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BEACON FACILITY AGREEMENT
This third amendment ("Amendment") amends the Beacon Facility Agreement. ("Agreement") entered into
by Beacon Hea'lth Options, Inc. ("Beacon") and the below-li'sted provider ("Facility"). Unless otherwise
defined herein, all capitalized terms used in this Amendment shall have the same meaning as set forth
in the Agreement. %
WHEREAS, the Agreement permits amendments to the Agreement by Beacon and Facility; and
WHEREAS, Beacon and Facility desire to am -end the Agreement to make certain changes to it.
NOW, THEREFORE, in consideration of the promises and mutual covenants contained herein and other
good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
Agreement is- hereby amended as follows:
1. Exhibit B -1A.2 Maximum Contract Amounts is removed and replaced with B 1A.3 Maximum
Contract Amounts effective July 1, 2018.
a. SABG Mobile Outreach Team is added with a $40,000 Contract Maximum, this $40.1.000
is moved from SABG Substance Abuse Block Grant to the SABG Mobile Outreach Team.
b. SABG Substance Abuse Block Grant is thereby reduced by $40,000, from $60,000 to
$207000.
c. Total Funding remains unchanged.
2. Addendum to Exhibit B-11 'is. added describing work -of specialized Mobil Outreach 'Team funded
under Substance Abuse Block Grant effective. July 1, 2018.
3. This Amendment shall be effective upon the date set forth by Beacon following signature by both
Beacon. and Facility.
4. Except as amended herein, all other terms- and conditions of the Agreement sh-all re -main in full
force and effect without modification,
5. Scope of work pursuant with contract terms between Beacon and Health Care Authority as
dictated in contract -amendment dated January 1, 20-19-.
Facility.: Grant Integrated Services
Ad -dress: 840 E. Plum Date this day of
Moses. Lake, WA 98837 Board ofC6ullty . Co; M nets
'Grant County, Washing�,On
N P 1., 1689677833,1982-792537
R E Co E0 v LY...e/ aW'
JUL. ." 2 2019
GRANT COUNTY COMM18SIONERSj.
BHO-F-CWMA-MCD/l 1/2015
(AG - VO STD FACT LITY) -
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Dist #j
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Dist #2. 'Dist #2
Dist -#1. D! . st # 3 Dist
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Intending to be legally bound, the parties have caused their authorized representatives to
execute this Agreement effective as of the date set forth by Beacon below.
Agreement
�Cllltyip
Iq
Ignature DAte
-6Y4, 004rlr
Print Name & Title
Federal Tax Identification Number
Beacon Health Options, Inc.:
7/25/2019
Signature
. Jon Shields, Regional Vice President.
Print Name & Title
Date
Address for Notice: Address for Notice:
Beacon Health Options, Inc.
P.O. Box 41055
Norfolk, VA 23541-1.055
Attn: National Provider Network Operations
Please do NOT write below this line. For Beacon office use ONLY,
July 1, 2018
EFFECTIVE DA TE
Negotiated By: Karen Black
Print Name
Contract Development Manager
Date Received By Beacon
Please -check if included-, El
X
BHO-F-COMMA-MCD/l 1/2015 Page 2 of 4
(AG — VO STD FACILITY)
Exhibit B-IA.3
Maximum Contract Amounts
Beacon shall have no obligation to pay for costs or claims in excess of the amounts -listed below for the
period of July 1, 2018 through June 30, 2019, unless this Exhibit is amended pursuant to the terms of the
Agreement,
Funding Source
Program
or Service
Exhibit
Payment Type
Contract Maximum
Jail Transition
Jail
B-6
Cost Reimbursement$22110,5*
CNWJT7
Transition
Mental Health Block
Mobile -
Grant (NWMH)
Outreach
B-4
Cost Reimbursement
$1 26, 89-8
Team
State GFS. (NWGF)1
Crisis
B4
Cost. Reimbursement
$904893
Medicaid
Services
,
Substance.
SHBG
Abuse
Block
B-11
Fee for Service
$2010-00
Grant
Mobile
Addendum to
-SABG
Outreach
B-1. I
Cost Reimbursement
$40100.0
Team
5883
Startup
ESSB 5883
Funds for
B-20
Cost Reimbursement
$1351-000
Residential
Beds
TOTAL FUNDING
$1,-248,896
*Jail Transition Services will sunset when ESSB 6032 plan implements.-
BHO-F-COM-MA-MCD/1 1/2015 Page 3 of 4.
(AG -- VO STD FACILITY}
Addendum to B-11
Mobile Outreach Team
Objective:
Engage two Peer Support Specialists to provide. Mobile Outreach SerVices to identified clients in
support of positive recovery outcomes. Mobil Outreach Services. will include peer support, support for
education activities, resource referral, sharing their lived experience with behavioral health issues and
recovery principles.
Services:
1 Provide outreach to engage identified clients in services or referrals by listening .encouraging,.
coaching,. empowering and connecting with resources to enhance client recovery needs.
2) Work in conjunction with community partners, law enforcement, medical community, and other
behavioral health staff.
3) Provide peer support, support for education activities, resource referral, share lived experience
with behavioral health issues. and recovery principles.
4) Services are provided countywide, where people are. Peer Support Specialists will go to
homeless encampments, food banks when open, the warming center when open, and the Jail.
They will travel with the Grant County Safe Syringe program, which is currently in Moses Lake
and Soap Lake each one day a week.
'Reporting Requirements:
1) 'Report monthly data- regarding the unique number of individuals served, number of services
provided, and year to date number of unduplicated individuals served.
2) Provide a quarterly narrative describing the activities, outcomes, barriers-, and lessons learned.
Funding Requirements and Limitations:
Facility shall not use- Funds for the following:
1 Services and programs that are covered under the capitation rate for Medicaid covered services
to Medicaid enrollees.
2) Inpatient mental health services.
3) Construction and/or renovation.
4) Capital assets or the accumulation of operating reserve accounts.
6) Equipment costs over $5,000.
6) 'Cash payments to consumers,
7) State match for other federal funds.
Payment:
Facility shall submit an Invoice requesting payment from Beacon at the end of each month for cost
reimbursement for a total maximum annual amount of .$40,000, Provision of required reports is a
condition for payment.
BHO-F-COM-MA-MCD/1 1/2015 Page 4 of 4
(AG — VO STD FACILITY)