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Home My WebLink AboutCAG2019-362 - Original - Public Health Seattle & King County (PHSKC) - Medicaid Administrative Claiming (MAC) Cost Mathching: Children's Therapy Center (CTC) - 07/01/2019 Agreement Routing Form KEN T For Approvals,Signatures and Records Management Director initials 'r W.SMIN GTON This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. (Print on pink or cherry colored paper) Manager initials Originator. Lori Guilfoyle Department: parks Date Sent. 7-10-2019 Date Required: Soonest possible please � Authorized Director Date of o NA p, to Sign: Council aMayor Approval. Budget NA Grant? Yes ❑✓ No Account Number. Type: N/A Vendor public Health- Seattle & King y Category.Count 9 ►y. Contract Name: = Vendor 35625 Sub-Category o Number: a Project E Name: Medicaid Administrative Claiming Cost Matching 0 c Project The City will certify funds paid to Children's Therapy Center for MAC activities. of Details: c Go E Agreement 0 Basis for 0 Amount: Selection of Direct Negotiation L Contractor: cm a Start Date: 7-1-2019 Termination Date: 12-31-20 20 Notice required prior to Yes No Contract Number: 22 disclosure? Z0II — 'J ( Z Date f04 Lb IlE �VED Comments: t 0 0 1W 1�ENT LAW ®EPT. C� V a Date Routed to the Mayor's Office: in y Date Routed to the City Clerk's Office: City Of Kent d Office of the Mayor Date Sent to Originator: Visit Documents.KentWA.gov to obtain copies of all agreements adccW22373_6_19 DocuSign Envelope ID:792E7D4A-478E-4EE9-841A-99E3C991F955 Agreement Between Public Health—Seattle & King County and the City of Kent 4445 CHS PURPOSE OF THIS AGREEMENT: This Agreement between Public Health—Seattle& King County ("PHSKC") and the City of Kent ("the City") is for the purpose of certification of expenditures paid by the City to partner agency Children's Therapy Center("CTC") for expenditures eligible for reimbursement under the Medicaid Administrative Claiming ("MAC") program. This Agreement is intended to ensure expenses paid by the City to Children's Therapy Center are eligible for use in the MAC cost-matching program. DEFINITIONS: 1. The term "Medicaid Administrative Claiming ("MAC")," as used in this Agreement, shall mean the joint federal-state financing program, authorized under Title XIX of the Social Security Act, which funds a portion of administrative costs incurred by agencies for the proper and efficient administration of the State Medicaid Plan. 2. The term "certification" or"certify"as used in this Agreement, shall mean the process by which LWSD documents Certified Public Expenditures (CPEs) made in support of allowable MAC activities performed by CTC pursuant to Federal Medicaid regulations 42 CFR 433.51 for Federal Financial Participation. 3. The term "eligible non-federal expenditure" as used in this Agreement shall mean a non-federal expenditure made by the City to CTC to pay for its allowable MAC activities, pursuant to 2 CFR 200 part 225 and 42 CFR 433.51. RESPONSIBILITIES OF THE PARTIE Responsibilities of PHSKC PHSKC agrees to: 1. Provide administrative oversight of CTC's MAC program, managing performance expectations, program compliance, and distribution of MAC funds to CTC. 2. PHSKC will provide materials, training and technical assistance necessary for the City to certify MAC eligible funds provided to CTC. 3. Enter into an Accounts Payable Agreement with CTC for payment of the total computable expense of CTC's MAC activities, subject to the availability of local and federal funding to cover the costs of this expense. 1 DocuSign Envelope ID:792E7D4A-478E-4EE9-841A-99E3C991F955 Responsibilities of the City The City agrees to: 1. Certify funds paid to CTC quarterly for MAC activities for expenditures beginning 07/01/2019 were eligible, non-federal, public expenditures using the certification form provided by PHSKC through verification of acceptable Certified Public Expenditures (CPEs) for local government agencies pursuant to Federal Medicaid regulations 42 CFR 433.51 for Federal Financial Participation. This will be accomplished through the following steps: • The City will make public expenditures for CTC's MAC activities that must be supported by auditable documentation such as a journal entry in the City's general ledger or equivalent documentation. • The City will complete and send to PHSKC a signed MAC Certification Form, as provided by PHSKC, for each quarterly payment made to CTC. GENERAL AGREEMENT PROVISIONS: Term This Agreement will take effect 07/01/2019, upon signing by both parties. Unless renewed, this Agreement will automatically terminate 12/31/2020. Renewal of Agreement It is anticipated that this Agreement may be renewed for additional periods of time. To accommodate renewal,the parties will meet prior to January 1 St each year to review results of the program. Changes to the Agreement will be available for review by both parties no later than December 31 st of each year. Termination This Agreement may be terminated by PHSKC or by the City upon written notice to the other party at least thirty (30)days in advance of the intended termination date. Assignment Neither party shall assign or sublet its rights or responsibilities under this Agreement without the written authorization of the other party. Written authorization shall not be withheld unreasonably. Severability If any term of this Agreement is held invalid or unenforceable, the remainder of the Agreement will not be affected but continue in full force. Non-Waiver Failure of either party to insist upon the strict performance of any term of this Agreement will not constitute a waiver of relinquishment of any party's right to thereafter enforce such term. Integration This writing contains all terms of this Agreement. It replaces all prior and contemporaneous negotiations and Agreements. Modifications must be in writing and be signed by each party's representative. 2 DocuSign Envelope ID:792E7D4A-478E-4EE9-841 A-99E3C991 F955 Funding Contingency Although neither party in this Agreement receives funding as a result of this Agreement, this partnership is supported indirectly by federal funds via PHSKC's contract from Washington State Health Care Authority ("HCA"). In the event funding from HCA is withdrawn, reduced, or limited in any way after the effective date of this Agreement and prior to normal completion, PHSKC may terminate or amend this Agreement or part thereof, under the termination or integration clause as applicable. No Third Party Beneficiaries Except for the parties to whom this Agreement is assigned in compliance with the terms of this Agreement, there are no third party beneficiaries to this Agreement, and this Agreement shall not impart any rights enforceable by any person or entity that is not a party hereto. IN WITNESS WHEREOF, the parties hereby agree to the terms and conditions of this Agreement: FOR City of Kent C� Dana Ralph, Mayor Date FOR Public Health —Seattle & King County D^^ocuSigned by: P COST m' 7/10/2019 FB... TJ Cosgrove, CHS Division Director Date 3 DocuSign Envelope ID:792E7D4A-478E-4EE9-841 A-99E3C991 F955 PUBLIC ENTITY CERTIFICATION AND ATTESTATION STATEMENT—MEDICAID ADMINISTRATIVE CLAIMING PUBLIC AGENCY (NAME): City of Kent (Agency) Claiming Agency: Children's Therapy Center Invoice Quarter: I HEREBY CERTIFY under penalty of perjury that: 1. 1 am the Agency official responsible for the information contained in this invoice, and I am authorized to make this certification on Agency's behalf. 2. The information provided in this invoice is true and correct and in accordance with state and federal law. a. This certification is based on actual expenditures incurred by Agency for claimable MAC activities performed by the Children's Therapy Center. The expenditures meet requirements for claiming federal financial participation pursuant to 2 Code of Federal Regulations 200 part 225. b. This invoice was prepared by the Children's Therapy Center and reviewed by Public Health Seattle King County for completeness and accuracy. _$XXX of the public expenditures detailed in the invoice were paid from funds provided to Children's Therapy Center by Agency and are so noted in Agency's general ledger 3. The expenditures reported in this invoice have not previously been, nor will subsequently be used for federal match in this or any other program. 4. The public funds expended by Agency for its share of the costs contained in this invoice do not include impermissible provider taxes or donations as defined under Section 1903(w) of the Social Security Act, or other federal funds. For this purpose, federal funds do not include patient care revenue received from Medicare or Medicaid. I, the undersigned state: I am authorized to make this certification for and on behalf of the Agency. . I understand the make of false statements or the filing of false or fraudulent costs is punishable and constitute violation of the Federal False Claims Act. Signature: Date: Print Name: Title: DocuSign Envelope ID:792E7D4A-478E-4EE9-841A-99E3C991F955 PUBLIC ENTITY CERTIFICATION AND ATTESTATION STATEMENT— MEDICAID ADMINISTRATIVE CLAIMING Public Health Seattle King County (PHSKC) Attestation Statement: I, the undersigned attest: that as the PHSKC Coordinator, Financial Officer, or other individual duly authorized as having authority to sign on behalf of PHSKC, that the certification above hereto are true to my knowledge. I attest the certification information is true and correct. I understand that the making of false statements or the filing of false or fraudulent costs is punishable and constitute violation of the Federal False Claims Act. Signature: Date: Print Name: Title: