01.01.2016-06.30.2016 PSA Trellis Center and KC

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Special Terms and Conditions volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with RCW 43.43.830-845, RCW 74.15.030, and Chapter 388 WAC. If the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in Chapter 74.34 RCW, then DDA shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance. f. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include members knowledgeable about developmental disabilities. No board member shall have a contract with the County to provide Training, Community Information Activities, Consumer Support as defined in this agreement , and shall not be a board member, officer, or employee of an agency subcontracting with the County to provide such services. g. Qualified Service Providers: The County assures that all service providers meet qualifications as outlined in the DDA Policy 6.13, Program Provider Qualifications. In. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to assign to DDA its Medicaid billing rights for services to DDA Clients eligible under Title XIX programs in this agreement. Written documentation shall be available to DSHS on request. i. Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters under RCW 74.34.020(l 1) must comply with reporting requirements described in RCW 74.34.035, .040 and Chapter,26.44 RCW. If the County is notified by DSHS that a subcontractor staff member is cited or on the registry for a substantiated finding, then that associated staff will be prohibited from providing services under this Program Agreement. j. Counties who provide Child Development Services (birth to three early intervention services), must provide those services under the regulations implementing the Individuals with Disabilities Education Act (IDEA), Part C, and Washington State's Early Support for Infant and Toddler Federally Approved Plan. k. The County staff who perform on-site evaluations of subcontractor work sites will promptly report to DSHS per DDA Policy 5.13, Protection from Abuse: Mandatory Reporting, if: (1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect (as defined in RCW 74.34,020) of a person who has a developmental disability (as defined in RCW 71A.10.020) has occurred, and, (2) If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement agency. 6. Duty to Disclose: Pursuant to 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)]. Page 7 DSHS Central Contract Services 1769CS County Agreement 7-14-2015