Contract Amendment #2 with DSHS, DDA BEFORE THE BOARD OF COUNTY COMMISSIONERS
OF LEWIS COUNTY, WASHINGTON
IN RE:
Approve contract amendment#2 between )
Lewis County and Washington State ) II I
Department of Social and Health Services ) Resolution No. 18- -i-11
(DSHS), Developmental Disabilities )
Administration (DDA), to provide services to )
individuals with developmental disabilities )
WHEREAS, the Board of County Commissioners, Lewis County, Washington,
has reviewed amendment#2 to contract#1763-96207 between Lewis County and
DSHS/DDA for the period of June 1, 2018 through June 30, 2019; AND
WHEREAS, this amendment extends contract end date to June 30, 2019 and
adds funding of $899,005 for a total contract amount of$1,778,382; AND
WHEREAS, funding is available from DSHS/DDA to provide funding for
administration, training, community education, and consumer support for employment
and related services for people in our county with developmental disabilities; AND
WHEREAS, it appears to be in the best public interest to authorize the execution
of said contract for Lewis County;
NOW, THEREFORE BE IT RESOLVED that agreement#1763-96207
Amendment #2 between DSHS/DDA and Lewis County in the amount of $899,005 for a
total maximum amount of $1,778,382 for the time period of June 1, 2018 through June
30, 2019, is hereby approved and the Director of Public Health & Social Services is
authorized to sign the same.
DONE IN OPEN SESSION this c.)O day of d1),A6.-- , 2018.
APPROVED AS TO FORM: BOARD OF COUNTY COMMISSIONERS
Jonathan Meye 'rose uting Attorney LEWIS COUNTY, WASHINGTON
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By: D. (Id Fine Edna J. Fund, Ch
Deputy Prosecuting Attorney
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ATTEST: .o••••. Robert C. Jackson, Vice Chair
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Rieva Lester, Clerk of the prd SINCE \i ord m
ry S mper, Meber
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Lewis County
Details of Budget or Request For Budget Amendment
Fund 104 Type of appropriation:
Department 613 0 Supplemental-has new offsetting revenue
Program 0 Emergency-using fund balance
Please Discuss Current Budget Uses or Describe a Need For Additional Funding
This budget detail is for the County Program Agreement between Lewis County and the Department of
Social and Health Services,Developmental Disabilities Administration for the contract period of July 1,
2018 through June 30,2019.This funding was anticipated.
Use of Funds
❑ New Expenditure 0 New Transfer Out or 0 Currently Budgeted
Account Description BARS Account Number Amount
Employment Services 104 613 000 000: 568 62: 41 00 681,554
Training 104 613 000 000 568 31! 41! 00 15,171
Admistration 104 613 000 000 568 10 41 00 58,434
Child Development Services 104 613 000 000 568 61 41 00 52,051
Community Access 104 613 000■ 0001 568^ 6777 41 00 52,795
Community Information 104 613 000! 000' 568 40 41 00 39,000
Total Use of Funds: $899,005
Source of Funds
New Revenue ❑Use of Fund Balance ❑ New Transfer In or ❑ Currently Budgeted
Account Description BARS Account Number Amount
DSHS-Devel Disabil State 104 613' 000 000, 346 60 00 00 899,005
Total Source of Funds: $899,005
Elected/Director Gieea, Data
DSHS CONTRACT NUMBER:
Washington state CONTRACT AMENDMENT 1763-96207
Department of Social
7 &Health Services Employment & Day Amendment No. 02
Transforming lives
This Contract Amendment is between the State of Washington Department of Program Contract Number
Social and Health Services (DSHS)and the Contractor identified below. Click here to enter text.
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as(DBA)
Lewis County Lewis County DDA County Services
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
360 NW North St IDENTIFIER(UBI) 1227
Chehalis, WA 98532- 212-002-978
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Meja Handlen (360) 740-1418 Click here to enter text. Meja.Handlen @lewiscounty.wa.
gov
DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE
Developmental Disabilities Admin Division of Developmental 1769CS-63
Disabilities
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Wendi Winchel PO BOX 45315
Regional Business Manager Olympia, WA 98504-5315
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
(360) 725-4264 (360) 586-6502 winchwa @dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
06/01/2018 06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT
$879,377.00 $899,005.00 $1,778,382.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT
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): Exhibit 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
,Dueik.D. Yak, D;rte- 7`Ihs
DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED f�
/��U�'✓v Melissa Diebert, Contract Specialist 8.-, �O
•
"; 932018
DSHS Central Contract Services Page 1
6024PF Contract Amendment(1-26-2018) 3udgef Finance & Contracts
This Contract between the State of Washington Department of Social and Health Services (DSHS)and the
Contractor is hereby amended as follows:
1. The Total Maximum Contract Amount is hereby increased in the amount of$899,005 for a new Contract
Amount of$1,778,382.
2. The Program Agreement end date is extended to June 30, 2019.
3. Special Terms and Conditions, Section 8, Billing and Payment is amended as follows:
a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by
DDA as costs incurred by the program for:
f. Program Administration: The County will provide program administration and may bill for
administrative costs up to the identified amount in Exhibit B. Administrative costs reimbursement
will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer
Support services unless millage has been declared or the Assistant Secretary of DDA approves a
request for an exception under Chapter 388-850 WAC. Monthly claims for administrative costs will
be for allowable expenditures incurred or 1/12 of the maximum Administration amount identified in
Exhibit B, or the lessor of the two.
4. Exhibit B. Program Agreement Budget is hereby amended to include the following Budget Revision:
EXHIBIT B
Program Agreement Budget
❑ Original Budget X Budget Revision
REVENUES
Fiscal
Year Fund Source Original 1st Revision 2nd Revision 3rd Revision
2018 State Funds $462,567 $467,632 $473,622
Medical Funds
Total $863,915 $879,377 $885,172
2019 State Funds $474,630
Federal Funds
Total $885,996
DSHS Central Contract Services Page 2
6024PF Contract Amendment(1-26-2018)
COUNTY FY 2018 SPENDING PLAN
Planned Expenditures
PASRR Medfd
Funds State Funds F TOTAL
ADMINISTRATION fti
(CMIS/AWA BARS 11) $829 $31,394 r ' : 686 $57,909
OTHER CONSUMER
SUPPORTS
(CMIS/AWA Code 31, 32,41,
92,93, 94 7�.. $29,340 : ., 4,005 $53,345
CONSUMER SUPPORT
STATE-ONLY
Child Development _ $51,030 $51,030
MEDICAID CLIENTS $11,840 $355,524 $355,524 $722,888
ROADS to COMMUNITY ' ,
LIVING �
TOTAL $ 12,669 $467,288 $405,215 $885,172
COUNTY FY 2019 SPENDING PLAN
Planned Expenditures
•
PASRR Medicaid
Funds State Funds Funds,,, TOTAL
ADMINISTRATION
(CMIS/AWA BARS 11) $472 $31,879 $26,083 $58,434
OTHER CONSUMER
SUPPORTS
(CMIS/AWA Code 31, 32,41,
92,93, 94) $29,794 • r 3_.A .: $54,171
CONSUMER SUPPORT
STATE-ONLY
Child Development $52,051 $52,051
MEDICAID CLIENTS $6,742 $360,906 _ ;.,:° s i 6-' $728,554
ROADS to COMMUNITY
LIVING
TOTAL $7,214 $474,630 _ $411,366 _ $893,210
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services Page 3
6024PF Contract Amendment(1-26-2018)
ST Arg
fp.
STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
Developmental Disabilities Administration
Point Plaza Bldg 2 East, 3rd floor, 6860 Capitol Blvd SE Tumwater,WA 38501
Mailing Address: PO Box 45315 Olympia,WA 98504-531E
August 13, 2018
')ear Provider:
Enclosed is your copy of the signed contract which allows you to provide services for clients of
The Developmental Disabilities Administration (DDA).
If you have specific questions regarding authorization issues, please contact the DDA Case
:.esource Manager of the client for whom you provide service. For billing is ;des, contact
ProviderOne. For contract issues, contact the contract staff indicated on the first page of the
contract. All services must be pre-authorized by a DDA Case Resource Manager.
hank you for providing care for the clients of DDA. Please feel free to con act me if you have
;;ny questions regarding this contract
Sincerely,
e
Luise Frank
Contracts Specialist 3
360-725-4252
Enclosure: Contract
cc: Provider File
BOCC AGENDA ITEM SUMMARY
Resolution: BOCC Meeting Date: Jul 30, 2018
Suggested Wording for Agenda Item: Agenda Type: Consent
Approve contract amendment#2 between Lewis County and Washington State Department of Social and Health
Services (DSHS), Developmental Disabilities Administration(DDA) to provide services to individuals with
developmental disabilities
Contact Danette York Phone: 2774
Department: Public Health and Social Services
Action Needed: Approve Resolution
Description
This amendment funds employment and related services for people in our county with developmental
disabilities. The DDA has traditionally contracted with counties to provide these services in our local
communities. This amendment will add additional funding and extend the current contract through June 30,
2019.
Approvals:
User Group Status
York, Danette Pending
Whiton, Wayne Pending
Cover Letter To
DSHS
Wendi Winchel,Reg.Business Mgr.
PO Box 45315
Olympia,WA 98504-5315
Additional Copies
Sandi Andrus
Sara Sons
Wayne Whiton
Suzette Smith
Amanda Migliaccio
Grace Jimenez