HomeMy WebLinkAboutCAG2019-1007 - Amendment - #2 - Public Health Seattle & King County (PHSKC) - Medicaid Administrative Claiming (MAC) Agreement # 4909 CHS Extension - 05/01/2023 FOR CITY OF KENT OFFICIAL USE ONLY
Sup/Mgr:
Agreement Routing Form DirAsst: /,0/-
For Approvals,Signatures and Records Management Dir/Dep: _VV
KEN T This form combines&replaces the Request for Mayor's Signature and Contract Cover (Optional)
W A S H I N G T O N Sheet forms. (Print on pink or cherry colored paper)
Originator: Department:
KateLynn Jennings for Lori Guilfoyle Parks, Recreation & Community Services
Date Sent: Date Required:
y 4/20/2023 Soonest possible please
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C. Authorized to Sign: Date of Council Approval:
a W]Mayor or Designee 11/15/2022
Budclet Account Number: Grant? Yes NoE]
10006370.64150.4690
Budget?W]Yes E]No Type: N/A
Vendor Name: Category:
Public Health - Seattle King County Contract
Vendor Number: Sub-Category:
C 1264312 Amendment
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Project Name: Medicaid Administrative Claiming Agreement - Amendment 2
N. Project Details: PHSKC will subcontract with City of Kent partner Children's Therapy Center to provide the
0 Children with Special Needs program.
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EO Basis for Selection of Contractor:
� Agreement Amount: $25,000 Other
*Memo to Mayor must be attached
aStart Date: 1 O/1/2O 1 9 Termination Date: 12/31/2023
Q Local Business?Des Who*If meets requirements per KCC3.70.100,please complete'Vendor Purchase-Local Exceptions'form on Cityspace.
Business License Verification: ❑Yes In-Processwl Exempt(KCC 5.01.045) 91 Authorized Signer Verified
Notice required prior to disclosure? Contract Number:
Yes W1 No CAG 2019-1007
Comments:
City signs first.
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Clerk's Office received 5/24/23
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Date Received:City Attorney: 5/3/23 Date Routed:Mayor's Office 5/4/23 City Clerk's Office5/9/23
adccW22373_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements
rev.20221201
DocuSign Envelope ID:OEE42665-BE07-49C4-A93A-9EDOB97361BA
Public Health
Seattle &King County
PHSKC Agreement# 4909 CHS —Amendment 2
AMENDMENT
This Amendment between PHSKC and the City of Kent changes the referenced Agreement for the following
purpose(s): This amendment adds funding and extends the end date for the contract between the City of Kent
and PHSKC. The County will then subcontract with Children's Therapy Center to conduct Medicaid
Administrative Claiming activities.
Other Party: City of Kent, 220 41"Avenue South, Kent, WA 98032
Project Title: Medicaid Administrative Claiming
Effective Date of Amendment: May 1, 2023
Revisions to Agreement:
1. Agreement Period is changed to 10/1/2019—12/31/2023
2. Section V is revised to have an end date of December 31, 2023.
3. Revise invoice element in Exhibit I, Section III as follows: PHSKC will invoice CITY OF KENT six to nine
months after each quarter ends due to the significant delay in administering the Medicaid Administrative
Claiming Program.
4. The maximum allocation amount in Exhibit I, Section III, is changed to read $137,500.
Notwithstanding the referenced Agreement's expiration on December 31, 2022, the parties explicitly agree that
all terms and conditions of the original contract continue to be applicable under this Amendment until the new
end date noted above. All acts consistent with the authority of the Agreement and prior to the effective date of
this Amendment are ratified and affirmed, and the terms of the Agreement shall be deemed to have applied. All
other terms and conditions of the referenced Agreement and any previous Agreement amendment not revised
herein shall remain unchanged and in full force and effect.
CITY OF KENT SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Dana Ralph, Mayor 05/09/2023
PHSKC SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
Docusigned by: Sheryl Davis 5/15/2023
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� Sheryl Davis, Deputy Division Director
)EOCC4448
CTC CONCURRENCE SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DocuSigned by: Janet Zamzow Bliss 5/15/2023
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