HomeMy WebLinkAboutAgreements/Contracts - Renewt1'3
May 31, 2023
Board of County Commissioners
PO Box 37
Ephrata, WA 98837
Re: Beneficiary Agreement with Health Care Authority — Agreement G247
Dear Commissioners,
Please see the attached Beneficiary Agreement fbr review and approval.
840 E. Plum Street
Moses Lake, WA 98837
Phone: (509) 765-9239
Fax: (509) 765,1 582
APPROVED
JUN 6 2023
CONSENT
Contractor: Health Care Authority
Term of Contract: Agreement End Date — 6/30/2023
Payment Amount: $20,970.83
Purpose: These funds are being distributed by Washington State Health Care Authority for Behavioral
Health workforce stabilization efforts for recruitment and retention
I am requesting permission to Docu-Sign electronically with Health Care Authority.
Thank you for your consideration. If you have any questions, please contact me.
Sincerely,
POW"
Dell Anderson, M.Ed, LMHC
Executive Director
MAY 31 2o23
GRANT COUNTY COMMISSIONERS
DocuSign Envelope ID: A8CE697A-0394-4BOA-A674-5C1782BFDO92
This Amendment to the parties Agreement is made by and between the Washington State Health Care Authority ("HCA")
and the Beneficiary identified below. HCA and Beneficiary may be individually referred to as a "party" or collectively
referred to as "parties."
To be valid. this Amendment must be signed by Beneficiary's authorized representative and returned electronically to
HCA before midnight June 9, 2023. Beneficiary may rely on DocuSign's verification or Beneficiary's sent email timestamp
as verification of receipt by HCA.
BENEFICIARY NAME
DOING BUSINESS AS DBA
Agreement Number: G247
Renew
BENEFICIARY AGREEMENT
CITY STATE ZIP + 4
Washington State'
AMENDMENT
Amendment Number: 01
Health Care uthority'
Behavioral Health Workforce
Beneficiary National PI Number:
HCA ADDRESS
Stabilization Funding
Cherry Street Plaza
626 8th Avenue SE
PO Box 42730
Olympia WA 98504-0001
HCA CONTACT
1689677833
This Amendment to the parties Agreement is made by and between the Washington State Health Care Authority ("HCA")
and the Beneficiary identified below. HCA and Beneficiary may be individually referred to as a "party" or collectively
referred to as "parties."
To be valid. this Amendment must be signed by Beneficiary's authorized representative and returned electronically to
HCA before midnight June 9, 2023. Beneficiary may rely on DocuSign's verification or Beneficiary's sent email timestamp
as verification of receipt by HCA.
BENEFICIARY NAME
DOING BUSINESS AS DBA
Grant County Dba Renew
Renew
BENEFICIARY ADDRESS
CITY STATE ZIP + 4
840 E Plum St
Moses Lake WA 98823
BENEFICIARY CONTACT
BENEFICIARY CONTACT EMAIL
Dell Anderson
daanderson@grantcountywa.gov
HCA ADDRESS
CITY STATE ZIP + 4
Cherry Street Plaza
626 8th Avenue SE
PO Box 42730
Olympia WA 98504-0001
HCA CONTACT
HCA CONTACT EMAIL
Kimberly Wright
Behavioral Health Policy and Planning Supervisor
HCADBHRinformation@hca.wa.gov
AMENDMENT START DATE
AGREEMENT END DATE
BEHAVIORAL HEALTH
WORKFORCE STABILIZATION
FUNDING
PROVIDED THROUGH
Date of Execution
06/30/2023
AMENDMENT 01
(ADDITIONAL PAYMENT)
$20,970.83
I. RECITALS
WHEREAS, the COVID-19 public health emergency created ongoing behavioral health treatment access issues resulting
from workforce shortages and adverse impacts of the emergency; and
WHEREAS, the parties entered into Beneficiary Agreement G247 ("the Agreement") to provide Behavioral Health
Workforce Stabilization (BHWS) funds to support Beneficiary's response to the economic and public health impacts of
COVID-19; and
WHEREAS, Beneficiary received BHWS funds ("Payment") as described in the Agreement; and
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DocuSign Envelope ID: A8CE697A-0394-4BOA-A674-5C1782BFDO92
1
WHEREAS, HCA notified Beneficiary of its eligibility to receive a portion of unclaimed BHWS funds as an "Additional
Payment"; and
WHEREAS Beneficiary affirmed its interest in the Additional Payment and provided HCA with Beneficiary's NPI number
to receive the Additional Payment.
THEREFORE, the Parties agree as follows:
II. TERMS AND CONDITIONS
1. SCOPE OF AMENDMENT 01. This Amendment increases the BHWS funds paid by HCA to Beneficiary in the amount
stated herein. The increase is an Additional Payment of BHWS funding, subject to the terms, conditions, and
restrictions of the Agreement.
2. OTHER TERMS UNCHANGED. The Agreement, as modified by this Amendment, remains, and continues in full force
and effect as the legal, valid, and binding obligations of the parties, and is in all respects agreed to, ratified, and
confirmed, including the Beneficiary Certifications. -
Each signatory below certifies they are authorized to bind their respective Party to this Agreement.
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i
Dell Anderson
Annette Schuffenhauer, Chief Legal Officer
Date signed
Date signed 5/24/2023
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