable notice of at least ninety (90) days to HCA in order to assure uninterrupted
service to clients and work with providers; and
ii. Work with HCA and other state partners to identiff potential new ABCD-lead agencies'
2. Reporting Requirements
A. Quarterly, the contractor must complete and submit the following via email:
i. Community and provider Outreach and Coordination Care summary which shall include;
a. Attachment 2, ABCD Quarterly Community and Provider Outreach and Case
Management Report for the specific quarter; and
b. Attachment3, ABCD Quarterty Outreach and Coordination of Care Report.
B. Annually, the Contractor must complete and submit via email the Attachment 4, ABCD Yearly Budget
Toot, aiapplicable to the requirements contained in Attachment 2.
i. The Contractor must allocate a defined percentage of staff time to the ABCD Coordinator
role, as documented in the Annual Budget Tool. This allocation must reflect actual, dedicated
hours spent on ABCD program activities and may not be reassigned to unrelated
organizationalduties. The assigned full-time employee (FTE) must be sufficiently available to
meet all requirements of the Sow anc align with the approved Action Plan. contractor shall
document and report how staff time supports ABCD Action Ptan (Attachment 5) activities and
deliverables as part of required in Attachment3: ABCD Quarterly outreach and coordination
of Care RePort.
C. Annually, the Contractor must complete and submit via email, Attachment 5, ABCD Action Plan
due no later than October 31't, each year'
D. The Contractor must meet with the State Managing Partner, Arcora Foundation, on a yearly basis to
V
vl.
HCA Contract No. K7461-2 Page 6 of 14
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review local needs, utilization, and review the desk manualthat outlines the ABCD contractual
deliverables and how the Contractor has met or plans to meet those deliverables'
E. euarterly, the Contractor must submit a fully completed invoice that correlates with dollar values for
completed deliverables outlined in Attachment 2 that includes the following:
i. Exhibit templates, which are available on the ABCD website http://abcd-dental'orq/for-
coordinators/;
ii. Each report must document the status of the SMART goals from the ABCD Action Plan
(Attachment 5), detailing specific achievements or ongoing effort; and
iii. Reports and billing must be submitted no later than one (1) month after each quarter end
date, unless otherwise mutually agreed by both parties'
3. Acceptance Criteria
i. Contractor may invoice for the deliverables listed below on completion of each
deliverable. HCA has the right to withhold payment if the Contractor fails to meet
deliverables standards.
a. HCA will consider the ABCD Yearty Budget Iool (Attachment 4) complete once HCA
confirms receipt of the report containing all required and relevant information.
b. HCA will consider the quarterly Community and Provider Outreach and Coordination
Care summary to be complete once HCA confirms receipt of the report containing the
ABCD euarlerly Community and Provider Outreach and Case Management Repoft
(Attachment 2) for the specific quarter; and the ABCD Quartely Outreach and
Coordination of Care Report (Attachment 3)'
c. HCA will consider the yearly ABCD Action Ptan (Attachment 5) complete once HCA
has confirmed receipt of the report containing all required and relevant information
completed to HCA reasonable satisfaction'
4. Invoicing Schedule
The lnvoicing pricing Table below is for FY27 and FY28, and prior fiscal year invoicing schedules are
referenced in the prior Contract #K746L Contractor shall invoice HCA once a quarter at the end of each
quarter for the amounts listed in the table below:
Deliverable Date Due to HGA lnvoice Amount SFY27 lnvoice Amount SFY28
October- Decsmber
$1,000.00$1,000.0031-OctCoordinatorAttendance
$1,298.00$1,298.00Outreach ReportComm
$324.00$324.00Coordinate Care for Patients
$500.00$500.00Coalition/Steering Committee Tasks
$3,122.00$3,122.0{lJuly - September Total
HCA Contract No. K7461-2 PageT of 14
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Dentistlink Roster
Jan - March
April - June
31 -Jan $100.00 $100.00
Community Outreach RePort $1,298.00 $1,298.00
Coordinate Care for Patients $324.00 $324.00
Development Care $2,000.00 $2,000.00
October - December Total $t,722.09 $3,722.00
Coordinator Meeti ng Attendance 30-Apr $1,000.00 $1,000.00
Community Outreach RePort $1,298.00 $1,298.00
Coordinate Care for Patients $324.00 $324.00
Coalition/Steering Comm ittee Tasks $500.00 $500.00
January - March Total
Dentistlink Roster 31-Jul
1
$100.00
122.04
100.00
Community Outreach RePort $1,298.0q $1,298.00
Coordinate Care for Patients $324.00 $324.00
Coordinators Meeting Attendance $1,000.00 $1,000.00
April - June Total $2,722.00 $2,722.00
SFY Total Amount $12,688.00 $12,688.00
Total Budget $25,376.00
HCA Contract No. K7461-2 Page 8 of 14
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Attach PIan
Example: Train Early Childhood
Staff on Refe nal Processes
Example: Establish and Formalize
Partnerships
Strategy
SMART Goals
1. Example: By June 30, 2027, esfablsh format refenal agreements with at least 10 early childhood s/tes (Head Staft, childcare centers, early
intervention programs), resulting in at teast 250 documented referrals to dental providers within 12 months.
2. You can have multiple smart goals /lsted in here. P/ease include individual goals for the 0-2 population.
Community Outreach: Ages 0€ (inclusive of the 0-2 demographic) (Secfion I A af the SOt4,
(Wrat strategies witt you imptement to improve access to and utilization of dental care for children ages 0-5?)
Example: Provide training to
ensure staff understand the
importance of oral health and
referral procedures.
Example: Develop structured
referral partnerships with early
childhoad programs (e.9., Head
Staft, childcare centers, home
visiting programs).
Activities
a Conduct an nual in-service
training on early childhood
caries and establishing a
dental home by age 1.
Provide refenal scnpfs and
caregive r talking pornfs.
Di strib ute m ultilingu al
ed ucation al m ate ri al s for
families.
ldentify a site-based "oral
health champion" to support
implementation.
a
a
a
a ldentify and prioritize sifes
serving Medicaid-e n rolled
children.
Conduct introductory meetings
to review local oral health data
and referralgoals.
Execute MOUs outlining
referral processes and roles.
Develop and distribute a
standardized referral form and
provider list.
a
a
Supporting Actions
a Number of staff trained.
P e rce ntage of p a rti ci p ati n g
sites with at least one trained
staff member.
P re/po st tra i n i n g kn owledg e
increase (target: 80%
demonstrate improved
knowledge).
O
a
a Number of early childhood
programs contacted.
Number of formal referral
agreements (MOUs) executed
Number of pafticipating sifes
actively submifting referrals.
o
a
Performance Measures
HCA Contract No. K7461-2 Page 9 of 14
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Example: Provide Direct Access
Support for Families
Example: lmplement a Refenal
Tracking and Follow-Up System
Example: Reduce logistical
baniers that prevent families from
completing referrals.
Example: Create a sysfem fo
monitor refenals and increase
completed dental visits.
Assr'sf with ap pointm ent sched u I i n g
atthe time of refenal.
Provide Medicaid enrollment or
in surance navigation support.
Share tran sportation resources
a n d co m m unify asslsfance
programs.
Coordinate on-slfe screening or
mobile dentalvisits when feasible
a Develop a secure referral
tracking log.
E stabl i sh fol low- u p ti mel i ne s
(e.9., 3hday stafus checks).
Coo rdi n ate re m i n de r cal I s/texts
with families.
Track referral completion rates
and identify baniers to care.
a
o
Number of families receiving
appointment schedu ling
assisfance.
Number of families receiving
i n s u ran ce/n avig ation s u ppo rt.
Percentage of suppofted families
who complete a dentalvisit.
Target example: Provide direct
access support to at least 150
families annually, with 60%
a dentalvisit
. Number of refenals submitted. Percentage of refenals
resulting in completed dental
visits within 90 days.. Reduction in lost-to-follow-up
rate.
HCA Contract No. K7461-2 Page 10 of 14
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Strategy Activities Supporting Actions Performance Measures
i:...ji
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Strategy Activities
:.': .: . I:*"':'rr ' -,, -..i,.j. ,...13.' . t: ,
Supporting Actions Performance Measures
HCA Contract No. K7461-2 Page 12 of 14
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Strategy Activities Supporting Actions lmportant Contacts
1.
2.
HCA Contract No. K7461-2 Page 13 of 14
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Strategy Activities Supporting Actions
1.
2,
Goal:
lmportant Contacts
HCA Contract No. K7461-2 Page 14 of 14