DSHS DD and KC Agreement - Laserfiche WebLink

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Special Terms and Conditions they shall also immediately report to the appropriate law enforcement agency. 5. Duty to Disclose: Under 42 CFR §455.104, the Administration must obtain certain disclosures and complete required screenings to ensure the State does not pay federal funds to excluded person or entities. The County is required to provide disclosures from managing employees, specifically the persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. the person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS Form 27-094, should be submitted to the Administration to complete the required screenings. Disclosures must be provided at contract renewal and within thirty-five (35) days whenever there is a change in the staff holding these management positions [42 CFR 455.104 (c)(1)]. 6. Statement of Work: The County shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below. Working collaboratively, the parties shall administer DD services within the county as set forth below: a. The DDA region shall. (1) Review subcontractors and shall immediately notify the County of any disapproval of the subcontractors identified by the County; (2) Inform and include the County in the discharge planning of individuals leaving institutions and returning to the community who will need program funding; (3) Inform the County of individuals who have had their waiver status changed; (4) Work with the County when referring individuals for services; (5) Inform Clients of service changes through Planned Action Notice(s); (6) Work with the County to document planned services in the Individual's Support Plan including notification of assessment dates; (7) Work with the County when terminating services; (8) Work with the County on Spending Plan adjustments; and (9) Work with the County in participating in on-site evaluation of direct service providers. b. The County shall: (1) Work with the DDA Region when individuals are referred for services; (2) Work with the DDA Region to document planned services in the Individual's Support Plan; (3) Assist with informing the DDA Region of any potential service level changes not documented in the individual's DD Assessment prior to any changes; (4) Work with the DDA Region regarding service termination; (5) Work with the DDA Region on Spending Plan adjustments; (6) Inform the DDA Region of new providers to be included on the CMIS system; DSHS Central Contract Services Page 6 1769CS County Agreement 6-15-2017