HomeMy WebLinkAboutPSA Entrust Community ServicesPROFESSIONAL SERVICES AGREEMENT
This Agreement is made by and between Kittitas County (hereinafter "the County")
and Entrust Community Services (hereinafter "Contractor"). The County and Contractor
agree as follows:
General Conditions; Attachment A (Scope of Work); Attachment B
(Compensation); Attachment C (Proof of Insurance); Attachment D
(Program Agreement between County and DSHS for Developmental
Disabilities County Services County Services, including Exhibits A and B,
which incorporates the DSHS and County Agreement on General Terms
and Conditions by reference); Attachment E (Program Activity Level and
Payment Rate Schedule)
copies of which are attached hereto and incorporated herein by this reference as fully as if
set forth herein.
The term of this Agreement shall commence on the July 1, 2016 and continue until
June 30, 2017. Any party may terminate this Agreement by giving thirty (30) days notice in
writing either personally delivered or mailed postage-prepaid by certified mail, return
receipt requested, to the party's last known address for the purposes of giving notice under
this paragraph.
Contractor acknowledges and by slgmng this Agreement agrees that the
Indemnification provisions set forth in Paragraphs 7 (Independent Contractor), 9 (Taxes),
15 (Defense and Indemnity Agreement), 22 (Patent/Copyright Infringement) and 25
(Confidentiality), are totally and fully part of this Agreement and have been mutually
negotiated by the parties.
Professional Services Agreement
Page 1
flJ I~;'-W SS WHEREOF, the parties have executed this Agreement this ~ay
of ~~ ,2016.
ENTRUST COMMUNITY SERVICES
Signature of Signatory
(Date "6""o-lb )
~----~ .
-12111 GaM Ike.--Gif?
Print Name of Signatory
Contractor Address :
Entrust Community Services
PO BOX 9727
1510 So. 36th Avenue
Yakima, WA 98909-0727
Project Contact:
Sherie Leadon
Chief Executive Officer
Professional Services Agreement
Page 2
APPROVED:
BOARD OF COUNTY COMMISSIONERS
KITTITAS COUNTY, WASl-ltNGTON
~(~
Obie O'Brien, Chairman
~an
L~d 2 Commissioner
County's Address:
Kittitas County
205 West 5th Avenue, Suite 108
Ellensburg, WA 98926
Project Contact:
Joann Schaan
County Coordinator
GENERAL CONDITIONS
1. Scope of Contractor's Services:
Contractor agrees to provide to the County services and any materials set forth in the
project narrative identified in Attachment "A" during the Agreement period. No material,
labor, or facilities will be furnished by the County, unless otherwise provided for in the
Agreement.
This Agreement is entered into between Contractor and the County. Its purpose is to
provide a coordinated and comprehensive local program of services for persons with
developmental disabilities and to fulfill the County's responsibilities in Attachment "0".
This Agreement includes statements of the Developmental Disabilities Administration
within DSHS (hereinafter "DDA") responsibilities from the attached Program Agreement
despite DOA not being a party to this Agreement.
2. Performance of Work :
Contractor shall perform work in accordance with, and shall comply with, all of the
provisions of this Agreement. All work shall comply with applicable laws, codes ordinances
and agreements .
3. Schedule of Performance:
Unless directed otherwise by the County, Contractor shall perform the work in accordance
with any schedules made a part of this Agreement.
4. Definitions :
4.1 "Additional Insured's" means the County, its successors and assigns, and
the respective directors, officers, employees, agents and representatives of
the County and its successors and assigns.
4.2 "Subcontractor" is any service provider or other vendor contracted by the
Contractor to provide consumer services or any other work for the purpose
of meeting the Contractor's obligations under this Agreement.
4.3 "Support" means the following: Contractor's directors, officers, employees,
agents and representatives; and sub-Contractors of any tier; the respective
directors, officers, employees, agents and representatives of these sub-
Contractors of any tier; and any other person or entity acting under the
direction or control of, or on behalf of, Contractor or any Contractor's sub-
Contractors of any tier in connection with or incident to the performance of
the Work or this Agreement.
Professional Services Agreement
Page 3
4.4 The "Work" means all of the duties listed in Attachment "A" and the
performance of all other obligations, under this Agreement by Contractor or
its Support.
4.5 All definitions listed in Attachment 0, Section 1 are incorporated by
reference into this Agreement, with the exception of "Subcontractor".
5. Accounting a nd Payment for Con tracto r Services:
Payment to the Contractor for services rendered under this Agreement shall be as set
forth in Attachment "B". Where Attachment "B" requires payments by the County,
payment shall be based upon billings, supported unless otherwise provided in Attachment
"B", by documentation of units of work actually performed and amounts earned, including
where appropriate, the actual number of days worked each month, total number of hours
for the month, and the total dollar payment requested. Unless specifically stated in
Attachment "B" or approved in writing in advance by the Kittitas County Board of
Commissioners, the County wi" not reimburse the Contractor for any costs or expenses
incurred by the Contractor in performance of this Agreement.
Where required, the County shall, upon receipt of appropriate documentation, compensate
the Contractor, no more often than monthly, through the County voucher system, for the
Contractor's service pursuant to the fee schedule set forth in Attachment "B".
6. Assignment a nd Subcontracting :
No portion of this Agreement may be assigned or subcontracted to any other individual,
firm or entity without the express and prior written approval of the County.
6.1 Contractor recognizes that under the attached Attachment 0 the County
has obligati6ns relative to subcontracting that may effect this agreement.
6.2 Contractor shall not enter into any subcontracts for the provision of direct
services per Section 388-845-0605 WAC. Any assignments of indirect
services entered into by Contractor shall ensure that all applicable terms
and conditions of this Agreement will be met. Contractor remains
responsible for all work performance as detailed in this Agreement.
7. Ind ependent Contract or:
The Contractor's services shall be furnished by the Contractor as an independent
Contractor and nothing herein contained shall be construed to create a relationship of
employer-employee or master-servant, but all payments made hereunder and all services
performed shall be made and performed pursuant to this Agreement by the Contractor as
an independent Contractor.
The Contractor acknowlAogAs that the entire compensation for this Agreement is specified
in Attachment "B" and the Contractor is not entitled to any County benefits including, but
Professional Services Agreement
Page 4
not limited to: vacation pay, holiday pay, sick leave pay, medical, dental, or other
insurance benefits, or any other rights or privileges afforded to Kittitas County employees.
Contractor will defend, indemnify and hold harmless the County, its Additional Insured's,
officers, agents or employees from any loss or expense, including but not limited to
settlements, judgments, setoffs, attorneys' fees or costs incurred by reason of claims or
demands because of breach of the provisions of this paragraph.
8. No Guarantee of Employment:
The performance of all or part of this Agreement by the Contractor shall not operate to
vest any employment rights whatsoever and shall not be deemed to guarantee any
employment of the Contractor or any employee of the Contractor or any sub-Contractor or
any employee of any sub-Contractor by the County at the present time or in the future.
9. Taxes:
The Contractor understands and acknowledges that the County will not withhold Federal
or State income taxes . Where required by State or Federal law, the Contractor authorizes
the County to make withholding for any taxes other than income taxes (i .e. Medicare). All
compensation received by the Contractor will be reported to the Internal Revenue Service
at the end of the calendar year in accordance with the applicable IRS regulations. It is the
responsibility of the Contractor to make the necessary estimated tax payments throughout
the year, if any, and the Contractor is solely liable for any tax obligation arising from the
Contractor's performance of this Agreement. The Contractor hereby agrees to indemnify
the County against any demand to pay taxes arising from the Contractor's failure to pay
taxes on compensation earned pursuant to this Agreement.
The County will pay sales and use taxes imposed on goods or services acquired by the
County hereunder as required by law. The Contractor must pay all other taxes including,
but not limited to: Business and Occupation Tax, taxes based on the Contractor's gross or
net income, or personal property to which the County does not hold title. The County is
exempt from Federal Excise Tax.
10. Regulations and Requirement:
This Agreement shall be subject to all laws, rules and regulations of the United States of
America, and State of Washington, and political subdivisions of the State of Washington,
and to any other provisions set forth herein or in the attached Attachments.
11. Right to Review:
This contract is subject to review by any Federal or State auditor. The County or its
designee shall have the right to review and monitor the financial and service components
of this program by whatever means are deemed expedient by the County. Such review
may occur with or without notice, and may include, but is not limited to, on-site inspection
by County agents or employees, inspection of all records or other materials which the
County deems pertinent to the Agreement and its performance, and any and all
Professional Services Agreement
Page 5
communications with or evaluation by service recipients under this Agreement. The
Contractor shall preserve and maintain all financial records and records relating to the
performance of work under this Agreement for 6 years after contract termination, and shall
make them available for such review, within Kittitas County, State of Washington, upon
request.
11.1 Records Maintenance: For six (6) years, unless otherwise stated herein,
following the termination of this Agreement, Contractor shall maintain
records that are sufficient to:
i) Document the performance of all acts required by law,
regulation, or this Agreement;
ii) Substantiate Contractor's statement of its organization's
structure, tax status, capabilities, and performance;
iii) Demonstrate accounting procedures and practices which
sufficiently and properly document Contractor's billings to the
County and all expenditures made by the Contractor to perform
as required by this Agreement;
iii) Ascertain that personnel policies, procedures and practices are
in compliance with this Agreement; and
v) Ascertain that all taxes and insurance required by State and
Federal law and this Agreement were paid by Contractor.
11.2 Right of Inspection. Contractor shall give access to its facilities and
records to the County, its officers, employees or agents, and to any other
authorized officer, employee or agent of the State of Washington or the
United States at all reasonable times. Authorized persons shall have the
right to examine Contractor's performance and financial records and
perform other activities to determine Contractor's compliance with the
terms of this Agreement.
11.3 Notice of Inspections. The Contactor shall verbally notify the County
immediately of any inspections, audits, accreditation, or program reviews
of services by any individual, agency, or governmental unit, and to
promptly provide the County with copies of any written reports of such
inspections, audits, accreditation or program reviews .
12. Modifications:
12.1 Either party may request changes in the Agreement. Any and all agreed
modifications shall be in writing , signed by each of the parties.
Professional Services Agreement
Page 6
12.2 The County may, at any time, by written notice thereof to Contractor
("Change Notice") makes changes in the Work within the general scope of
this Agreement, including, but not limited to: (a) changes in, revisions to,
substitutions for, additions to or deletions of any Work; (b) changes in
schedule; and (c) acceleration, deceleration or suspension of performance
of any Work.
12.3 If any change in the Work causes an increase or decrease on Contractor's
cost of, or the time required for, performance of the Work, an equitable
adjustment in the compensation to Contractor and in the schedule for the
performance of the Work shall be made to reflect such an increase or
decrease.
12.4 Notwithstanding any dispute or delay in arriving at a mutually acceptable
equitable adjustment, Contractor shall proceed in accordance with all
Change Notices. Contractor must, within thirty (30) days after receipt of any
Change Notice that does not set forth any acceptable adjustment, submit to
the County a written statement setting forth any adjustment claimed.
12.5 If any change results in a decrease in the Work performed, Contractor shall
be entitled to compensation associated with changing the Work, such as
revising design already completed, revising calculations already performed,
and revising documents.
13. Termination for Default:
If the Contractor defaults by failing to perform any of the obligations of the Agreement,
including violating any law, regulation , rule or ordinance applicable to this Agreement , or
becomes insolvent or is declared bankrupt or commits any act of bankruptcy or insolvency
or makes an assignment for the benefit of creditors, the County may, by depositing written
notice to the Contractor in the U.S. mail, postage prepaid, terminate the Agreement, and at
the County's option, obtain performance of the work elsewhere. If the Agreement is
terminated for default, the Contractor shall not be entitled to receive any further payments
under the Agreement until all work called for has been fully performed. Any extra cost or
damage to the County resulting from such default(s) shall be deducted from any money
due or coming due to the Contractor. The Contractor shall bear any extra expenses
incurred by the County in completing the work , and all damage sustained, or which may be
sustained by the County by reason of such default.
If a notice of termination for default has been issued and it is later determined for any
reason that the Contractor was not in default, the rights and obligations of the parties shall
be the same as if the notice of termination had been issued pursuant to the Termination for
Public Convenience paragraph hereof.
Professional Serv ices Agreement
Page 7
14. Termination for Public Convenience:
The County may terminate the Agreement in whole or in part whenever the County
determines, in its sole discretion that such termination is in the best interests of the
County. Whenever the Agreement is terminated in accordance with this paragraph, the
Contractor shall be entitled to payment for actual work performed at unit contract prices for
completed items of work. In the event of such termination, an equitable adjustment shall
be made in the compensation payable to Contractor.
An equitable adjustment in the contract price for partially completed items of work will be
made, but such adjustment shall not include provision for loss of anticipated profit on
deleted or uncompleted work. Termination of this Agreement by the County at any time
during the term, whether for default or convenience, shall not constitute a breach of
contract by the County .
15. Termination Due to Change in Funding. If the funds upon which the County relied to
establish any Program Agreement are withdrawn, reduced or limited, or if additional or
modified conditions are placed on such funding, the County may terminate this Agreement
by providing at least fifteen (15) calendar days written notice to the County. The
termination shall be effective on the date specified in the notice of termination.
16. Defense & Indemnity Agreement:
The Contractor agrees to and shall defend, indemnify and hold harmless the County, its
Additional Insured's , appointed and elective officers, agents and employees, from and
against all loss or expense, including but not limited to judgments, settlements, attorney's
fees and costs by reason of any and all claims and demands upon the County, its
Additional Insured's, its elected or appointed officials, agents, or employees for damages
because of personal or bodily injury, including death at any time resulting therefrom,
sustained by any person or persons and on account of damage to property including loss
of use thereof, whether such injury to persons or damage to property is due to the
negligence of the Contractor, its sub-Contractors, its elected officers, employees or their
agents, except only such injury or damage as shall have been occasioned by the sole
negligence of the County, its Additional Insured's, appointed or elected officials, agents, or
employees. It is further provided that no liability shall attach to the County by reason of
entering into this contract, except as expressly provided herein.
17. Industrial Insurance Waiver:
With respect to the performance of this Agreement and as to claims against the County, its
Additional Insured's, officers, agents and employees, the Contractor expressly waives its
immunity under Title 51 of the Revised Code of Washington, the Industrial Insurance Act,
for injuries to its employees and agrees that the obligations to indemnify, defend and hold
harmless provided in this agreement extend to any claim brought by or on behalf of any
Professional Services Agreement
Page 8
employee of the Contractor. This waiver is mutually negotiated by the parties to this
Agreement.
18. Venue and Choice of Law :
In the event that any litigation should arise concerning the construction or interpretation of
any of the terms of this Agreement, the venue of such action of litigation shall be in the
Superior Court of the State of Washington in and for the County of Kittitas. This
Agreement shall be governed by the law of the State of Washington.
19 . Withholdi ng Payment:
In the event the Contractor has failed to perform any obligation to be performed by the
Contractor under this Agreement within the time set forth in this Agreement, then the
County may, upon written notice, withhold all monies due and payable to Contractor,
without penalty, until such failure to perform is cured or otherwise adjudicated.
20. Future Non-Allocation of Funds:
If sufficient funds are not appropriated or allocated for payment under this Agreement for
any future fiscal period, the County will not be obligated to make payments for services or
amounts incurred after the end of the current fiscal period. No penalty or expense shall
accrue to the County in the event this provision applies.
21. Contractor Commitments , Warranties and Rep rese nta tions:
The Contractor represents and warrants to the County as follows:
21.1 The Contractor is duly incorporated, validly existing and in good standing
under the laws of the State of Washington, and has all requisite corporate
power and authority to enter into and to perform its obligations under this
Agreement.
21 .2 The Contractor has the authority to execute this Agreement, to make the
representations and warranties set forth in it and to perform the obligations
of the Contractor under this Agreement in accordance with its terms.
21.3 The Contractor is a qualified service provider and is authorized to provide
consumer services and additional consumer services.
21.4 This Agreement has been validly executed by an authorized
representative of the Contractor and constitutes a valid and legally binding
and enforceable obligation of Contractor.
21.5 The Contractor has or will obtain prior to the commencement date such
licenses , permits and other authorizations from federal, state and other
governmental authorities, as are necessary for the performance of its
obligations under this Agreement.
21.6 The Contractor is not in violation of any applicable law, ordinance or
regulation the consequence of which will or may materially affect
Contractor's ability to perform its obligations under this Agreement. The
Contractor is not subject to any order or judgment of any court, tribunal or
governmental agency which materially and adversely affects its operations
Professional Services Agreement
Page 9
or assets in the State of Washington, or its ability to perform its obligations
under this Agreement.
21.7 None of the representations or warranties in this Agreement, and none of
the documents, statements, certificates or schedules furnished or to be
furnished by Contractor pursuant hereto or in connection with the
performance of the obligations contemplated under this Agreement,
contains or will contain any untrue statement of a material fact or omits or
will omit to state a material fact necessary to make the statements of fact
contained therein not misleading.
22. Patent/Copyright Infringement:
Contractor will defend and indemnify the County from any claimed action, cause or
demand brought against the County; to the extent such action is based on the claim that
information supplied by the Contractor infringes any patent or copyright. The Contractor
will pay those costs and damages attributable to any such claims that are finally awarded
against the County in any action. Such defense and payments are conditioned upon the
following:
22.1
22.2
Contractor shall be notified promptly in writing by County of any notice of
such claim.
Contractor shall have the right, hereunder, at its option and expense, to
obtain for the County the right to continue using the information, in the event
such claim of infringement is made, provided no reduction in performance or
loss results to the County.
23. Disputes:
23.1 General
i Differences between the Contractor and the County, arising under and by
; virtue of the Agreement Documents shall be brought to the attention of the
County at the earliest possible time in order that such matters may be settled
or other appropriate action promptly taken. Except for such objections as are
made of record in the manner hereinafter specified and within the time limits
stated, the records, orders, instructions, and decisions of the Kittitas County
Commissioners shall be final and conclusive.
23.2 Notice of Potential Claims
The Contractor shall not be entitled to additional compensation which
otherwise may be payable, or to extension of time for (1) any act or failure to
act by the County, or (2) the happening of any event or occurrence, unless
the Contractor has given the County a written Notice of Potential Claim
within ten (10) days of the commencement of the act, failure, or event giving
rise to the claim, and before final payment by the County. The written Notice
of Potential Claim shall set forth the reasons for which the Contractor
believes additional compensation or extension of time is due, the nature of
the cost involved, and insofar as possible, the amount of the potential claim.
Professional Services Agreement
Page 10
Contractor shall keep full and complete daily records of the work performed,
labor and material used, and all costs and additional time claimed to be
additional.
23.3. Detailed Claim
The Contractor shall not be entitled to claim any such additional
compensation, or extension of time, unless within thirty (30) days of the
completion of the portion of the work from which the claim arose, and before
final payment by the County, the Contractor has given the County a detailed
written statement of each element of cost or other compensation requested
and of all elements of additional time required , and copies of any supporting
documents evidencing the amount or extension of time claimed to be due.
24. Own ers hip of Item s P ro duced:
All writings, programs, data, public records or other materials prepared by the Contractor
and/or its consultants or sub-Contractors, in connection with performance of this
Agreement shall be the sole and absolute property of the County and/or DSHS.
25. Co nfidentiality :
The Contractor, its employees, Sub-Contractors, and their employees shall maintain the
confidentiality of all information provided by the County or DSHS or acquired by the
Contractor in performance of this Agreement, except: 1) as provided below, 2) upon the
prior written consent of the Kittitas County Prosecuting Attorney; or 3) upon an order
entered by a court after having acquired jurisdiction over the County. Contractor shall
immediately give to the County notice of any judicial proceedings seeking disclosure of
such information. Contractor shall indemnify and hold harmless the County, its Additional
Insured's, officials, agents or employees from all loss or expense, including, but not limited
to settlements, judgments, setoffs, attorneys' fees and costs resulting from Contractor's
breach of this provision .
25.1 The Contractor shall not use, publish, transfer, sell or otherwise disclose any
Confidential Information gained by reason of this Agreement for any purpose
that is not directly connected with the performance of the services
contemplated hereunder, except:
25.1.1 As provided by law; or
25.1.2 In the case of Personal Information, as provided by law or with the
prior written consent of the person or personal representative of the
person who is the subject of the Personal information.
25.2 The Contractor shall protect and maintain all Confidential Information gained
by reason of this Agreement against unauthorized use, access, disclosure,
modification or loss. This duty requires the Contractor to employ reasonable
Professional Services Agreement
Page 11
security measures, which include restricting access to the Confidential
I nformation by:
25.2.1 Allowing access only to staff that have an authorized business
requirement to view the confidential information.
25.2.2 Physically securing any computers, documents, or other media
containing the Confidential Information.
25.2.3 Ensure the security of Confidential Information transmitted via fax
(facsimile) by verifying the recipient phone number to prevent
accidental transmittal of Confidential Information to unauthorized
persons.
25.2.4 When transporting six (6) to one hundred forty nine (149) records
containing Confidential Information outside a Secure Area, do one or
more of the following as appropriate:
25.2.4(1 )
25.2.4(2)
Use a Trusted System
Encrypt the Confidential Information, including :
25.2.4(2)(i) Email and/or email attachments.
25.2.4(2)(ii) Confidential Information when it is stored
on portable devices or media, including but not limited
to laptop computers and flash memory devices.
25.2.5 When transporting one hundred fifty (150) records or more containing
Confidential Information outside a Secure Area refer to the
requirements in Attachment D, Exhibit A: Data Security
Requirements.
25.2.6 Send paper documents containing Confidential Information via a
Trusted System
25.3 To the extent allowed by law, at the end of the Agreement term, or when no
longer needed, the parties shall return Confidential Information or certify in
writing the destruction of Confidential Information upon written request by
the other party.
25.4 Paper documents with Confidential Information may be recycled through a
contracted firm, provided the contract with the recycler specifies that the
confidentiality of the information will be protected, and the information
Professional Services Agreement
Page 12
destroyed through the recycling process. Paper documents containing
Confidential Information requiring special handling (e.g. protected health
information) must be destroyed through shredding, pulping or incineration.
25.5 The compromise of potential compromise of Confidential Information must
be reported to the County within one (1) business day of discovery. The
parties must also take actions to mitigate the risk of loss and comply with
any notification or other requirements imposed by law.
26. Notice:
Except as set forth elsewhere in the Agreement, for all purposes under this Agreement,
except service of process, notice shall be given by the Contractor to the department head
of the department for whom services are ren de red , and to the Kittitas County
Commissioners, 205 W 5th Ave, Su ite 10 8, Ell en sburg , WA 98926. Notice to the
Contractor for all purposes under this Agreement shall be given to the address reflected on
the signature page. Notice may be given by delivery or by depositing in the U.S. Mail, first
class, postage prepaid.
27. Severa bi lity :
If any term or condition of this Agreement or the application thereof to any person(s) or
circumstances is held invalid, such invalidity shall not affect other terms, conditions or
applications which can be given effect without the invalid term, condition or application. To
this end, the terms and conditions of this Agreement are declared severable.
28. Miscellaneous:
28 .1 The County's failure or delay to insist upon strict performance of any of the
provisions of this Agreement or to exercise any rights or remedies under this
Agreement shall not be construed as a waiver or relinquishment to any
extent of its right to assert or rely upon any such provisions, rights or
remedies in that or any other instance; rather the same shall be and remain
in full force and effect.
28.2 This Agreement embodies the entire Agreement between the County and
Contractor, and supersedes any and all prior agreements, regarding the
Work. No change, amendment or modification of any provisions of this
Agreement shall be valid unless set forth in a written instrument signed by
the party to be bound thereby.
28.3 The rights and remedies of the County set forth in any provision of this
Agreement are in addition to and do not in any way limit any other rights of
remedies afforded to the County by any other provisions of this Agreement,
by any of Contractor's Support or by law.
28.4 The headings of sections and paragraphs of this Agreement are for
convenience of reference only and are not intended to restrict, affect or be
of any weight in the interpretation or construction of the provisions of such
sections or paragraphs.
Professional Services Agreement
Page 13
29. Waiver:
Waiver of any breach or condition of this Agreement shall not be deemed a waiver of any
prior or subsequent breach. No terms or conditions of this Agreement shall be held to be
waived, modified or deleted except by an instrument, in writing, signed by the parties
hereto.
30. Survival:
The provisions of paragraphs 7,9,11,13,14,15,16,17,18,19,20,21,22,23,24,25,
29, 31, and 32, shall survive, notwithstanding the termination or invalidity of this
Agreement for any reason.
31. Nondiscrimination :
31.1 The County is an equal opportunity employer.
31.2 Nondiscrimination in Employment
In the performance of this Agreement, the Contractor will not
discriminate against any employee or applicant for employment on the
grounds of race, creed, color, national origin, sex, sexual orientation,
marital status, age or the presence of any sensory, mental or
physical handicap; provided that the prohibition against discrimination
in employment because of handicap shall not apply if the particular
disability prevents the proper performance of the particular worker
involved. The Contractor shall ensure that applicants are employed,
and that employees are treated during employment without
discrimination because of their race, creed, color, national origin, sex,
sexual orientation, marital status, age or the presence of any sensory,
mental or physical handicap. Such action shall include, but not be
limited to: employment, upgrading, demotion or transfers, recruitment or
recruitment advertising, layoff or termination, rates of payor other
forms of compensation, and programs for training including
apprenticeships. The Contractor shall take such action with respect to
this Agreement as may be required to ensure full compliance with
local, state and federal laws prohibiting discrimination in employment.
31.3 Nondiscrimination in Services
The Contractor will not discriminate against any recipient of any services
or benefits provided for in this Agreement on the grounds of race,
creed, color, national origin, sex, sexual orientation, marital status, age or
the presence of any sensory, mental or physical handicap.
31.4 If any assignment and/or subcontracting has been authorized by the
County, said assignment or subcontract shall include appropriate
Professional Services Agreement
Page 14
safeguards against discrimination . The Contractor shall take such
action as may be required to ensure full compliance with the
provisions in the immediately preceding paragraphs herein.
32. Prevailing Wage:
Contractor shall pay the prevailing rate of wages to all workers, laborers, or mechanics
employed in the performance of any part of the Work in accordance with RCW 39.12
and the rules and regulations of the Department of Labor and Industries. The schedule
of prevailing wages rates for the locality or localities of the Work is determined by the
Industrial Statistician of the Department of Labor and Industries. It is the Contractor's
responsibility to verify the applicable prevailing wage rate. It is understood that the
Contractor is responsible for obtaining and completing all required government forms
and submitting same to the proper authorities.
Disputes regarding prevailing wage rates shall be referred for arbitration to the Director
of the Department of Labor and Industries. The arbitration decision shall be final and
conclusive and binding on all parties involved in the dispute as provided for by RCW
39.12.060.
33. Debarment Certification .
The Contractor certifies that it:
33.1 Is not presently debarred, suspended, proposed for debarment, declared
ineligible or voluntarily excluded from covered transactions by any Federal
department or agency.
33.2 Has not within a three-year period preceding the execution of this contract
with Kittitas County, been convicted of or had a civil judgment rendered
against them for commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public or private
agreement or transaction, violation of Federal or State antitrust statutes or
commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements, tax evasion, receiving
stolen property, making false claims, or obstruction of justice.
33.3 Is not presently indicted for or otherwise criminally or civilly charged by a
governmental entity (Federal, State, or local) with commission of any of
the offenses enumerated in paragraph 33.2 of this section.
33.4 Has not within a three-year period preceding the preceding the execution
of this contract with Kittitas County had one or more public transactions
(Federal, State, or local) terminated for cause of default.
34 . Treatment of Clien t Property. The Contractor shall ensure that any adult client
receiving services from the Contractor under this Agreement has unrestricted access to
the client's personal property. The Contractor shall not interfere with any adult client's
ownership, possession, or use of the client's property. The Contrar.tor shall provide
clients under age eighteen (18) with reasonable access to their personal property that is
Professional Services Agreement
Page 15
appropriate to the client's age, development, and needs. Upon termination or
completion of the Agreement, the Contractor shall promptly release to the client and/or
the client's guardian or custodian all of the client's personal property. This section does
not prohibit the Contractor from implementing such lawful and reasonable policies,
procedures and practices as the Contractor deems necessary for safe, appropriate, and
effective service delivery (for example, appropriately restricting clients' access to, or
possession or use of, lawful or unlawful weapons and drugs).
35. T it le to Pro pe rty . Title to all property furnished or purchased by the County for use
by the Contractor during the term of this Agreement shall remain with the County. Title
to all property purchased or furnished by the Contractor for which the Contractor is
entitled to reimbursement by the county under this Agreement shall pass to and vest in
the County . The Contractor shall take reasonable steps to protect and maintain all
County property in its possession against loss or damage and shall return County
property to the County upon termination or expiration of this Agreement pursuant to
which it was purchased or furnished, reasonable wear and tear excepted.
36. S ubrecipie nt Requ irements.
36.1 General. If the Contractor is a subrecipient of federal awards as defined by
Office of Management and Budget (OMB) Circular A-133, the Contractor shall:
(1) Maintain records that identify, in its accounts, all federal awards
received and expended and the federal programs under which they were
received , by Catalog of Federal Domestic Assistance (CFDA) title and
number, award number and year, name of the federal agency, and name
of the pass-through entity;
(2) Maintain internal controls that provide reasonable assurance that the
County is managing federal awards in compliance with laws, regulations,
and provisions of contracts or grant agreements that could have a material
effect on each of its federal programs;
(3) Prepare appropriate financial statements, including a schedule of
expenditures of federal awards;
(4) Incorporate OMB Circular A-133 audit requirements into all
agreements between the Contractor and its Subcontractors who are
subrecipients;
(5) Comply with any future amendments to OMB Circular A-133 and any
successor or replacement circular or regulation;
Professional Services Agreement
Page 16
(6) Comply with the applicable requirements of either 2 CFR Part 225
(OMS Circular A-87) or 2 CFR Part 230 (OMS Circular A-122), and any
successor or replacement circular or regulation as applicable; and
(7) Comply with the Omnibus Crime Control and Safe Streets Act of 1968;
Title VI of the Civil Rights Act of 1964; Section 504 of the Rehabilitation
Act of 1973; Title" of the Americans with Disabilities Act of 1990; Title IX
of the Education Amendments of 1972; The Age Discrimination Act of
1975; and The Department of Justice Non-Discrimination Regulations at
28 CFR Part 42, Subparts C. D, E, and G, and 28 CFR Parts 35 and 39.
(See http://www.ojp.usdoj.gov/aboutloffices/ocr.htm for additional
information and access to the aforementioned federal laws and
regulations.)
36.2 Single Audit Act Compliance. If the Contractor is a sub recipient and
expends $500,000 or more in federal awards from all sources in any fiscal year,
the County shall procure and pay for a single audit or a program-specific audit for
that fiscal year. Upon completion of each audit, the Contractor shall:
(1) Submit to the County contact person, listed on the first page of the
Program Agreement, the data collection form and reporting package
specified in OMS Circular A-133, reports required by the program-specific
audit guide (if applicable), and a copy of any management letters issued
by the auditor; and
(2) Follow-up and develop corrective action for all audit findings, in
accordance with OMS Circular A-133, and prepare a "Summary Schedule
of Prior Audit Findings."
36.3 Other Audit. If the Contractor is not subject to an OMS Circular A-133 audit,
the Contractor shall provide to the County a CPA audit or CPA review within 180
days of the subcontractor's fiscal year end. The scope of the audit or review
shall include the entire operation and related legal entity, be in accordance with
Generally Accepted Accounting Principles (GAAP), and include a management
letter that addresses any audit findings.
36.4 Overpayments . If it is determined by the County, or by DSHS, or by an
auditor during the course of a required audit, that the Contractor has been paid
unallowable costs under any applicable Program Agreement, DSHS or the
County may require the Contractor to reimburse DSHS in accordance with either
2 CFR Part 225 (OMS Circular A-87) or 2 CFR Part 230 (OMS Circular A-122),
as applicable.
Professional Services Agreement
Page 17
37. Order of Precedence. In the event of an inconsistency in this Agreement and any
Attachments, unless otherwise provided herein, the inconsistency shall be resolved by
giving precedence, in the following order, to :
37.1 Applicable federal and State of Washington statutes and regulations;
37.2 DSHS and County Agreement on Special Terms and Conditions
(Incorporated by reference in Attachment D);
37.3 Attachment D: DSHS and County Program Agreement on DDA County
Services;
37.4 This Agreement.
Professional Services Agreement
Page 18
ATTACHMENT "A"
SCOPE OF WORK
In addition to providing all material and labor, the Contractor shall perform the following :
1. Client Eligibility: Client eligibility and service referral are the responsibility of the
DDA in line with Chapter 388-823 WAC (Eligibility) and WAC 388-825 (Service
Rules). Only persons referred by the DDA shall be eligible for direct client services
under the attached Program Agreement. It is the DDA's responsibility to determine
and authorize the appropriate direct service(s) type. Direct client services provided
by Contractor or subcontractors or providers without authorization by DDA are not
reimbursable under this Agreement.
2. Client Rights. The Contractor shall:
a. Ensure that a statement of Client Rights are posted in compliance with Section
388-850-050 WAC; and
b. Ensure that Client rights and client health and safety are protected in
compliance with Section 388-850-040 WAC and DDA Policy 5.06: Client
Rights.
3. Credentials and Minimum Requirements.
Contractor shall ensure that Contractor meets the following requirements:
a. Fiscally Responsible. The Contractor must demonstrate the ability to safeguard
public funds including maintaining books, records, documents and other
materials relevant to the provision of goods and services.
b. Sufficient Policies and Procedures: Establish and maintain adequate internal
control systems. The Contractor will maintain written policy procedural
manuals for information systems, personnel, and accounting/finance in
sufficient detail such that operations can continue should staffing change or
absences occur.
c. Background / Criminal History Check: Contractor shall conduct background
criminal history checks every three years for all employees, subcontractors,
and/or volunteers who may have unsupervised access to vulnerable DSHS
clients, in accordance with RCW 43.43.830-845, RCW 74 .15.030, and Chapter
388.06 WAC. If the Contractor or 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
Professional Services Agreement
Page 19
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) shall be utilized to obtain background clearance. The Contractor shall
annually and upon request provide copies of all such checks .
d. Qualified Service Providers: The Contractor shall meet all service providers
qualifications as outlined in the DDA Policy 6.13, Program Provider
Qualification during the effective dates of this Agreement.
e. Home and Community Based Waiver Services Assignment of Medicaid Billing
Rights: The Contractor agrees to assign to the County 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.
f. Reporting Abuse and Neglect: Contractor's staff are mandated reporters under
RCW 74.34.020, and must comply with reporting requirements described in
RCW 74.34.035 and 040 RCW and 26.44 RCW. If the County is notified by
DSHS that Contractor is cited or on the registry for a substantiated finding then
associated staff will be prohibited from providing services under this
Agreement.
g. Contractor recognizes that the County staff must perform on-site evaluations of
Contractor work sites and promptly report findings from such evaluations to
DSHS under the attached Program Agreement. The evaluation will have a
Quality Assurance and a Quality Improvement component and will include
objective measures to comply with DDA Criteria and Service Agreement.
Contractor shall provide full assistance with any such inspection and does
hereby waive any cause of action against the County, its officers or staff for any
action associated with such evaluations or reporting.
4. Statement of Work
a. The Contractor 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 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;
Professional Services Agreement
Page 20
(5) Work with the County on Spending Plan adjustments;
(6) Inform the DDA Region of new providers to be included on the CMIS
system; and
(7) Upon written request from the DDA Region or the County, the Contractor
shall provide a copy of each subcontractor's contract.
b. Compliance with BARS Policies: The Contractor shall take any necessary and
reasonable steps to comply with the currently effective DDA BARS
Supplemental manual incorporated by reference herein.
c. The Contractor shall comply with the following referenced documents found at
DDA Internet site https:/Iwww .dshs.wa.gov/dda/county-best-practices:
(1) DDA Policy 4.11, County Services for Working Age Adults;
(2) WAC 388-850-025, WAC 388-845-0001,0030,0205,0210,0215,0220,
0600-0610,1200-1210,1400-1410,2100,2110;
(3) Criteria for Evaluation;
(4) County Guidelines; and
(5) Disability Rights of Washington (formerly Washington Protection and
Advocacy System) Access Agreement.
d. Qualified Employment and Day Program Service Providers for consumer
support services shall include the following program outcomes:
(1) Monthly Community Access service support hours will be based on the
Client's community access service level per WAC 388-828-9310 for all
Clients who began receiving community access services July 1, 2011 and
forward.
(a) To ensure health and safety, promote positive image and relationships in
the community, increase competence and individualized skill-building,
and achieve other expected benefits of Community Access, services will
occur individually or in a group of no more than two (2) or three (3)
individuals with similar interests and needs.
(b) Community Access services will focus on activities that are typically
experienced by the general public. Support to participate in segregated
activities and/or specialized activities will not be reimbursed.
Professional Services Agreement
Page 21
(c) A Client receiving Community Access services will not receive
employment support simultaneously.
(d) A Client receiving Community Access services may at any time choose
to leave Community Access to pursue work and receive employment
support.
(2) Clients in an employment program will be supported to work towards a living
wage . A living wage is the amount needed to enable an individual to meet or
exceed his/her living expenses. Clients should average twenty (20) hours of
community work per week or eighty-six (86) hours per month. The amount
of service a Client receives will be based on his/her demonstrated need,
acuity level and work history per WAC 388-828.
(3) Prior to beginning service or prior to an expected change in service, the
provider will clearly communicate to the Client and the County the maximum
service hours per month the Client can expect to receive . Service changes
will not occur until the Client has received proper notification from DDA.
(a) The Client's DDA ISP is the driver for service . The CMIS County Service
Authorization and updated Planned Rates information will not exceed the
Client's DDA ISP.
(b) The amount of service the Client receives should match with the CMIS
County Service Authorization and updated Planned Rates information.
(4) All Clients will have an individualized plan to identify Client's preferences.
Minimum plan elements are outlined in the reference document "Criteria for
an Evaluation." A copy of the Client's individualized plan will be provided to
their CRM, guardian and others as appropriate.
(5) Semi-annual progress reports that describe the outcomes of activities will be
provided by the provider to the County and the CRM, guardian and others
as appropriate. The report will summarize the progress made towards the
Client's individualized goals.
(6) All Clients will be contacted by their service provider according to Client
need and at least once per month .
(7) If Clients in Individual Employment, Group Supported Employment, or
Prevocational services have not obtained paid employment at minimum
wage or better within six (6) months, the County will assure the following
steps are taken:
Professional Services Agreement
Page 22
(a) Review the progress toward employment goals;
(b) Provide evidence of consultation with the family/Client; and
(c) Develop additional strategies with the family/Client, county staff,
employment support staff and the case manager. Strategies may include
providing technical assistance, changing to a new provider, and/or
providing additional resources as needed to support the individual's
pursuit of employment. The additional strategies will be documented for
each Client and kept in the Client's file(s).
(8) If after twelve (12) months the Client remains unemployed, an additional
review will be conducted. The provider will address steps outlined in the
previous six month progress report in the next six month progress report.
The Client may request to participate in Community Access activities or the
Client may choose to remain in an employment program. When requesting
to participate in Community Access services, the Client shall communicate
directly with his or her DDA Case Manager. The DDA Case Manager is
responsible for authorizing Community Access services.
(9) For Individual Employment where the service provider is also the Client's
employer long term funding will remain available to the service provider /
employer for six (6) months after the employee / DDA Client's date of hire.
At the end of the six month period, if the DDA Client continues to need
support on the job, another service provider who is not the employer of
record must provide the support unless the County issues prior written
approval for the service provider to continue to provide long-term supports if
needed.
(10) For Group Supported Employment, Clients must have paid work or paid
training. The total number of direct service staff hours provided to the group
should be equal to or greater than the group's collective amount of
individual support monthly base hours. If the direct service staff hours are
less than the collective amount, then the provider will be reimbursed only
for the number of hours staff actually provided.
(11) For Prevocational services, Clients will receive training and skill
development in groups as well as individual support in the community. The
total number of direct service staff hours provided to the group should be
equal to or greater than the group's collective amount of individual support
monthly base hours. If the direct service staff hours are less than the
collective amount, then the provider will be reimbursed only for the number
of hOlJrs staff actually provided.
Professional Services Agreement
Page 23
(12) Employment and day services must adhere to the Home and Community
Based settings (HCBS) requirements of 42CFR 441 530(a)(1), including
that:
(a) The setting is integrated in the greater community and supports
individuals to have full access to the greater community;
(b) Ensures the individual receives services in the community to the same
degree of access as individuals not receiving Medicaid HCBS;
(c) The setting provides opportunities to seek employment and work in
competitive integrated settings; and
(d) The setting facilitates individual choice regarding services and supports,
and who provides them.
5. Quality Assurance & Evaluation.
a. Service Review and Evaluation System: Contractor shall develop and have
available for review an evaluation system to review subcontractors of indirect
services. The evaluation system will incorporate Quality Assurance items as
defined and Quality Improvement measures. A copy of such evaluation system
shall be provided upon request to the DDA for review and approval.
b. County On-Site Evaluat ion and Review: The County shall evaluate and review
services delivered to reasonably assure compliance and quality. The County
shall conduct at least one on-site visit to each subcontractor during the
biennium. The County shall maintain written documentation of all evaluations,
recommendations and corrective action plans fbr each subcontractor, and
reviews of on-site visits. Cop ie s of such documentation will be provided to the
DDA Office upon request.
S. Single State Medicaid Agency-DSHS. DSHS as the single state Medicaid
Agency, has administrative authority for Title XIX coverage of services for people
with developmental disabilities per 42 CFR 431.10 . Contractor only. has
responsibility for services covered in this agreement.
7. DSHS/DRW Access Agreement: The ORW February 27,2001 Access Agreement
with the OOA is incorporated by reference. Contractor assures that it and its
subcontractors have reviewed the Access Agreement. The agreement covers
ORW's access to individuals w ith developmental disabilities , clients, programs and
records, outreach activities, authority to investigate allegations of abuse and neglect,
other miscellaneous matters, and is binding for all providers of OOA contracted
services.
Professional Services Agreement
Page 24
8. eM IS Data System. The Contractor shall use the CMIS data system for all billing
requests, service provider address and phone number maintenance, evaluation
dates and to provide employment outcome information. The Contractor shall:
a. Monthly provide all data described in the Billing Instructions and in the
Employment Outcomes Instructions incorporated by reference .
b. Assure integrity of data submitted to state. When data is submitted and
rejected due to errors or later an error is identified, Contractor will correct and
resubmit within thirty (30) days
Professional Services Agreement
Page 25
ATTACHMENT "B"
COMPENSATION
As full compensation for satisfactory performance of the work, the County shall pay
Contractor compensation not to exceed $14,000.00, as described below:
1. Consideration
a. Approval of Fees -DDA Responsibility: The DDA Region shall approve
fees/rates being provided. The rate schedule (Attachment E) should align to a
client's demonstrated acuity level. The County, on behalf of the Contractor, will
submit a fee/rate schedule with the initial County Program Agreement
(Attachment D). The County will submit on behalf of the Contractor an updated
fee/rate schedules to the DDA Region for approval as changes occur.
b. Attachment D -Budget: Budget amount listed in Attachment D -Contractor
may not exceed the state revenue dollar amount or the total revenue dollar
amount indicated on the Budget attached to the Program Agreement
Attachment D).
2. Billing and Payment
a . County Program Agreement Budget: The County shall pay Contractor all
allowable costs (with the exception in Section 2e of this Attachment), as defined
in the current DDA Budget Accounting and Reporting System (BARS) Manual
Supplement. Reimbursement for Fiscal Year (FY) costs shall not exceed the
revenue for each of the FY's revenues listed in Attachment D: Exhibit B to a
total maximum amount of $14,000.00. However, with a program agreement
amendment, the parties may increase or decrease the program agreement
amount.
b. Monthly Invoices with Documentation: All requests for reimbursement by
Contractor for performance hereunder must be submitted in a manner
designated by the County.
c. Reimbursement of client services. A claim for each individual is made on the
CMIS system documents by indicating the number of service units delivered to
each individual listed and the fee per unit. A unit is defined as:
An "Hour" is at least fifty (50) minutes of direct service. Partial hour to
the quarter may be recorded; or
Professional Services Agreement
Page 26
A "Day" is at least four (4) hours of direct service and will only be used
in connection with Adult Day Care reimbursement; or
A "Month" represents a defined tier rate which is documented range of
service hours that correlate to a specific reimbursement for a month.
d. Administration: The County will provide program administration. Administrative
costs will not exceed those amounts designated for administration in
Attachment D: Exhibit B.
e . Contractor's billing must not exceed the allowable costs as provided in Section
2a of this Attachment. Contractor agrees to bill only for services provided and
further agrees that such payments shall be full consideration for those services
and the administrative duties required by this contract.
f. Timeliness of and Modification to Billings: All initial invoices with documentation
must be received by the DDA Region within sixty (60) calendar days following
the last day of the month in which the service is provided. Corrected invoices
and documentation will be accepted throughout the fiscal year as long as they
are received within sixty (60) calendar days of the associated fiscal year unless
an extension is approved by the DDA Regional Administrator or designee.
Contractor shall provide all initial invoices to the County to submit to the DDA
Region. Payment will not be made on any invoice submitted past the 60
calendar days of the contract fiscal year.
g. Contractor's compensation under this agreement shall be limited to money's as
provided in Section 2a of this Attachment. If the County does not receive
payment for any reason, it shall not be obligated to provide other funds and
Contractor agrees that it will not receive payment. Contractor agrees to assist
as needed to ensure that payment is received from DDA.
3. Duplicative Funding. It is an expectation that all Clients access DVR funding as a
resource. Client services shall not be reimbursed under this Agreement when the
same services are paid for under the Rehabilitation Act of 1973 by DVR, Public Law
94-142, or any other source of public or private funding.
4. Recovery of Fees: If Contractor bills and is paid fees for services that DSHS or the
County later finds were (a) not delivered or (b) not delivered in accordance with
applicable standards, DSHS or the County shall recover the fees for those services
and Contractor shall fully cooperate during the recovery.
Professional Services Agreement
Page2?
ATTACHMENT "C"
Proof of Insurance
The Contractor shall secure and maintain in effect at all times during performance of
the Work such insurance as will protect Contractor, its Support and the Additional
Insured's from all claims, losses , harm, costs , liabilities, damages and expenses arising
out of personal injury (including death) or property damage that may result from
performance of the work or this Agreement, whether such performance is by
Contractor or any of its Support.
• A copy of the additional insured endorsement must be submitted prior to
entering into the contract so that the County may ensure that all insurance
provided is occurrence-based, primary and non-contributory.
All insurance shall be issued by companies admitted to do business in the State of
Washington and have a rating of A-, Class VII or better in the most recently published
edition of Best's Reports unless otherwise approved by the County. If an insurer is not
admitted, all insurance policies and procedures for issuing the insurance policies must
comply with Chapter 48 .15 RCW and 284-15 WAC .
The Contractor shall provide proof of insurance for:
1) Commercial Ge nera l Liability Insurance .
• Coverage limits not less than :
• $1,000,000 per occurrence per project
• $3,000,000 project aggregate
• $1,000,000 products & completed operations aggregate
• $1,000,000 personal and advertising injury, each offense
• Certificate Holder -Kittitas County
• The Certificate must name the County as additional insured as
defined in the Agreement
• All insurance provided in compliance with this Agreement shall be
primary and non-contributory as to any other insurance or self-
insurance programs afforded to or maintained by the County.
• Sixty (60) days written notice to the County of cancellation
of the insurance policy.
2) St op Gap/Em ployers Li a bi li ty .
• Coverage limits not less than :
• $1,000,000 each accident
• $1,000,000 disease -policy limit
• $1,000,000 disease -each employee
• Thirty (30) days written notice to the County of cancellation
Professional Services Agreement
Page 28
of the insurance policy .
3) Commercial Automobile Liability Insurance.
• Automobile Liability for owned, non-owned, hired, and leased
vehicles, with an MCS 90 endorsement and a CA 9946
endorsement attached if 'pollutants' are to be transported.
• Coverage limits not less than:
• $1 ,000 ,000 combined single limit
• Thirty (30) days written notice to the County of cancellation
of the insurance policy.
4) Workers' Compensation.
• Workers' Compensation in amounts required by law.
7) Professional Liability
• Professional Liability Insurance covering professional errors and
omissions. Such policy must provide the following minimum limits:
• $1,000,000 per occurrence
• $3,000,000 project aggregate
• If insurance is on a claims-made form, its retroactive date, and that
of all subsequent renewals, shall be no later than the effective date
of this Agreement.
• Sixty (60) days written notice to the County of cancellation
of the insurance policy.
Contractor shall furnish the County a certificate of insurance with Endorsement as
evidence that policies providing insurance required by this Agreement are in full force
and effect. Contractor hereby waives all rights of recourse, including any right to which
another may be subrogated, against Kittitas County for personal injury, including death,
and property damage. Contractor's insurance policies required above shall be primary
insurance and shall be non-contributing with any other insurance maintained by Kittitas
County.
The Contractor shall assume full responsibility for all loss or damage from any cause
whatsoever to any tools, Contractor's employee-owned tools, machinery, equipment, or
motor vehicles owned or rented by the Contractor, or the Contractor's agents, suppliers
or contractors as well as to any temporary structures, scaffolding and protective fences.
The Contractor shall have sole responsibility for ensuring the insurance coverage and
limits required are obtained by subcontractors.
NOTE: No contract shall form until and unless a copy of the Certificate of Insurance
with Endorsement, properly completed and in the amount required , is attached hereto.
Professional Services Agreement
Page 29
All ACHMENl "0"
Program Agreement between OSHS and the County for OOA County Services
Professional Services Agreement
Page 30
Kittitas County
Review Form
Grants & Contract Agreement
Today's Date
Fund/Department
116-Public Health
Contract/Grant Information
I I Agenda Date
Contract /Grant Agency: DSHS DDA County Services Agreement
Period Begin Date: 07/01/2015 I I Period End Date: 06/30/2016
Total Grant/Contract Amount: $689,190.00
Grant/Contract Number: 1769CS-63
Contract/Grant Summary:
The contract between the State of Washington Department of Social and Health Services and Kittitas
County is established to provide services and staff to administer DO services within the county as set in
the agreement.
Recommendation for Board of Health and Board of Health Review on
~==~--------~
Department Head Signature : ____________ -', Administrator Date: ___ _
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
APPROVED AS TO FORM :
Date
Signature of Board of Health member Date
Financial Information
Total Amount $689,190.00 State Funds $689,190.00 I Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
In-Kind $
Explain
Grant/Contract Review Page 1
r---
Is Equipment being purchased? --Who owns equipment? :-
New Personnel being hired?_ Contact HR hiring -reporting requirements
Future impacts or liability to Kittitas County:
Bud get Information
Budget Amendment Needed? VesD attach budget form No []] Why not
New Division Created? Will only need if actual amount billed exceeds
contract amount -will do at year end. -Revenue Code
105-568.334.04.68 -$689,190
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub-Contract Approved Date:
Prosecutor Review I Has the Prosecutor reviewed this agreement? I Yes 0 No 0
county Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
I_S~ig=n_a_t_u_re_: _______________________________ j Dat_e_: ________________________________ ~
Department: .
A ssignment of Trackin g Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
[ Reviewer
Grant/Contract Review
I Date
Page 2
.JHt1t .... '"'' " , '"'' COUNTY DSHS Agreement Number
ocpa.lmcnl of Social PROGRAM AGREEMENT
1563-44899
&. .Icallh Services
rransfo ,,-flJ ing lives DDA County Services
This Progra r"\1 Agreement Is by and between the State of Washington Department of Administration or Division
Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number
conjunction vvith a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference. County Agreement Number
DSHS ADMINI S TRATION DSHS DIVISION OS HS INDEX NUMB E R DSHS CONTRACT CODE
Developmental Disabilities Division of Developmental 1225 1769CS-63
Admin Disabilities
OSHS CONTACT NA ME AND TI TLE D.SHS CONTACT ADDRESS
Roger Van Allen 1611 W Indiana Ave
Op erations Manager Spo kane.VVA 99205-
DSHSCONTACT TE LEPHONE I OSHS COI'ITACT FAX I DSHS CONTA CT E ·MAIL
(509) 329-2952 (509) 568-3037 va nalrl@dshs.wa .(lov
C0 UNTY NAM e: COUNTY AD DRES S
Kittitas County 507 North Nanum Street Suite 102
Kittitas County DDA County Services EIJensbu rg l WA 98926-
COUNTY FEDERAL EMP LOYER IDENT IFICATION COUNTY CONTACT NAM E
NUMBER C{ I-V 00 ( ?J L{-or Sigrid Welker
COUI'ITY CONTACT TELEPHONE I COUNTY CONTACT FAX I COUNTY CONTACTE·MA1L
(509) 962-7567
IS THE COUN'iY A SUBRECIPIE NT FOR PURPOSES OF THIS PROGRAM CFDA NUMB ERS
AGREEMEI'IT?
No
PROGRAM AG~eeMENT START DATE T PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
07/01/2015 06/30/2016 $689,190.00
EXHIBITS. The follow ing Exhibits are attached: Ex hibit A -Data Security Requirements ; Exhibit B -Program
Agreement Budget; Exhibit C -Local Match Certification
By their sIg natures below, the parties agree to the terms and conditions of this County Program Agreement and all
documents incorporated by reference . No other understandings or representations, oral or otherwise, regarding the
subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify
that they are authorized to sign this P(ogr~m Agreement. .
OOllNTY SIGNA TURE(S') PRINTED NAME(S) AND nnE(S) . OATE(S) SIGN ED
)0.., 'BJ1-elan" 8 e rnd:t J f3tJeu{MJU G ~11 6 h.5
DSHS SIGNATURE PRINTED NAME AND TI TLE DATE SIGNED
flU~:v.LV1 Me·L\~:.·:._~ Melissa Diebert, Contract Manager 1-2)-/)-
ru:vt:;t y ........
OCT 052015
ODA SPOKANE
aece\vj.~
s~p. a 1 iO'S
REC··-~···VED EI
SEP 252015
DSHS Centra l contract Sen/Ices
1769CS county Agreement 7-14·2015 DDA sPOKA~il get, Finllnce & Contracts
Page 1
Special Terms and Conditions
1. Definitions Specific to Program Agreement: The words and phrases listed below, as used in this
Program Agreement, shall each have the following definitions:
a. "Acuity Level" means the level of an individual's abilities and needs as determined through the DDA
assessment.
b. "AWA" means ADSA Web Access also referred to as the CMIS .
c . "Additional Consumer Services" refers to indirect Client service types as follows :
(1) "Community Information and Education": Activities to inform and/or educate the general public
about developmental disabilities and related services. These may include information and
referral services; activities aimed at promoting public awareness and involvement; and
community consultation, capacity building and organization activities .
(2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or
interning students in the provision of services to people with developmental disabilities . Also to
enhance program related skills of board or advisory board members.
(3) "Other Activities" reserved for special projects and demonstrations categorized into the following
types:
(a) Infrastructure projects: Projects in support of Clients (services not easily tracked back to a
specific working age Client) or that directly benefit a Client(s) but the Client is not of working
age . Examples include planning services like benefits planning and generic job
development e.g. "Project Search."
(b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples
include equipment purchases and agency administrative support.
(c) "Partnership Project": Collaborative partnerships with school districts, employment
providers, DVR, families, employers and other community collaborators needed to provide
the employment supports and services young adults with developmental disabilities require
to become employed during the school year they turn twenty-one (21).
d. "ADSA" means Aging & Disability Services Administration.
e. "Authorized User(s)" means an individual or individuals with an authorized business requirement to
access DSHS Confidential Information.
f. "BARS" means DDA Budget and Accounting Reporting System .
g . "CSA" means County Service Authorization.
h . "CMIS" means the Case Management Information System also referred to as AWA.
i. "Client" means a person with a developmental disability as defined in Chapter 388 ~823 WAC who is
currently eligible and active with the Developmental Disabilities Administration or is an identified
PASRR Client.
j. "County" means the county or counties entering intI:) this Program Agreement.
k . "Confidential Information" means information that is exempt from disclosure to the public or other
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 2
Special Terms and Conditions
unauthorized persons under RCW 42.56 or other federal or state laws. Confidential information
includes, but not limited to, Personal information.
I. "Consumer Support" refers to direct Client service types as follows:
(1) "Community Access" or "CA": services are individualized services provided in typical integrated
community settings for individuals in retirement. Services will promote individualized skill
developme nt, independent living and community integration for perso ns' to learn how to actively
and indepe ndently engage in their local community. Activities will provide opportunities to
develop relationships and to learn, practice and apply skills that result in greater independence
and community inclusion. These services may be authorized instead of employment support
(Individual Employment, Group Supported Employment or Pre-Vocational services) for working
age individuals who have received nine months of employment support, have not found a job
and decide not to continue looking for work .
(2) "Child Development Services" or "CDS": Birth to three services are designed to meet the
developmental needs of each eligible child eligible and the needs of the family related to
enhancing the child's development. Services may include specialized instruction, speech-
language pathology, occupational therapy, physical therapy, assistive technology, and vision
services . Services ar~ provided in natural environments to the maximum extent appropriate.
(3) "Individual Supported Employment" or "IE": services are a part of an individual's pathway to
employment and are tailored to individual needs, interests, and abilities to, and promote career
development. These are individualized services necessary to help persons with developmental
disabilities obtain and continue integrated employment at or above the state's minimum wage in
the general workforce. These services may include intake, discovery, assessment, job
preparation, job marketing, job supports, record keeping and support to maintain a job.
(4) "Individualized Technical Assistance" or "ITA": services are a part of an individual's pathway to
individual employment. This service provides assessment and consultation to the employment
provider to identify and address existing barriers to employment. This is in addition to supports
received through supported employment services or pre-vocational services for individuals who
have not yet achieved their employment goal.
(5) "Group Supported Employment" or "GSE": services are a part of an individual's pathway to
integrated jobs in typical community employment. These services are intended to be short term
and offer ongoing·supervised employment for groups of no more than eight (8) workers with
disabilities in the same setting. The service outcome is sustained paid employment leading to
further career development in integrated employment at or above minimum wage. Examples
include enclaves, mobile crews, and other business models employing small groups of workers
with disabilities in integrated employment in community settings.
(6) "Pre-Vocational Services" or "PVS": services are a part of an individual's pathway to integrated
jobs in typical community employment. These services and supports are intended to be short
term and ·should be designed to further habilitation goals that will lead to greater opportunities
for competitive and integrated employment and career advancement at or above minimum
wage. Services are provided by agencies established to provide services to people with
disabilities and offer training and skill development for groups of workers with disabilities in the
same setting as well as individual support. Participants are provided at least monthly
opportunities to experience typical community settings in support of their pursuit to integrated
employment.
OSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 3
Special Terms and Conditions
m. "CRM" means the DDA Case Resource Manager.
n. "DO" means developmental disabilities.
o. "DDA" means the Developmental Disabilities Administration within DSHS .
p. "DDA Region" means the DDA Regional office.
q. "DVR" means the Division of Vocational Rehabilitation .
r. "Encrypt" means to encode Confidential Information into a format that can only be read by those
possessing a "key": a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 128 bits.
s. "Hardened Password" means a string of at least eight characters containing at least one alphabetic
character, at least one number and at least one special character such as an asterisk, ampersand
or exclamation point.
t. "HCBS" means the Medicaid Home and Community Based Services.
u. "ISP" means the Individual Support Plan, a document that authorizes and identifies the DDA paid
services to meet a Client's assessed needs.
v. "PASRR" means Preadmission Screening and Resident Review.
w . "Personal Information" means information identifiable to any persoll including, but not limited to,
information that relates to a person's name, health, finances, education, business, use or receipt of
governmental services or other activities, addresses, telephone numbers, Social Security Numbers,
driver's license numbers, other identifying numbers, and any financial identifiers .
x. "Physically Secure" means that access is restricted through physical means to authorized
individuals only.
y. "Quality Assurance" means an adherence to all Program Agreement requirements, including DDA
Policy 6.13, Employment/Day Program Provider Qualifications, County Guidelines and the Criteria
for Evaluation, as well as a focus on reasonably expected levels of performance, quality, anq
practice.
z. "Quality Improvement" means a focus on activities to improve performance above minimum
standards and reasonably expected levels of performance, quality and practice ..
aa. "Secured Area" means an area to which only authorized representatives of the entity possessing
the Confidential Information have access. Secured Areas may include buildings, rooms or locked
storage containers (such as a filing cabinet) within a room, as long as access to the Confidential
Information is not available to unauthorized personnel.
bb. "Service Provider" is a qualified Client service vendor who is contracted to provide Employment and
Day Program services.
cc. "Subcontractor" is the service provider contracted by the County to provide consumer services.
dd. "Tracking" means a record keeping system that identifies when the sender begins delivery of
Confidential Information to the authorized and intended recipient, and when the sender receives
DSHS Central Contract Services
1769CS county Agreement 7-14-2015
Page 4
Special Terms and Conditions
confirmation of delivery from the authorized and intended recipient of Confidential Information.
ee. "Trusted Systems" include only the following methods of physical delivery: (1) hand-delivery by a
person authorized to have access to the Confidential Information with written acknowledgement of
receipt; (2) United States Postal Service ("USPS") first class mail, or USPS delivery services that
include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery
services (e.g. Fed Ex, UPS, DHL) which offer tracking and receipt confirmation; and (4) the
Washington State Campus mail system. For electronic transmission, the Washington State
Governmental Network (SGN) is a Trusted System for communications within that Network.
ft. "Unique User 10" means a string of characters that identifies a specific user and which, in
conjunction with a password, passphrase or other mechanism, authenticates a user to an
information system.
2. Purpose: This Program Agreement is entered into between DOA and the County in accordance with
Chapter 71A.14 RCW. Its purpose is to advance the state legislative policy to provide a coordinated
and comprehensive state and local program of services for persons with developmental disabilities.
3. Confidentiality:
a. The County shall not use, publish, transfer, sell or otherWise disclose any Confidential Information
gained by reason of this Program Agreement for any purpose that is not directly connected with the
performance of the services contemplated hereunder, except:
(1) As provided by law; or,
(2) In the case of Personal Information, as provided by law or with the prior written consent of the
person or personal representative of the person who is the subject of the Personal Information.
b. The County shall protect and maintain all Confidential Information gained by reason of this Program
Agreement against unauthorized use, access, disclosure, modification or loss. This duty requires
. the County to employ reasonable security measures, which include restricting access to the
Confidential Information by:
(1) Allowing access only to staff that have an authorized business requirement to view the
Confidential Information;
(2) Physically Securing any computers, documents, or other media containing the Confidential
Information;
(3) Ensuring the security of Confidential Information transmitted via fax (facsimile) by verifying the
recipient phone number to prevent accidental transmittal of Confidential Information to
unauthorized persons;
(4) When transporting six (6) to one hundred forty nine (149) records containing Confidential
Information outside a Secure Area, one or more of the following as appropriate:
(a) Using a Trusted System, or
(b) Encrypting the Confidential Information, including:
i. Email and/or email attachments.
OSHS Central Contract SelVices
1769GS County Agreement 7-14-2015
Page 5
Special Terms and Conditions
ii. Confidential Information when it is stored on portable devices or media, including but not
limited to laptop computers and flash memory devices.
(5) When transporting one hundred fifty (150) records or more containing Confidential Information
outside a Secure Area, referring to the requirements in Exhibit A -Data Security Requirements;
and
(6) Sending paper documents containing Confidential Information via a Trusted System.
c . To the extent allowed by law, at the end of the Program Agreement term or when no longer needed,
the parties shall return Confidential Information or certify in writing the destruction of Confidential
Information upon written request by the other party.
d. Paper documents with Confidential Information may be recycled through a contracted firm , proviqed
the contract with the recycler specifies that the confidentiality of information will be protected and
the information destroyed through the recycling process. Paper documents containing Confidential
Information requiring special handling (e .g. protected health information) must be destroyed through
shredding, pulping, or incineration.
e. The compromise or potential compromise of Confidential Information must be reported to the DSHS
Contact designated on this Program Agreement Wlthlh five (5) business days of discovery for
breaches of less than one hundred fifty (150) persons' protected data, and ·one (1) business day of
discovery of breaches of over one hundred fifty (150) persons' protected data. The parties must
also take actions to mitigate the risk of loss and comply with any notification or other requirements
imposed by law ..
4. Client Eligibility: Client eligibility and service referral are the responsibility of the DDA pursuant to
Chapter 388-823 WAC (Eligibility) and Chapter 388-825 WAC (Service Rules). Only persons referred
by ODA shall be eligible for direct Client services under this Program Agreement. It is DDA's
responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services
provided without authorization are not reimbursable under this Program Agreement:
5. Credentials and Minimum Requirements:
a. Administration of the developmental disabilities County program cannot be subcontracted.
b. Qualified DD Program Coordinator: A qualified DD program coordinator has a minimum of five
years training and experience in the administration and/or the delivery of developmental disabilities
services to a community. For a county where the coordi nator administers more than one program
area (e.g. Chemical Dependency, Mental Health, Developmental Disabilities), tra ini ng and
experience in administration and/or a related Human or Social service may be considered.
c. Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including
maintaining books, records, documents and other materials relevant to the provision of goods and
services.
d . Sufficient Policies and Procedures for Establishment and Maintenance of adequate internal control
systems: The County will maintain written policy procedural manuals for information systems,
personnel, and accounting/finance in sufficient detail such that operations can continue should
staffing change or absences occur.
e . Background/Criminal History Check: A background/criminal history clearance is required every
three years for all employees (including DO program County staff)" subcontractors, and/or
DSHS Central Contract ServIces
1769CS County Agreement 7·14·2015
Page 6
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.
h. 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(11) 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.1 0.020) 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 §455.1 04, 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 )].
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 7
Special Terms and Conditions
7 . 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 DO 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 identifiec;l 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 in.dividual's DO Assessment prior to any changes;
(4) Work with the ODA 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;
(7) Notify the DDA Region of any intent to terminate a sUbtontrador who is serving a DOA referral;
(8) Provide a copy of each subcontractor's contract upon written request from the DDA Region; and
(9) Notify and work with the DDA Region when performing on-site evaluations of direct service
providers.
c. Compliance with BARS Policies: The County shall take any necessary and reasonable steps to
comply with BARS.
d. The County shall comply with the following referenced documents found at DDA Internet site
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 8
Special Terms and Conditions
https :llwww.d shs.wa.gov/dda/co untv-best-praGtices under "Counties":
(1) DDA Policy 4 .11, County Services for Working Age Adults;
(2) WAC 388-850, WAC 388-828, WAC 388-845-0001, 0030,0205,0210,0215,0220,0600-0610,
1200-1210,1400-1410,2100,2110;
(3) Criteria for Evaluation;
(4) County Guidelines; and
(5) Disability Rights Washington (formerly Washington Protection and Advocacy System) Access
Agreement.
e. The County shall develop and submit a comprehensive plan for the County DD Services as
required by WAC 388-850-020.
f . Conveyance of The Estimated Number of People to be Served and Targeted Outcomes : The
County shall submit the Service Information Forms (SIF's) (provided by DDA at Internet site
https ;IJwww .d s h s .wa .gov/dda/c ount y~b e s t-p[a c tjce s to indicate the estimated number of people to
be served, targeted outcomes, and identified 90al(S) that focus on quality improvement within the
categories of Training, Community Information, Direct Client Services, and Other Activities within 30
days of execution of the Program Agreement. Once approved, the SIF outcomes may be modified
only by mutual agreement of the County and the DDA Region .
g . Solicitation for Qualified Employment and Day Program Service Providers: Requests for Information
(RFI's) and/or Requests for Proposals (RFPs). Requests for Qualifications (RFQ's) for direct
services will be issued at a minimum of once every four years for new providers. If a Client's needs
cannot be met by the current qualified providers or there is a capacity issue, then the County shall
issue Em RFQ prior to the four year cycle.
h. Qualified Providers: A qualified provider must be a county or an individual or agency contracted
with a county or DDA
i. Regional Approval of Subcontractors : The DDA Region shall review new subcontractors and shall
immediately notify the County of any disapproval of the subcontractors identified by the County.
j . Subcontractors : The County will pass on all applicable contractual requirements that are between
DDA and the County to the subcontractor. The County shall immediately notify the DDA Region of
the County's intent to terminate a subcontractor who is serving a DDA referral.
k. The County shall provide or contract with qualified Employment and Day Program Service
PrOViders for consumer support services that include the following program outcomes:
(1) Monthly Community Access service support hours will be based on the Client's community
access service level per WAC 388-828-9310 for all Clients who began receiving community
access services July 1, 2011 and forward.
(a) To ensure health and safety, promote positive image and relationships in the community,
increase competence and individualized skill-building, and achieve other expected benefits
of Community Access, services Will occur individually or in a group of no more than two (2)
or three (3) individuals with similar interests and needs .
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 9
Special Terms and Conditions
(b) Community Access services will focus on activities that are typically experienced by the
,general public. Support to participate in segregated act iviUes and/o r specialized activ ities
will not be reimbursed,
(c) A Client receiving Community Access services will not receive employment support
simultaneously.
(d) A Client receiving Community Access services may at any time choose to leave Community
Access to pursue work and receive employment support.
(2) Clients in an employment program will be supported to work towards a living wage, A living
wage is the amount needed to enable an individual to meet or exceed his/her living expenses,
Clients should average twenty (20) hours of community work per week or eighty-six (86) hours
per month. The amount of service a Client receives will be based on his/her demonstrated need,
acuity level and work history per WAC 388-828.
(3) Prior to beginning service or prior to an expected change in service, the provider will clearly
communicate to the Client and the County the maximum service hours per month the Client can
expect to r~ceive. Service changes will not occur until the Client has received proper
notification from DDA.
(a) The Client's DDA ISP is the driver for service, The CMIS County Service Authorization and
updated Planned Rates information will not exceed the Client's DDA ISP.
(b) The amount of service the Client receives should match with the CMIS County Service
Authorization and updated Planned Rates information
(4) All Clients will have an individualized plan to identify Client's preferences. Minimum plan
elements are outlined in the reference document "Criteria for an Evaluation." A copy of the
Client's individualized plan will be provided to their CRM, guardian and others as appropriate.
(5) Semi-annual progress reports that describe the outcomes of activities will be provided by the
provider or the County to the CRM, guardian and others as appropriate. The report will
summarize the progress made towards the Client's individualized goals.
(6) All Clients will be contacted by their service provider according to Client need and at least once
per month.
(7) If Clients in Individual Employment, Group Supported Employment, or Prevocational services
have not obtained paid employment at minimum wage or better within six (6) months, the
County will assure the following steps are taken:
(a) Review the progress toward employment goals;
(b) Provide evidence of consultation with the family/Client; and
(c) Develop additional strategies with the family/Client, county staff, employment support staff
and the case manager. Strategies may include providihg technical assistance, changing to
a new provider, and/or providing additional resources as needed to support the Individual's
pursuit of employment. The additional strategies will be documented for each Client and
kept in the Client's filees).
(8) If after twelve (12) months the Client remains unemployed, an additional review will be
DSHS Central Contract Ser'vices
1769CS County Agreement 7-14-2015
Page 10
Special Terms and Conditions
conducted. The provider will address steps outlined in the previous six month progress report in
the next six month progress report . The Client may request to participate in Community Access
activities or the Client may choose to remain in an employment program . When requesting to
participate in Community Access services, the Client shall communicate directly with his or her
DDA Case Manager. The DDA Case Manager is responsible for authorizing Community
Access services.
(9) For Individual Employment where the service provider is also the Client's employer long term
funding will remain available to the service provider I employer for six months after the
employee I DDA Client's date of hire. At the end of the six month period, if the DDA Client
continues to need support on the job, another service provider who is not the employer of record
must provide the support unless the County issues prior written approval for the service provider
to oontinue to provide long-term supports if needed .
(10) For Group Supported Employment, Clients must have paid work or paid training. The total
number of direct service staff hours provided to the group should be equal to or greater than the
group's collective amount of individual support monthly base hours. If the direct service staff
hours are less than the collective amount, then the provider will be reimbursed only for the
number of hours staff actually provided.
(11) For Prevocational services, Clients will receive training and skill development in groups as well
as individual support in the community. The total number of direct service staff hours provided
to the group should be equal to or greater than the group's collective amount of individual
support monthly base hours. If the direct service staff hours are less than the collective amount,
then the provider will be reimbursed only for the number of hours staff actually provided.
(12) Employment and day services must adhere to the Home and Community Based settings
(HeBS) requirements of 42CFR 441 530(a)(1), including that:
(a) The setting is integrated in the greater community and supports individuals to have full
access to the greater community;
(b) Ensures the individual receives services in the community to the same degree of access as
individuals not receiving Medicaid HCBS;
(c) The setting provides opportunities to seek employment and work in competitive integrated
settings; and
(d) The setting facilitates individual choice regarding services and supports, and who provides
them.
I. Quality Assurance and Service Evaluation: The County shall develop and have available an
evaluation system to review services. The evaluation system must have both a Quality Assurance
and a Quality Improvement component, and both must include objective measures. The County's
service evaluation system shall serve as the method by which current providers demonstrate that
they continue to be qualified providers. A copy of such evaluation system shall be provided upon
request to DDA for review and approval.
m . On-Site Evaluation: The County shall evaluate and review services delivered to reasonably assure
compliance and quality. The County shall conduct at least one on-site visit to each subcontractor
during the biennium. The County shall maintain written documentation of all evaluations,
recommendations and corrective action plans for each subcontractor. Copies of such
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 11
Special Terms and Conditions
documentation will be provided to the DDA upon request.
n, The County shall work with local developmental disability advisory groups to plan for and coordinate
services.
o. The County shall participate i n regularly scheduled bi-monthly meetings between County
developmental disability staff and DDA staff to remain updated and current.
p. CMIS Data System: The County shall use the CMIS data system for all billing requests, service
provider address and phone number maintenance, evaluation dates and to provide employment
outcome information.
(1) Monthly provide all data described in the Billing Instructions and in the Employment Outcomes
Instructions, which is hereby incorporated by reference.
(2) Assure the integrity of data submitted to the State. When data is submitted and rejeCted due to
errors or an error is later identified, the County will correct and resubmit the data within thirty
(30) days.
8. Consideration:
a. COllnty MiII<;Ige Funds: Per RCW 71 .20.110, a County may elect to declare all or part of millage
funps to the state of Washington, Department of Social and Health Services, for the purpose of
obtaining federal matching funds to coordinate and provide community services for individuals with
developmental disabilities. Millage funds that are matched with federal dollars must comply with
federal requirements . Counties electing to make such a declaration of Millage funds will:
(1) Ensure that services provided using millage and matching funds meet HeSS Waiver
requirements. Additionally, millage and matching funds shall not be used when the same
services are paid for under the Rehabilitation Act of 1973 or Public Law 94-142.
(2) Eqch Month complete a separate A·'19 identifying the amount of tota l expenditures by category,
the -amount of millage contributed, and the expected amount of federal mqtch. Additionally
enter this infonnation into AWAI CARE County billing summary.
(3) Submit a Local Match Certification (Exhibit C) with the final contract billing.
b. Fees:
(1) Approval of fees is the responsibility of the DDA. The DDA Region reserves the right to approve
fees/rates for the services being provided. The County will submit a feelrate schedule with the
initial Program Agreement. The County will submit updated fee/rate schedules to the DDA
Region for approval as changes occur. The rate schedule will include the' following information:
(a) County(s) name;
(b) Time period for which the schedule is applicable; and
(c) Each contracted direct service (IE, GSE, PVS, CA, ITA, CDS) and its associated rate.
(2) Fee Limitations: The DDA will set limitations on the Hourly Rate for each' direct service. Hourly
rates must be divisible by four. The current rates are as follows:
DSHS Central Contract Services
1769CS County Agreement 7·14·2015
Page 12
Special Terms and Conditions
(a) Employment services .
i. Individual Employment services will not exceed $75.00/hour.
ii. Group Supported Employment services will not exceed $65.00/hour.
iii. Prevocational services will not exceed $55.00Jhour.
(b) Community Access services will not exceed an hourly rate of $30.00.
(c) Child Development services will not exceed a monthly rate of $500.00 .
c. 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: DDA 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 contract amendment.
d. If a County provides Community Information and Education services under additional consumer
services, then activities must include outreach efforts to federally recognized local tribes.
e. 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 III services
(Adult Day Health). Level II and III services are licensed rehabilitation and skilled nursing services
along with socialization. Levell 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 III. 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.
f. Exemptions: The DDA Assistant Secretary may approve in writing an exemption to a specific
program agreement requirement.
9. Billing and Payment:
a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by
DDA as:
(1) Administration: Costs of the County Human Services Department or similar county office,
responsible for administration of the Developmental Disabilities Program. Allowable costs
OSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 13
Special Terms and Conditions
include personnel and overhead costs directly related to the administration and coordination of
the program, including such activities as program planning, budgeting, contracting, monitoring,
and evaluation . Also included are departmental and county indirect and/or direct administrative
costs, to the extent that such costs are appropriately allocated to the program using an
established methodology consistent with grants management guidelines.
(2) Additional Consumer Services :
(a) Training :
i. Staff Training: Costs incurred by the program for planned, structured activities for the
purpose of providing, or improving, or enhancing job~related knowledge and skills of
staff, providers, volunteers , or interning stUdents in the provision of developmental
disabilities services.
ii. Board Training: Costs incurred by the program for planned, structured activities
designed to provide, improve, or enhance program~related skills of board and advisory
committee members.
(b) Community Information and Education: to inform and/or educate the general public about
developmental disabilities and related services. These may include information and referral
services; activities aimed at promoting public awareness and involvement; and community
consultation, capacity building and organization activities .
(c) Other Activities
i. Infrastructure projects: Projects in support of Clients (services not easily tracked back to
a specific working age Client) or that directly benefit a Client(s) but the Client is not of
working age. Examples include planning services like benefits planning and generic job
development e.g. "Project Search."
ii. Start-up projects: Projects that support an agency or directly benefit the agency.
Examples include equipment purchases and ~gency administrative support.
iii. Partnership project: Collaborative partnerships with schpol districts, employment
providers, DVR, families, employers and other community collaborators needed to
provide the employment supports and services young adults with developmental
disabilities require to become employed during the school year they turn twenty~one
(21 ).
(3) Consumer Support
(a) Adult Day Care services 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" or III services (Adult Day Health). Level" and '" 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.
(b) Community Access services are individualized services provided in typical integrated
community settings for individuals in retirement. Services will promote individualized skill
development, independent living and community integration for persons to learn how to
actively and independently engage in their local community. Activities will provide
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 14
Special Terms and Conditions
opportunities to develop relationships and to learn, practice and apply skills that result in
greater independence and community inclusion. These services may be authorized instead
of employment support (Individual Employment, Group Supported Employment or Pre-
Vocational services) for working age individuals who have received nine (9) months of
employment support, have not found a job and decide not to continue looking for work.
(c) Child Development Services are designed to meet the developmental needs of each eligible
child and the needs of the family related to enhancing the child's development. Services
may include specialized instruction, speech-language pathology, occupational therapy.
physical therapy, assistive technology, and vision services . Services are provided in natural
environments to the maximum extent appropriate.
(d) Individual Supported Employment services are a part of an individual's pathway to
employment and are tailored to individual needs, interests, and abilities to promote career
development. These are individualized services necessary to help persons with
developmental disabilities obtain and continue integrated employment at or above the
state's minimum wage in the general workforce. These services may include intake,
discovery, assessment, job preparation, job marketing, job supports, record keeping and
support to maintain a job,
(e) Individualized Technical Assistance services are a part of an individual's pathway to
employment. This service provides assessment and consultation to the employment
provider to identify and address existing barriers to employment. This is in addition to
supports received through supported employment services or pre-vocational services for
individuals who have not yet achieved their employment goal.
(f) Group Supported Employment services are a part of an individual's pathway to integrated
jobs in typical community employment. These services are intended to be short term and
offer ongoing supervised employment for groups of no more than eight (8) workers with
disabilities in the same setting , The service outcome is sustained paid employment leading
to further career development in integrated employment at or above minimum wage.
Examples include enclaves, mobile crews, and other business models employing small
groups of workers with disabilities in integrated employment community settings.
(g) Pre-Vocational Services are a part of an individual's pathway to integrated jobs in typical
community employment. These services and supports are intended to be short term and
should be designed to further habilitation goals that will lead to greater opportunities for
competitive and integrated employment and career advancement at or above minimum
wage, Services are provided by agencies established to provide services to people with
disabilities and offer training and skill development for groups of workers with disabilities
in the same setting as well as individual support. Participants are provided at least
monthly opportunities to experience typical community settings in support of their pursuit
to integrated employment.
b . Reimbursement for the Fiscal Year shall not exceed the total 'amount listed in Exhibit B to this
Program Agreement. However, with a Program Agreement amendment, the parties may increase
or decrease the Program Agreement amount.
c. Monthly Invoice with Documentation: All requests for reimbursement amounts must be entered and
posted into the CMIS system, The Contractor may post a combined claim of all programs/services
covered by this agreement. DSHS shall mak.e all payments due to the Contractor for all invoices
submitted pursuant to this section within sixty (60) days following posting of required information.
DSHS Central Contract Serv ices
1769CS County Agreement 7-14-2015
Page 15
Special Terms and Conditions
d. It is an expectation that all Clients access DVR funding as a resource. Client services shall not be
reimbursed under this Program Agreement when the same services are paid for under the
Rehabilitation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private
funding.
e. Reimbursement of Client Services: A claim for each individual is made on the CM IS sys tem by
indicating the number of service units delivered to each individual listed and the fee per unit. Units
are defined as:
(1) An "Hour" is at least fifty (50) minutes of direct service. Partial hour to the quarter may be
recorded.
(2) A "Day" is at least four (4) hours of direct service and will only be used in connection with Adult
Day Care (ADC) reimbursement.
(3) A "Month" represents a minimum of one service visit which is at least fifty (50) minutes of direct
service for Child Development Services (CDS) reimbursement.
f. Program Administration: The County will provide program administration and may bill for
administrative costs as identified in Exhibit B. Administrative costs will not exceed 7% of the total
combined allocation for Consumer Support and Other Consumer Support services un less milla'ge
has been declared or the Assistant Secretary of DOA ~pproves a request for an exc-ept ion under
Chapter 388-850 WAC. Monthly cla ims for administrative costs will be 1/12 of the maximum
Administration amount identified in Exhibit B.
g. The Employment Phases & Billable Activities document defines the individual Client services that
DDA reimburses. That document is located on the DSHS DDA County Best Practices Web site at
http://www.dshs.wa.gov/ddd/counties.shtm.
h. The Community Access Billable Activities document defines the individual Client services DDA
reimburses. That document is located on the DSHS DDA County Best Practices Web site at
http://www.dshs.wa.gov/ddd/counties.shtm.
i. Timeliness of and Modification to Billings: All initial invoices with documentation must be received
by the DOA Region within sixty (60) calendar days following the last day of the month in which the
service is provided. Corrected invoices and documentation including re-posted billing information
will be accepted throughout the fiscal year as long as they are received within sixty (60) calendar
days of the associated fiscal year unless an extension is approved by the DDA Regional
Administrator or designee, Payment will not be made on any invoice submitted past sixty (60)
calendar days after the Program Agreement fiscal year.
j. Recovery of Fees: If the County bills and Is paid fees for services that DSHS later finds were (a)
not delivered or (b) not delivered in accordance w ith Program Ag reement standards, DSHS shall
recover the fees for those services and the County shall fully cooperate during the recovery.
10. Intermediate Care Facilities for Intellectual Disabilities (ICFIID) Agreement. If applicable per 42
CFR 483.410, the County shall assure that all county-operated or subcontr acted programs serving
persons living in ICFIID facilities develop a plan and coord inate their serVices with the facility on behalf
of the ICF/ID resident. DDA will supply to tbe County a list of ICFIID residents who attend a day
program.
DSHS Central Contract Services
1769CS County Agreement 7·14·2015
Page 16
Special Terms and Conditions
11. Single State Medicaid Agency-Health Care Authority (HeA): HCA, as the single state Medicaid
Agency, has administrative authority for Title XIX coverage per 42 CFR 431.10. DSHS is the operating
agency for the Home and Community Based Waivers for services for people with developmental
disabilities . The County only has responsibility for services covered in this agreement.
12. DSHS/DRW Access Agreement: The ORW February 27,2001 Access Agreement with DDA is
incorporated by reference. The County assures that it and its subcontractors have reviewed the
Access Agreement. The agreement covers ORW's access to individuals with developmental
disabilities, Clients, programs and records, outreach activities, authority to investigate allegations of
abuse and neglect, and other miscellaneous matters and is binding for all providers of ODA contracted
services.
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 17
Exhibit A -Data Security Requirements
1 . Oefinitions. The words and phrases listed below, as used in this Exhibit, shall each have the following
definitions:
a. "Authorized User(s)" means an individual or individuals with an authorized business requirement to
access DSHS Confidential Information.
b. "Hardened Passwordll means a string of at least eight ch aracters containing at least one alphabetic
character, at least one number and at least one special character such as an asteris k, ampersand
or exclamation point.
c. "Unique User 10" means a string of characters that identifies a specific user and which, in
conjunction with a password, pass phrase or other mechanism, authenticates a user to an
information system.
2. Data Transport. When transporting oSHS Confidential Information electronica"y, including via email ,
the Data will be protected by:
a. Transporting the Data within the (State Governmental Network) SGN or Contractor's internal
network, or;
b. i;ncrypting any Data that will be in transit outside the SGN or Contractor's internal network. This
includes transit over the public Internet.
3. Protection of Data. The Contractor agrees to store Data on one or more of the following media and
protect the Data as described:
a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be
restricted to Authorized User(s) by requiring togon to the local workstation using a Unique User 10
and Hardened Password or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards.
b. Network server disks. Data stored on hard disks mounted on network servers and made available
through shared folders. Access to the Pata will be restricted to Authorized Users through the use of
access control lists Which will grant access only after the Authorized User has authenticated to the
network using a Unique User 10 and Ha rdened Password or other authentication mechanisms
which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted
to such servers must be located in an area which is accessible only to authorized personne', with
access controlled through use of a key, card key, combination lock. or comparable mechanism.
For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as
long as the disks remain in a Secured Area and otherwise meet the requirements listed in the
above paragraph. Destruction of the Data as outlined in Section 5. Oata Disposition may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area.
c, Optical discs (CDs or DVOs) in local workstation optical disc drives. Data provide d by oSHS
on optical discs which will be used in local workstation optical disc drives and which will not be
transported out of a Secured Area. When not in use for the contracted purpose, such discs must be
locked in a drawer, cabinet or other container to which only Authorized Users have the key,
combination or mechanism required to access the contents of the container. Workstations which
access DSHS Data on optical discs must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 18
d. Optical discs (CDs or DVDs) In drives or jukeboxes attached to servers. Data provided by
DSHS on optical ~iscs which will be attached to network servers and which will not be transported
out of a. Secured Area . Access to Data on these discs will be restricted to A uthorized Users th rough
. the use of access control lists which will grant access only after the Authorized User has
~uthenticated to the network using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
ca fds. D.ata on discs attached to such servers must be located in an area which Is accessible only
to authorized personnel, with access controlled through use of a key, card key , comb in ation lock, or
comparable mechanism .
e. Paper documents. Any paper records must be protected by storing the records in a Secured Area
which is only accessible to authorized personnel. When not in use, such records must be stored in
a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons
have access.
f. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or
Secure Access Washingto n (SAW) will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User ID and Ha rdene d Password) to Authorized Users on Contractor
staff. Contractor will notify DSHS staff immediately whenever an Autho rized User in possess ion of
such credentials Is te rminated 0( otherwise leaves the employ of the Contractor, and whenever an
Authori~ed Use rs duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically autho rize d within the terms and conditions of the
Contract. If so authorized, the Data shall be given the following protections:
(a) Encrypt the Data with a key length of at least 128 bits
(b) Contro! access to devices with a Unique User ID and Hard ened Password or stronger
authentication method such as a physicall token or biometrics.
(c) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum period of
inactivity is 20 minutes.
Physically Secure the portable device(s) and/or media by
(d) Keeping them in locked storage when not in use
(e) Using check-jn/check-out procedures when they are shared, and
(f) Taking frequent inventories
(2) When being transported outside of a Secured Area, portable devices and media with DSHS
Confidential Information must be under the physical control of Contractor staff with authorization
to access the Data.
(3) Portable devices include, but are not lim ited to; smart phon'es , tablets, flash memory devices
(e .g . USB flash drives, personal med ia playe rs), portable hard disks, and
laptop/npteboQklnetbook computers if those computers may be transported outside of a
Secured Area.
OSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 19
(4) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic media
(e.g. floppy disks, tape), or flash media (e.g. CompactFlash, SO, MMC).
h. Data stored for backup purposes.
(1) DSHS data may be stored on portable media as part of a Contractor's existing, documented
backup process for business continuity or d isaster recovery purposes . Such storage is
authorized until such time as that media WQuld be reused during the course of normal backup
operations. If backup media is retired while DSHS Confidential Information 5tH!, exists upon tt,
such media will be destroyed at that time in accordance with the disposition requirements in
Section 5. Data Disposition
(2) DSHS Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual
media, etc.) as part of a Contractor's existing, documented backup process for business
continuity or disaster recovery purposes. If so, such media will be protected as otherwise
described in this exhibit. If this media is retired while DSHS Confidential Information still exists
upon it, the data will be destroyed at that time in accordance with the disposition requirements in
Section 5. Data Disposition.
4. Data Segregation.
a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to
ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or
destruction. It also aids in determining whether DSHS Data has or may have been compromised in
the event of a security breach. As such, one or more of the following methods will be used for data
segregation.
b. DSHS Data will be kept on media (e .g. hard disk, optical disc, tape, etc.) which will contain no
non-DSHS data. And/or,
c. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data. And/or,
d. DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
e . DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the
value of a specific field or fields within database records .
f. When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer, folder, or other container.
g. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the
DSHS Data and the non-DSHS data with which it is commingled must be protected as described in
this exhibit.
5. Data Disposition. When the contracted work has been completed or when no longer needed, except
as noted in Section 3. Protection of Data b. Network Server Disks above, Data shall be returned to
DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of
destruction are as follows:
Data stored on:
Server or workstation hard disks, or
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Will be destro~e d ~y~ ___ .
Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
Page 20
Removable media (e.g. floppies, USB flash drives, character data, or
portable hard disks) excluding optical discs
Degaussing sufficiently to ensure that the Data cannot
be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or Confidential Recycling through a contracted firm provided the
Information contract with the recycler assures that the
confidentialit:t of Data will be protected .
Paper documents containing Confidential Information On-site shredding, pulping, or incineration
requiring special handling (e.g. protected health
information)
Optical discs (e.g. CDs or DVDs) Incineration , shredding, or completely defacing the
. readable surface with a coarse abrasive
Magnetic tape Degaussing, incinerating or crosscut shredding
6. Notification of Compromise or Potential Compromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact des ignated in the Contract within one (1)
business day of discovery. If no DSHS Contact is designated in the Con1ract , then the notification must
be reported to the DSHS Privacy Officer at ds"hsprivacyofficer@dshs.wa.gov. Contractor must also
take actions to mitigate the risk of loss and comply with any notification or other requirements imposed
by law .or DSHS .
7. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a
subcontractor, the Contract w ith the subcontractor must include all of the data security provisions within
this Contract ~nd w ithin any amendments, attachments, or exhibits within this Contract. If the
Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub-
Contractor must be submitted to the DSHS Contact specified for this contract for review and approval.
DSHS Central Contract Services
1769CS County Agreement 7-14-2015
Page 21
EXHIBIT B
Program Agreement Budget
XX Original Budget Budget Revision
Fiscal
Year Fund Source
2016 state
Waiver
Local
Medicaid Match to Local
Total Rev.
Fiscal
Year Fund Source
. 2017 State
Waiver
Local
Medicaid Match to Local
Totai Rev .
DSHS Central Contract Services
1769CS County Agreement 7·14·2015
REVENUES
Original 1st Revision 2nd Revision 3rd Revision
358425
$689190 $ $ $
Original 1 st Revision 2nd Revision 3rd Revision
$ $ $ $
COUNTY FY 2016 SPENDING PLAN
Planned Expenditures
Local PASRR Medicaid
Funds TOTAL
19953 44339
Page 22
ExhibitC
local Match
Local Match Certification
I FSA ~ih.uclol S.I\'k ...
Admjnj!lll"~LJn
(This form must be submitted with final contract billing.)
=-:
1,-=-::--:-::=-=-"",.....,...,.,:-_____________ certify that local funds and/or In-kind items
PRINT NAME
=:-:=-=-,.,.,..",~~~-=~_:_:_:='"="".,...,._=__--------------were provided in the amount of
TYPE AND SOURCE OF FUND SIITEMS
$ ___________ and were used to match federal funds paid during the time period
of __________ through ___________ for
TYPE OF SERVICE/C O!IITRACT
NAME OF ENJITY
NAME OF AUTHORIZED AGENT I CONTRACTNENDOR NUMBER
AUTHORIZEO REPRESENTAT IV E'S SIG NATURE DATE TITLE OR POSITION
PRINTED NAME OF AUTttORI ZED REPRESENTATIVE TEl.EPHON E NUMBER
Instructions
Name: Printed name of the local entity's agent authorized to complete certification form.
Type and source of funds: The type and source of loca l funds use d. In-k in d sources need specific identification
showing who donated the Item(s) (e .g., volunteers, building use, etc.).
Dollar amount: Dollars that were used to match federal funds paid during the time period. Dollars
repor ted must agree with amoun t on the final billing.
Time frame: Period of time the services were provided.
Type of service/contact: Services eligible for FFP.
Name of entity: Name of local entity that is providing the local funding match.
Name of authorized agent: Name of local entity that is authorized to act in behalf of local entity.
Contract/vendor number: The contract or vendor number of the local entity .
Authorized representative's signature: The signature of the local entity authorized representative.
Date: Date when form was completed.
Title or position: Title or position of local entity authorized representative
Printed name: Printed name of authorized representative.
Telephone number: Telephone number of authorized representative. Include the area code.
DSHS Central Contract Services
1769CS County Agreement 7·14·2015
Page 23
ATTACHMENT "E"
Program Activity Level and Payment Rate Schedule
Kittitas County-Department of Developmental Disabilities
2016-2017 Contract Rate Schedule
Individual Employment (IE) $70.00 per service hour
Group Supported Employment (GSE) $50.00 per service hour
Community Access (CA) $30.00 per service hour
Professional Services Agreement
Page 31