Loading...
AG 13-184RETURN TO: EXT: CITY OF FEDERAL WAY LAW DEPARTMENT ROUTING FORM 1. ORIGINATING DEPT./DIV: 2. ORIGINATING STAFF PERSON: EXT: 2 3. DATE REQ. BY: 4. TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) • PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT • PROFESSIONAL SERVICE AGREEMENT ❑ AINTENANCE AGREEMENT • GOODS AND SERVICE AGREEMENTIUMAN SERVICES / CDBG • REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. BOND RELATED DOCUMENTS) • ORDINANCE ❑ RESOLUTION • CONTRACT AMENDMENT (AG #): D INTERLOCAL • OTHER 6. 8. 9. PROJECT NAM] NAME OF CON ADDRESS: E -MAIL: SIGNATURE NAME: FAX: TITLE EXHIBITS AND ATTACHMENT�COPE, WORK OR SERVICES -COMPENSATION ❑ INSURANCE REQUIREMENTS /CERTIFICATE ❑ ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT /AMENDMENTS TERM: COMMENCEMENT DATE: �/ / �� COMPLETION DATE: , TOTAL COMPENSATION $ 0 V (INCLUDE EXPENSES AND SALES TAX, IF ANY) (IF CALCULATED ON HOURLY LABOR CHARGE - ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) REIMBURSABLE EXPENSE: ❑ YES ❑ No IF YES, MAXIMUM DOLLAR AMOUNT, IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY' ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 001-1,30-093-5-W--40— lko 10. DOCUMENT /CONTRACT REVIEW ❑ PROJECT MANAGER ,2' IRECTOR • RISK MANAGEMENT (aF APPLICABLE) • LAW 013 11. COUNCIL APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: 12. CONTRACT SIGNATURE ROUTING INITIAL /DATE APPROVED COUNCIL APPROVAL DATE: ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS ❑ LAW DEPARTMENT • SIGNATORY (MAYOR OR DIRECTOR) • CITY CLERK • ASSIGNED AG# • SIGNED COPY RETURNED COMMENTS: INITIAL / DATE SIGNED Alr •25.13 0' AG# _ DATE SENT: 11/9 Ct� S323__7 } � CITY OF CITY HALL Federal Way 33325 8th Avenue South Federal Way, WA 98003 -6325 (253) 835 -7000 www.dtyoffederaMW.com MEDICAID ADMINISTRATIVE MATCH AGREEMENT BETWEEN THE CITY OF FEDERAL WAY AND PUBLIC HEALTH — SEATTLE & KING COUNTY THIS AGREEMENT is made and entered into this 7th day of August 2013. The parties ( "Parties ") to this Agreement are the City of Federal Way, a State of Washington municipal corporation ( "City ") and the Seattle -King County Department of Public Health aka Public Health- Seattle & King County, a political subdivision of the State of Washington ( "PHSKC "). The City and Contractor (together "Parties ") are located and do business at the below addresses which shall be valid for any notice required under this Agreement: PUBLIC HEALTH — SEATTLE & KING COUNTY: CITY OF FEDERAL WAY: Dr. David Fleming, Director Denise Catalano Public Health- Seattle & King County 33325 8t' Ave. S. 401 Fifth Avenue, Suite 1300 Federal Way, WA 98003 -6325 Seattle, WA 98104 206 - 296 -4600 (telephone) 206 - 296 -0629 (facsimile) (253) 835 -2651 (telephone) (253) 835 -2409 (facsimile) dense .catalanot7acityoffederalway.com A. The City is entering into this agreement with PHSKC to enable Birth to Three Development Center (`Birth to Three) to use its Human Services General Fund award for 2013 totaling $20,000 to earn Medicaid Administrative MATCH funds through the Medicaid Administrative MATCH Program; and B. The City, by entering into this agreement, will have the ability to leverage its grant award so that more services are provided to Federal Way residents; and In consideration of the mutual terms, provisions and obligations contained herein, it is agreed by and between the City and PHSKC as follows: 1. Objective. This Agreement specifies administrative and fiscal procedures for reimbursing agency partners of the City with City funds and allowable Medicaid Administrative Match funds. The objective of the program is to maximize funding for the City's agency partners, so these agency partners can expand services to Medicaid- eligible clients in the Seattle -King County area. 2. Term. The term of this Agreement shall be in force from January 1 through December 31, 2013, unless otherwise terminated pursuant to Section 3. 3. Termination. Prior to the expiration of the Term, either the City or PHSKC may terminate this Agreement upon thirty (30) days written notice to the other Party unless a shorter period is mutually agreed upon the by the Parties. 4. Key Elements. Key elements of the operational agreement between the City and PHSKC are as follows: 4.1 The City will provide PHSKC with funds upon receipt of quarterly invoices. MEDICAID ADMINISTRATIVE MATCH - 1 - 8/2013 i CITY OF CITY HALL Federal Way 33325 8th Avenue South Federal Way WA 68003 -6325 (253) 835 -7000 mm.. cFWffederaMW__ corn 4.2 Funds received by PHSKC will be distributed to Birth to Three Development Center, (`Birth to Three "). Total funds received by PHSKC for distribution to Birth to Three shall not exceed $20,000.00. 4.3 PHSKC will match the City funds with allowable Medicaid Administrative Match dollars, according to provisions outlined by the state administered Medicaid Administrative Match program. 4.4 PHSKC will reimburse Birth to Three with allowable matched funds for costs incurred to provide delegated Medicaid- related administrative activities upon receipt and verification of the quarterly invoices. Copies of these invoices will be forwarded to the City. 4.5 Unmatchable City expenses will be paid by PHSKC with City funds as mentioned in item 4.2 above; these funds will be distributed on a quarterly basis. 4.6 If expected reimbursement to PHSKC from the state administered Medicaid Administrative Match program is reduced or denied, PHSKC retains the right to recover from Birth to Three any "match" funds paid and subsequently not recovered from the state. If the Medicaid Administrative Match program is discontinued during the term of this agreement, PHSKC may cease paying the "match" portion of reimbursement to Birth to Three effective the end date of the Medicaid Administrative Match program. 5. Indemnification. Each Party shall protect, defend, indemnify and save harmless the other Party, its officers, officials, employees and agents while acting within the scope of their employment as such, from any and all suits, costs, claims, actions, losses, penalties, judgments, and/or awards of damages, of whatsoever kind arising out of, or in connection with, or incident to the goods and/or the services associated with this Agreement caused by or resulting from each Party's own negligent acts or omissions. Each Party agrees that its obligations under this provision extend to any claim, demand, and/or cause of action brought by or on behalf of any of its employees, or agents. The foregoing indemnity is specifically and expressly intended to constitute a waiver of each Party's immunity under Washington's Industrial Insurance act, RCW Title 51, as respects the other Party only, and only to the extent necessary to provide the indemnified Party with a full and complete indemnity of claims made by the indemnitor's employees. The Parties acknowledge that these provisions were specifically negotiated and agreed upon by them. 6. Entire Agreement — Amendments. This printed Agreement shall constitute the whole agreement between the Parties. There are no terms, obligations, covenants, or conditions other than those contained herein. Except as otherwise provided herein, no modification or amendment of the Agreement shall be valid or effective unless evidenced by an agreement in writing signed by both Parties. [Signature page follows] MEDICAID ADMINISTRATIVE MATCH - 2 - 8/2013 a. CIYY OF CITY HALL 4S 33325 8ih Avenue South h Federal Way, WA 98003-6325 (253) 835 -7000 ww+w. a4O#federaMey. awry IN WITNESS, the Parties execute this Agreement below, effective the last date written below. CITY OF FEDERAL WAY Skip Pries ayor DATE: 7/;Z r/ /' ? PUBLIC HEALTH — SEATTLE & KING COUNTY By: Printed Name: Title: DATE: «� STATE OF WASHINGTON ) ss. COUNTY OF ATTEST: (�aA� C()Qn ti 0)� City Clerk, Carol McNeilly, MC APPROVED AS TO FORM: 6MWqf/449aB. P#9- City Atto , Patricia A Richardson On this day personally appeared before me -40440, ts 1 4 el- m„ , to me known to be the of Public Health — Seattle & King County that executed the foregoing instrument, and acknowledged the said instrument to be the free and voluntary act and deed of said corporation, for the uses and purposes therein mentioned, and on oath stated that he /she was authorized to execute said instrument and that the seal affixed, if any, is the corporate seal of said corporation. G`I ; �jjjfy�hand and official seal this /7 AL day of �`iy ~�� ONE ®�!� Notary's s si afore f ' Notary's printed name _ Notary Public in and for d e State of Washington. U &OLV 0 ` My commission expires o0*4wwf /f, 40 /L • OF 11 MEDICAID ADMINISTRATIVE MATCH - 3 - 8/2013