HomeMy WebLinkAboutWashington State Health Care Authority Amendment # 2 1
DocuSign Envelope ID:5B1C705C-E648-49C4-8B30-29841A491E34
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MC Contract.#20-066
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CONTRACT HCA Contract No.: K2751
Washington State AMENDMENT Amendment No.: 02
Health Care Vuthority For
ABCD DENTAL
SERVICES
THIS AMENDMENT TO THE CONTRACT is between the Washington State Health Care Authority
and the party whose name appears below, and is effective as of the date set forth below.
CONTRACTOR NAME- CONTRACTOR doing business as (DBA)
Mason County Public Health
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS IDENTIFIER
415.N. 6th Street (UBI)
Shelton,WA 98564
WHEREAS, HCA and Contractor previously entered into a Contract for to provide 'Access to Baby and
Child Dentistry'(ABCD) services to detect and prevent early childhood dental-decay by engaging
dentists in seeing birth to six(6) year old Medicaid eligible children and engaging local public health
departments in outreach and case management, and;
WHEREAS, HCA and Contractor wish to amend the Contract pursuant to Section 4.3 to lncrease.
funds, add definitions, extend term, update SOW and Exhibits;
NOW THEREFORE, the:parties agree the Contract is amended as follows:
1. The maximum contract amount is being increased by $38,200.00,.fora new maximum contract
total of$76,400.00..
2. Sectio.n 3 Special Terms and Conditions, two new subsections are added as follows:
h) "Coordinator" means the individual hired to organize events and activities related to the
ABCD"program and who also acts as a liaison/advocate between providers and families of
ABCD.eligible children birth up to six (6) years old.
i) "DentistLink" means a free.referral service for anyone in Washington(Sponsored by
Arcora Foundation),connecting clients with dental providers. - -
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All remaining subsections are subsequently re.lettered and internal references updated
accordingly.
3. Section 3..2 Term, subsection 3.2.1 .is deleted and replaced in its entirety as follows:
321 The initial start date of the Contract was.on July 1, 20.18, the term has been extended for'
an;additional two (2)year term, and set to continue through June 30, 2022, unless
terminated sooner as provided herein.
4. Section 3.3 Compensation, subsection 3..3.1 is deleted and replaced in its entirety as follows
HCA Contract No. K2751-02 Page 1 of 20
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33.1 The Maximum Compensation payable.to the Contractor for the performance of all things
necessary for or incident to the performance of the work as set forth in Schedule A-1:
Statement.of Work has increased by$ 38,200.00, for anew Contract Maximum
Compensation of$76,400.00,,and includes any allowable expenses.
5. Section 3.8'Incorporation of Documents and Order.of Precedence is deleted and replaced in its i
entirety as follows:
3.8 INCORPORATION OF DOCUMENTS AND ORDER OF PRECEDENCE
Each of the documents listed below is by this reference incorporated into this Contract. In the
event ofan inconsistency, the inconsistency will be resolved in the following order of i
precedence:
3.8.1 Applicable Federal and State of Washington statutes and regulations;
3.8.2 Recitals;
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3.8.3 Special Terms.and Conditions;
3.8.4 General Terms and Conditions;
3.8.5 Attachment 1: Federal Compliance, .Certifications and Assurances;
3.8.6 Attachment 2; Federal funding Accountability and Transparency Act(FFATA) Data
Collection Form;
3.8.7 Schedule A-1: Statement of Work;
3.8.8 Exhibits A-1: ABCD Quarterly Community and Provider Outreach and Case
Management.Report;
3.8.9 Exhibit B: ABCD Quarterly Outreach and Coordination of Care-Report;
3.8.10 Exhibit C-1: ABCD Yearly Budget.Tool;
3.8.11 Exhibit D: ABCD Coordinator Performance Expectations:and Abilities;and
3.8.12 Any other provision, term or material incorporated herein by reference or otherwise
incorporated.
6. Schedule A: Statement of Work, is replaced in its entirety with Schedule A-1: Statement of Work,
attached:hereto and incorporated herein.
T. Exhibit A: ABCD Quarterly Outreach and Case Management Report, is renamed and replaced in
its entirety with Exhibit A-1: ABCD Quarterly'Community.andProvider Outreach and.Case
Management Report, attached hereto and incorporated herein.
8. Exhibit B:ABCD Quarterly Outreach and Coordination of Care Report.is°replaced in its entirety
with Exhibit B-1: ABCD Quarterly Outreach and Coordination of Care Report, attached hereto
and incorporated.herein.
FICA Contract No. K2751-02 Page 2 of 20
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9. Exhibit.C: ABCD Yearly Budget Tool is replaced in its entirety with Exhibit C-1: ABCD Yearly
Budget Tool, attached hereto and incorporated herein.
10.Exhibit D:.ABCD Coordinator Performance Expectations and Abilities is incorporated into the
Contract, attached hereto and incorporated herein.
11.This Amendment will be effective July 1, 20.20 ("Effective Date").
12.All capitalized terms not otherwise defined herein have the meaning ascribed to there in the
Contract.
13.All other terms and conditions of the Contract remain unchanged and in full force and effect.
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The parties signing below warrant that they have read and understand this Amendment and have
authority to execute the Amendment. This Amendment will be binding on'HCA only upon.signature by
both parties.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
�ha,�h`"trash,�,hetn�r 11m1'yv
HCA SIGNATURE RaRtf�e f I e AWAmeANND TTITLE DATE SIGNED
Dcousigned by: 7/22/2020
rR.,. ...GL.. —4-n,...t,,;,1.., contracts Administrator
71 EWFEBBC774E7...
HCA Contract No. K2751-02 Page 3 of 20.
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Schedule.A-1:
Statement of Work(SOW)
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The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental
to the performance of work, as set forth below:
A. In accordance with deadlines in Exhibit A-1, ABCD Quarterly Community and Provider Outreach and
Case Management Report, develop and implement an ABCD action plan in accordance with the
ABCD program principles and submit corresponding budget, using Exhibit C, ABCD Yearly Budget
Tool. The ABCD program principles are outlined below.
t
1. Provide outreach and linkage of Apple Health/Medicaid-eligible Clients, ages birth to six(6), with
an emphasis on children of color, children 0-2, and other eligible but underserved.children in the
service area in collaboration with other organizations, including, but not limited to:
a) Provide outreach by.attending, visiting or working with the below, but not limited to the following:
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i. Outreach and marketing events and activities such as health fairs, use of social
media (ie; Facebook, Twitter, lnstagram, Constant Contact, etc)to perform targeted
outreach activities that effectively connect with families of eligible children.
ii. SmileMobile (sponsored by the Arcora Foundation) locations (a mobile dental clinic
providing dental services to children,.pregnant women, and others
iii. Women, Infants, and Children WIC offices (a federal assistance program of the !
Food and Nutrition Services of the United States Department of Agriculture;
iv. Head Start.and Early Head Start facilities(a federal program that promotes-the j
school readiness of children under five from low-income families);
v. Early Learning Regional Coalitions (that are a not-for-profit alliance of employers
and community subsidized before and after school child care); and
vi. Day Care facilities throughout the state of Washington. '
.............. b) Provide care coordination, including:
i. Provide family orientation; including but not.limited to, sharing information about the
value of an infant, toddler, or young child going to the dentist,what activities to expect at
the dentist's office, and the importance of oral health care at home.
ii. Connect families with an ABCD certified dentist who accepts Apple Health/Medicaid, and
providing information including, but not limited to, names and referrals to dentists,
sharing information about interpreters and transportation benefits, and following up after
an appointment, if appropriate;
iii. Assist, as needed, in scheduling dental appointments for eligible children and counsel on
the importance of keeping the appointment; and
c) Work with the DentistLink team to align Dentisti-ink tool with local program's referral processes to
ensure ABCD clients have a variety of complementary avenues for referral and linkage to ABCD
providers.
i. Coordinate ABCD program's dentist recruitment and support efforts with DentistLink's by
assuring both programs have the same updated information:
HCA Contract No. K2751-02 Page 4 of 20
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ii. Contact each practice-to update participating-ABCD dentist,roster: I
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1. number and frequency of clients accepted;
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2. appointment times/days;
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3. translation availability times/days;
4. change business status of practice (not accepting new.ABCD clients, accepting
more clients, etc.);
5.. new providers, Phase.I, Phase II; and
6. other. j
iii. Submit updated.ABCD provider roster to DentistLink electronically via one.shared file
Iv. Identify and address family barriers to accessing oral health care.
d) Bi-annually convene or participate in a county-wide or regional.oral health coalition or ABCD
steering committee or other groups which focuses on health care, access or early learning in
order to build awareness of the ABCD program and.solicit input on process improvements.
.i. Invite to participate in:the meeting.with the ABCD state managing director, the Arcora
Foundation, and the Health Care Authority dental program administrator.
e) Continuously coordinate with the local ABCD Dental Champions)to:
I. Identify and recruit dental providers to accept and provide care to Apple Health/Medicaid
clients birth to six (6)years through the ABCD Program;
ii. Maintain.a list of active ABCD dental providers who accept Apple Health/Medicaid
Clients birth.to six.(6)years and monitor provider availability to accept new Clients birth
to six (6) years into their practice;.
iii. Support.current.ABCD,providers by communicating program changes and policy updates
through in-person meetings and written communication;
IV. Plan and implement, in coordination with the UW School of Dentistry, timely ABCD
provider trainings(Phase I, II and refresher training) leading to certification of providers
and onboarding of their staff;
v. Assure provider ABCD certification process is completed;
vi. Provide or arrange for, timely Apple Health/Medicaid billing training assistance to ABCD
office staff and providers, as needed;
vii. At minimum annually update dental society(or local dentists/study clubs in counties
without a society) on the ABCD Program and support their continued participation in the
program and encourage recruitment of new Apple Health/Medicaid providers; and
viii.Support the Dental Champion(s) participation in meetings and activities necessary to
effectively conduct Apple Health/Medicaid provider outreach, recruitment and training,
including financial support of attendance (travel, lodging, etc.) in Development Day.
HCA Contract No. K2751-02 Page 6 of 20
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ix. Identify and recruit primary care medical providers to participate in Apple
Health/Medicaid as ABCD certified providers, secure their training through Arcora
Foundation in preventive oral health care techniques (Family Oral Health Education,, f
fluoride varnish, etc.) and build their role in referring Apple Health/Medicaid-eligible
children to the ABCD Program.
x. Participate in all three (3) statewide ABCD Coordinators group meetings to remain
current with ABCD policies, practices and opportunities..Programs which do not meet this
annual contract requirement will be subject to contract review by HCA and potentially, to ;
loss of this contract.
A Participate in the annual statewide.ABCD Champion Development Day meeting to
remain current with aWnew clinical practices and opportunities. Meet, network, and
share knowledge with other champions regarding program.roadblocks and successes..
With HCA permission, attendance at Development Day may be counted in lieu of
participation at one missed ABCD Coordinators meeting.
xii. Identify an ABCD Coordinator within the contracting organization who will develop and
maintain a desk manual that outlines the expected ABCD contractual deliverables and
how the contractor meets each deliverable. The Coordinator will utilize this manual to
fulfill the contractual requirements and to orient new lead staff within the organization to
the ABCD program.
f) If the Contractor's Coordinator vacates the position,the contractor must notify the Health
Care Authority within two weeks, of the coordinators departure, and;
i. Share the Contractor's developed work plan that outlines how the expected contract
deliverables will be met;
ii. Share with HCA the contact information of the newly hired or appointed Coordinator and;
iii. Coordinate with HCA to assure a smooth transition of the expected contracted work
deliverables, including participation in program orientation with HCA and other state,
partners.
iv. ABCD Coordinator new hire must reasonably meet the expectations as identified in
Exhibit D ABCD Coordinator Performance Expectations and Abilities.
g) If the Contractor determines that it can no longer serve as the ABCD Contractor, reasonable
notice 90 days must be given to HCA in order to assure uninterrupted service to clients and work
with providers and:
L Work with HCA and other state partners to identify potential new ABCD-lead agencies.
2. Each quarter,the contractor must complete and submit the following via email:
a) Community and Provider Outreach and Coordination Care summary which shall
include;
i. Exhibit A-1,ABCD Quarterly Community and Provider Outreach and Case Management
Report for the specific quarter; and
ii. Exhibit B, ABCD Quarterly Outreach and Coordination of Care Report.
3. Each year, the contractor must complete and submit via email the Exhibit C, ABCD Yearly Budget
HCA Contract No. K2751-02 Page 6 of 20
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Tool, as applicable to the requirements, contained in Exhibit A-1. k
4. Each quarter the contractor must submit.a fully completed invoice that correlates with dollar
values for completed deliverables outlined in Exhibit A-1: '
a) Exhibit templates are available on the ABCD website htto://abcd-dental.org/for-coordinators/:
and
b) Reports and billing must be submitted no later than one month after each quarter end date,. I
unless otherwise mutually agreed by both parties.
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HCA Contract No. K2751-02 Page 7 of 20
0
0
C
CD
Exhibit A-9 ABCD Quarterly Community and Provider Outreach and Case:Management Report
Year One 2020 -2021 1st Quarter Report
0
CD
Please complete and submit report electronically to:
Janice Tadeo, ABCD Program Manager at ianice.tadeoAhca.wa.gov C3
Cc: Pixie Needham, Dental Program Administrator at pixie.needham(o)-hca.wa.gov 0
Division of Health Care Services, Washington State Health Care Authority A
PO Box 45506, Olympia,WA 98504-5506
Phone: (360) 725-1583 A
C6
W
Organization: o
ABCD Contact Person: CD
Phone and Email:
1st Quarter A
7/1/2020- 'm
Re ort Due: 1.0/31/2020 9130l2020 �
Maximum Brief description (for events,provide date held/attended/
$$available for staff assignments,provide name and title)-no more
for this than.100 words(complete Exhibit A-1 and attach
Performance Category Yes/No deliverable 'supporting document if providing additional detail
Attend and.participate in ABCD
Coordinator/Program Meeting including DentistLink
Trainin 9/2020 $1,470.00 Complete DentistLink Trainin
Community and.Provider Outreach $2,140.00 Complete Exhibit B
Coordinate Care $665.00 Complete Exhibit B
g rin
Convene Health Coalition/ABCD Steering Provide outcome information such as minutesi copies of
Steering information provided or list of items provided,examples of
committee or participate in a.Coalition type of Organizations attended,what were outcomes or next
Committee Focused on Health Care,Access Steering
steps for ABCD.
Early Learning with ABCD as a Quarterly Agenda
Item. Send.invitatiomand report back any concerns/issues to HCA
$500.00 I Dental Program Administrator&ABCD Managing Director
HCA Contract No. K2751-02 Page 1.of 20
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Exhibit A-1 .ABCD Quarterly Community and Provider Outreach and Case Management Report
Year One 2020 2021 •2nd Quarter Report
0
Please complete'and submit"report electronically to: `°
0
Janice Tadeo, ABCD Program.Manager at ianice.tadeo aAhca.wa.gov w
Cc: Pixie Needham, Dental Program Administrator at pixie.need ham(cDhca.wa.00v m
Division of Health`Care Services;Washington State Health Care Authority
PO Box 45500, Olympia,WA 98504-5506
Phone: (360).725-15.83 52
co
CD
C.
Organization:
ABCD Contact Person: co
Phone and Email: co
2nd Quarter
co
1011/2020—
Re ort Due:01/31/21 12/31/2020 a
Brief description (for events, provide date CD
held/attended/for staff assignments, provide name W
Maximum and title) -no more than 100 words(complete Exhibit
$$available for A-1 and attach supporting document.if providing
Performance-Category Yes/No this deliverable additional detail
Community and Provider Outreach $965.00 Complete Exhibit B
Coordinate Care $2,140.00 Complete Exhibit B
Complete an HCA approved cultural Complete Dentisti-ink Training
diversity training Identify and meet with organizations and agencies in your
ABCD service area which work with families of color and
$200.00 families of children under the age of two 2
Attend and participate in development day Reach out to.dental champion and invite to development
(1 111 3/20 2 0) $1,470.00 day-
HCA Contract No.K2751-02 Page 2 of 20
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Exhibit A-1 ABCD Quarterly Community and Provider Outreach and Case Management Report
Year One 2020 -2021 • 3rd Quarter Report
CD
CD
Please complete and submit report electronically to:
Janice Tadeo,ABCD Program Manager at janice.tadeoaa.hca:wa.aov
Cc: Pixie Needham, Dental Program Administrator at pixie.needham(a).hca.wa.aov 0
Division of Health Care Services,Washington State Health Care Authority
PO Box 45506, Olympia,WA 98504-5506
A
Phone: (360)725-1583
CD
Organization: C6
co
ABCD Contact Person: o
Phone and Email:
co
3rd Quarter
1/.112021 - A
Report Due:04/30/21 3/31/2021 Co
Brief description(for events,provide date held/attended/for staff ca
m
Maximum assignments, provide name and title)-no more than 100 words "
$$available for (complete Exhibit A4 and attach supporting document if
Performance Category Yes/No this deliverable providing additional detail
Attend,and.participate in ABCD
Coordinator/Program Meeting 212021 $500.00
Community and Provider Outreach $2,625.00 Complete Exhibit B'
Coordinate Care $1 150.00 Complete Exhibit B
Provide outcome information such as minutes,copies of information
Convene Health Coalition/ABCD'Steering provided or list of items:provided, examples of type of Organizations
committee or participate in a Coalition or attended,what were outcomes or next steps for ABCD.
Steering Committee Focused on Health
Care,Access or Early Learning with ABCD
as a Quarterly Agenda Item. Send invitation and report back any concerns/issues to HCA Dental
$500.00 Program Administrator&ABCD Administrator.
HCA Contract No. K2751-02 Page 3 of 20
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Exhibit A-1 ABCD Quarterly Community and Provider Outreach and Case Management Report
Year One 2020 -.2021 •4t'' Quarter Report <
CD
CD
Please complete and submit report electronically to:
Janice Tadeo,ABCD Program Manager at,ianice.tadeoO-hca.wa.gov_ 4
Cc: Pixie Needham, Dental Program Administrator at pixie.needham(a)-hcama.gov
Division of Health Care Services, Washington State Health Care Authority it
PO Box 45506, Olympia,WA 98504-5506 co
Phone: (360) 725-1583 co
co
A
Organization: Cl)
ABCD Contact Person: N
Phone and Email: m
4th Quarter y
411/2021 — i
Re ort Due:07/31/2021 6/30/2021 m
Maximum Brief description (for events,provide date held/attended/ A
$$available for staff assignments,provide name and title) no more
for this than 100 words(complete Exhibit A-1 and attach
Performance Category Yes/No deliverable supporting document if providing,additional detail
Attend and participate in ABCD
Coordinator/Program Meeting 512021 $1,470.00
Submit updated ABCD provider roster to Dentisti-ink Complete Exhibit'B
electron ically via one shared file $500.00
Complete Exhibit.B
Community and Provider Outreach $2,140.00
Complete Exhibit.B
Coordinate Care $665.00
HCA Contract No. K2751-02 Page 4 of 20
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Exhibit A-1 ABCD Quarterly Community and Provider Outreach and Case Management Report
rn
Year TWo 2021 -2022 . 1st Quarter Report
s
e
Please complete and submit report electronically to:
Janice Tadeo,ABCD Program Manager at ianice.tadeo(D_hca.wa:gov 4
Cc: Pixie Needham, Dental Program Administrator at pixie.needham(a�hca.wa.gov
Division of Health Care Services,Washington State Health Care Authority
PO Box 45506, Olympia,WA.98504-5506 co
Phone: (360)725-1583 .CD
I.
Organization: a)
ABCD Contact Person: N
Phone and Email: co
1st Quarter
D
7/1/2021 — co
Report Due: 1013112021 9/30/2021 m
Brief'description (for events,provide date held/attended/for
Maximum staff assignments,provide name and title).-no more than 100
$$available for words(complete Exhibit A-1 and-attach supporting document if
Performance Category Yes/No this deliverable providing additional detail
Attend and participate in ABCD
Coordinator/Program Meeting including
DentistLink Training 9/2021 $1,470.00 Com fete DentistLink Training. Update provider roster.
Community and Provider Outreach $2,140.00 Complete Exhibit B
Coordinate Care $665.00, Complete Exhibit B
Provide outcome information such as minutes,copies of information
Convene Health Coalition/ABCD Steering provided or list;of items provided, examples of type of Organizations
committee or participate in a Coalition or attended,what were outcomes or next steps for ABCD.
Steering Committee Focused on Health
Care,Access or Early Learning with ABCD Send invitation and report back any concerns/issues to HCA Dental
as a Quarterly Agenda Item. $500,00 Program Administrator&ABCD Administrator
HCA Contract No.K2751-02 Page 5 of 20
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Exhibit A-1 ABCD Quarterly Community and Provider Outreach and Case Management Report
Year Two 2021 -2022. 2"d Quarter Report
s
Please complete and submit report electronically to:
0
Janice Tadeo,ABCD Program Manager at ianice.tadeo(a-h'ca.wa:gov
Cc: Pixie Needham, Dental Program Administrator at pixie.needhamCdlhca'.wa.aov 00
Division of Health Care Services,Washington State Health Care AuthorityCI
PO Box 45506, Olympia,WA 9850.4-5506
Phone, (360) 725-1583 CD
A
co
Organization:
ABCD Contact Person: co
Phone and Email: m
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2nd Quarter
10/1/2021 — A
Report Due:01/31/2022 12/31/2021 D
Maximum Brief description(for events,provide date held/attended/for i
$$available staff assignments,provide name and title)-no more than 100 m
for this words(complete Exhibit A-1 and attach supporting document if .A.
Performance Category Yes/No deliverable providing additional detail
Community and Provider Outreach $966.00 Complete Exhibit B
Coordinate Care. $2,140.00 Com lete Exhibit B
Identify and meet with organizations and agencies in your ABCD
service area which work.with families of color and families of
Complete:an HCA approved cultural children under the.age of two to develop'and/or update collaborative
diversity training $200.00 ABCD outreach strategies.
Attend and participate in development day
11/2021 $1,470.00 Reach out to dental champion and'invite to development a7_]
.
HCA'Contract No.K2751-02 Page 6 of 20
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Exhibit A4 ABCD Quarterly Community and Provider Outreach and Case Management Report
rn
YearTwo 2021 -2022 . 3rd Quarter Report
s
Please complete and submit report electronically to: `°
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Janice Tadeo,ABCD Program Managerat ianice.tadeo(a),hca.wa.gov CCn
Cc: Pixie Needham, Dental Program Administrator at pixie needhamaa hca.wa.gov
Division of Health Care Services,Washington State Health Care Authority
PO Box 45506, Olympia,WA 98504-5506
Phone: (360) 725-1583 m
co
.1�
CD
Organization:
ABCD Contact Person:
Phone and Email: 00
3rd Quarter N
1/l/2022— `O
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Report Due:04/30/2022 3/31/2022
Maximum Brief description(for events,provide date held/attended/forco
$$available staff assignments,provide name and title)-no more than m
for this 100 words(complete Exhibit A-1 and attach supporting,
Performance Category Yes/No deliverable document if providing additional detail
Attend and participate in ABCD
Coordinator/Program Meeting 2/2022 $500.00
Community and Provider Outreach $2,625.00 Complete Exhibit.B.
Coordinate Care $1,160.00 Com lete Exhibit.B
Provide outcome information such as minutes.,.copies of
Convene Health Coalition/ABCD Steering information provided or list.of items provided, examples of type
committee or participate in a Coalition or Steering of Organizations attended,what were outcomes or next steps
Committee Focused..on Health Care,Access or for ABCD.
Early Learning with ABCD as a Quarterly Agenda
Item. Send invitation and report back any concerns/issues to HCA
$500.00 Dental Program Administrator&ABCD Administrator
HCA Contract No. K2751-02 Page,7 of 20
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Exhibit A-1 ABCD Quarterly Community and Provider Outreach and Case Management Report
Year Two 2021 -2022 .4th Quarter Report
s
CD
03
Please complete and submit report electronically.to: 0
Janice Tadeo,ABCD Program Manager at ianice.tadeoe-hca.wa.aov
Cc: Pixie Needham, Dental Program Administrator at pixie.needham(c,hca.wa.gov 9
Division of HealthCare Services, Washington State Health Care Authority A
PO Box 45506, Olympia,WA 98604-5506co
Phone: (360)725-1583 A
m
Organization: W
0
ABCD Contact Person:
Phone and Email:
4th Quarter
4/1/2022—
m
Re ort Due:07/31/2022 6/30/2022 p
Maximum Brief description (for events,provide date held/attended/for
$$available staff assignments,provide name and title):no more than
for this 100 words(complete Exhibit A-1 and attach supporting
PerformanceCate o Yes/No deliverable document if providing additional detail
Attend and participate in ABCD
Coordinator/Program Meeting 5/2022 . $1 470.00
Submit updated ABCD provider roster to
DentistLink electronically via one shared file $500.00 Complete Exhibit B
Community and Provider Outreach $2,140.00 1 Complete Exhibit B
Coordinate Care $665.00 Com lete Exhibit B
FICA Contract No. K2751-02 Page 8 of 20
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Exhibit B-1 ABCD Quarterly Outreach and Coordination_of Care Report
m
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COORDINATE CARE
CD
Family Or�entat�on HOw
Howe , Location Date co
Haw provided !n persorlphoiie/ema�Urnailletc Many
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m HOW . co
Update prro
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ovider roster and DentistLink training Many
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to
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-Assistetl Client wllri�tial Dental Appts
&Prodded NFollow U How,
p Many
If applicable
How
Referrals TOP Home
Many.
Barnes to Care Identifred` How
mte�preter services/transportation/etc , _ , .,any,,
HCA Contract No. K275142 Page 9 of 20
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COMMUNITY OUTREACH
ry T Outreach/Place ny rea
yp" Date How ring ched
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CY
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Examples: County health fairs/coordination w/Smile Mobile/WIC offices/HeadstartlEarly Learning Centers/Day Cares.
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WORK WITH.CHAMPION/RECRUIT PROVIDERS
,.Ac#vity':. .. :._ ... , How Many,_.. .` ca
Notes m
New Providers Certified
m
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m
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Provtler Trammgs Held+' How Many _ Place and Date
Provider Recrwtment : .___ _.........How Many Place antl Date
HCA Contract No. K2751-02 Page 10 of 20
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Exhibit C-1 ABCD Yearly Budget Tool
2020-2022 Yearly Expenses(estimated)
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0
0
Year One r Year TwCn
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EXPEWSES ' July to2020` Ju[y ,o 021co
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Ju'ne:30, CA
Staffng/Salary&Benefits—add a column to identify%and hours per week for each year
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Program Coordinator(x hrs/week=,X FTE)
Outreach Staff.(x hrs/week=.X FTE)
CD
Program Manager(x hrs/week=.X FTE) 00
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Support Staff(clerical, IT,:finance, communications/per staff, other x hrs/week=.X FTE) ro
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Administration (x hrs/week(.X.FTE) i
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Salary&Benefits Subtotal A
Operating Expenses
Advertising/Marketing (print, broadcast ads;cable TV time, movie.ads,weekly newspaper, billboards,
social media)
Office Equipment(Copier, Fax).
Meeting Expenses(steering committee room,food, etc.)
Postage
Printing(Outside Vendors)
Professional Services
Office Supplies
Operating Supplies
Telephone
ABCD Certification Training/dentists and staff(room,audiovisuals,food,thank you to participating
families, promotion, etc.)
Travel(Per Diem,Transportation, Mileage/airfare, accommodations as required)for 3x annual ABCD
Coordinators:meeting-2 Seattle, 1 Central WA;and for 1x annual Dental
HCA Contract No. K2751-02 Page 11 of 20
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CD
Cont.
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Champion(s)travel/expenses to Development Day, Seattle(Coordinator participation in this meeting
optional but recommended
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Computer Support/Tech Services i?
Rent/Insurance/Janitorial/Maintenance m
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Utilities o
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Operating Expenses Subtotal A
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CD
Indirect Costs 0
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TOTAL EXPENSES
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FUNDING SOURC)=S? ;
CD
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Other Funding(United Way, Grants, Community Development Block Grant,etc.)
Agency Funds and/or In-Kind
Current Health Care Authority Contract
TOTAL FUNDING
HCA Contract No.K2751-02 Page,12 of 20
L Dow Sig n Envelope ID:5B1C705C-E648-49C4-8B30-29841A491E34
Exhibit Dt
ABCD Coordinator Performance Expectations and Abilities
i
Promote early childhood oral health and disease prevention by connecting Apple Health(Medicaid)enrolled children birth to
six(6),to care.with ABCD-certified dental and medical providers,
1.. Continuously provide outreach to families of Apple Health enrolled children, birth to six(6). Coordinate care, provide
case management and linkage to dental care.Provide orientation for families of eligible children to routine
preventive oral health care and behaviors that promote positive dental clinic experiences. I
a. Focus specifically on strategies to connect eligible children under age.two,children of color,and other
underserved populations,with care;and
b. Address family needs, including translation,transportation, and other case management needs,which may be i
barriers to care.
2. Continuously outreach to local dental and.medical providers and their staff/agency,both private practice and '
community health center-based,to recruit,train,certify and maintain their participation in the ABCD program.
Collaborate with the local dental champion(s)to achieve these goals.
a. Plan and facilitate ABCD trainings leading to ABCD certification.in collaboration with the UW School of
Dentistry; and
b. Follow-up regularly, both.in.person and via email/phone,with ABCD providers and staff to assure their
continued involvement with the program, including troubleshooting billing issues and outreaching to Washington
Health Care Authority(HCA)for additional assistance.
c. Provide opportunity for HCA and state partners to participate in the process of selecting local ABCD
coordinator.
3. Continuously ensure that.community agencies,families, and medical providers are.aware of and make referrals to
the ABCD Program. Ensure dental providers and the broader community are aware of and utilize the ABCD
program.
a. Obtain media support, including earned.media(TV, radio, print), paid media(advertising and underwriting)and
social media to reach target populations with ABCD referral and oral health/prevention messages;and
b. Participate in community outreach events,service area coalitions and organizations.
Desired Knowledge,Skills,and Abilities
1. Ability to translate medical and oral health concepts into clear language for an audience which may have basic
literacy skills and for whom English may not be their first language.
2. Respect for and ability to work with people of diverse:races and ethnicities, ages, abilities and socioeconomic status
in a culturally relevant and sensitive manner.
i 3. Ability,when possible, to.communicate in preferred.language(s)commonly spoken by families served in the
county/region and/or access translation services.
4. Ability to_participate, engage and present at public meetings, including dental society meetings, dental study clubs,
agency.and community meetings, Board of Health,etc.
5. Ability to work with and communicate effectively with private practice dentists and physicians and their staffs, and
community health center providers and staff.
6. Ability to communicate effectively both orally and In writing.
7. Ability to work independently,with good judgment and a minimum of supervision.
8. Demonstrated ability to maintain a high level of confidentiality.
9. Demonstrated ability to work with computers and computer software programs including.email, databases,Word,
and Excel spreadsheets.
10. Demonstrated ability to input data to interface with dentist referral/client support systems.
11. Demonstrated ability to use social media and communication tools,such as Facebook, Constant Contact,Twitter,
and Instagram to communicate effectively with target population.
HCA Contract No K2751-02 Page 1 of 20