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(2) Fee Limitations: The DOA will set limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four. The current rates are as follows: (a) Employment services. i. Individual Employment services will not exceed $75.00/hour. ii. Group Supported Employment services will not exceed $65.00/hour. (b) Community Inclusion services will not exceed an hourly rate of $35 .00. (c) Child Development services will not exceed a monthly rate of $500.00 . b . Budget and Spending Plan, attached as Exhibit B: (1) Budget amount listed in Exhibit B : The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state-only employment and day services to waiver employment and day services. (2) Spending Plan: ODA will provide the initial Spending Plan . Funding shall be distributed under planned expenditures as well as allocated under State and Medicaid shall function as a line item budget for expenditures under this agreement. The planned expenditures for Consumer Support are based on Client numbers as well as planned additional consumer services expenditures. The spending plan may only be modified by mutual agreement of the parties in writing and shall not require a program agreement. (a) Funds Designated for Additional Consumer Services: If a County provides Community Information and Education services under additional consumer services, then activities must include outreach efforts to federally recognized local tribes. (b) Funds Designated for Adult Day Care Consumers: Funds designated for Adult Day Care Consumers are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level II or Ill services (Adult Day Health). Level II and Ill services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. These Clients may be referred to services defined in the statement of work, or to an Adult Day Care service other than Level II or Ill. If a Client no longer needs and wants services, the funds are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003 . An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the local Area Agency on Aging. Adult Day Care service is not a waiver approved service. c . Program Agreement Amendments : A County can request an amendment at any time . An amendment for additional client(s) may be supported when clients exceed the number used to develop the contract. An amendment for additior,al service hours authorized may be supported when county provides evidence. An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers . d. Exemptions: The ODA Assistant Secretary may approve in writing an exemption to a specific Page 11 DSHS Central Contract Services 1769CS County Agreement 5-1-2019