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(11) For Prevocational services, Clients will receive training and skill <br />development in groups as well as individual support in the community. The <br />total number of direct service staff hours provided to the group should be <br />equal to or greater than the group's collective amount of individual support <br />monthly base hours. If the direct service staff hours are less than the <br />collective amount, then the provider will be reimbursed only for the number <br />of hours staff actually provided. <br />(12) Employment and day services must adhere to the Home and Community <br />Based settings (HCBS) requirements of 42CFR 441 530(a)(1), including <br />that: <br />(a) The setting is integrated in the greater community and supports <br />individuals to have full access to the greater community; <br />(b) Ensures the individual receives services in the community to the same <br />degree of access as individuals not receiving Medicaid HCBS; <br />(c) The setting provides opportunities to seek employment and work in <br />competitive integrated settings; and <br />(d) The setting facilitates individual choice regarding services and supports, <br />and who provides them. <br />5. Quality Assurance & Evaluation. <br />a. Service Review and Evaluation System: Contractor shall develop and have <br />available for review an evaluation system to review subcontractors of indirect <br />services. The evaluation system will incorporate Quality Assurance items as <br />defined and Quality Improvement measures. A copy of such evaluation system <br />shall be provided upon request to the DDA for review and approval. <br />b. County On -Site Evaluation and Review: The County shall evaluate and review <br />services delivered to reasonably assure compliance and quality. The County <br />shall conduct at least one on-site visit to each subcontractor during the year. <br />The County shall maintain written documentation of all evaluations, <br />recommendations and corrective action plans for each subcontractor, and <br />reviews of on-site visits. Copies of such documentation will be provided to the <br />DDA Office upon request. <br />6. Single State Medicaid Agency—DSHS. DSHS, as the single state Medicaid <br />Agency, has administrative authority for Title XIX coverage of services for people <br />with developmental disabilities per 42 CFR 431.10. Contractor only has <br />responsibility for services covered in this agreement. <br />Professional Services Agreement <br />Page 24 <br />