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Kittitas County
Review Form
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Grants & Contract Agreement
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Today's Date
05/09/2019
Fund/Department
116 -Public Health
Agenda Date
Contract/Grant Information
Contract /Grant Agency: Yakima Valley Memorial DD Info and Education Contract
Period Begin Date: April 1, 2019 Period End Date: June 30, 2019
Total Grant/Contract Amount: $7,025.03
Grant/Contract Number:
Contract/Grant Summary:
Yakima Valley Memorial Hospital Association DBA Virginia Mason Memorial is assuming the previous
developmental disabilities information and education contract with Bright Beginnings for Kittitas County
(BBFKC). The change is a result of BBFKC organizational changes. Current services and staffing remain
the same under the new leadership of Yakima Valley Memorial.
I
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:
Sr Lire of Prosecutor's Ofle Date
Signa u e o Auditor's Office Date
Signature of Board of Health member Date
Financial Information
Total Amount $ 7,025.03 State Funds $ 7,025.03 Federal Funds $
Percentage County Funds Matching Funds $ CFDA#
Grant/Contract Review Page 1
In -Kind $
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring — reporting requirements
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form No ❑ why not
New Division Created?
Revenue Code 105.568.334.04.68
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? Yes ❑ No
county uepartments impactea
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource _
Prosecutor's Office
Who Signed the grant application
Reviewer I Date
Grant/Contract Review Page 2
PROFESSIONAL SERVICES AGREEMENT
This Agreement is made by and between Kittitas County (hereinafter "the County")
and Yakima Valley Memorial Hospital Association dba Virginia Mason Memorial, a
Washington nonprofit corporation located at 2811 Tieton Drive, Yakima, WA 98902
(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).
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 April 1, 2019 and continue until
June 30, 2019. 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 signing this Agreement agrees that the
Indemnification provisions set forth in Paragraphs 7 (Independent Contractor), 9 (Taxes),
16 (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.
IN WITNESS WHEREOF, the parties have executed this Agreement this day
of , 2019.
APPROVED:
YAKIMA VALLEY MEMORIAL KITTITAS COUNTY
HOSPITAL ASSOCIATION DBA BOARD OF COUNTY COMMISSIONERS
VIRGINIA MASON MEMORIAL KITTITAS COUNTY, WASHINGTON
Signature of Signatory Cory Wright, Chairman
(Date }
Print Name of Signatory Brett Wachsmith, Vice -Chairman
Professional Services Agreement
Page 1
Contractor Address:
Yakima Valley Memorial Hospital
Association dba Virginia Mason
Memorial
Attn: Cindy Carroll
2811 Tieton Drive
Yakima, WA 98902
Commissioner
Attest:
Clerk of the Board
County's Address:
Kittitas County
205 West 5th Avenue, Suite 108
Yakima, WA 98908
With a copy to:
Virginia Mason Medical Center
Attn: Sr Vice President & General Counsel
1100 Ninth Avenue
Seattle, WA 98101
Project Contact:
Cindy Carroll
Child Health Services Manager
Professional Services Agreement
Page 2
Project Contact:
Kasey Knutson
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 "D".
This Agreement includes statements of the Developmental Disabilities Administration
within DSHS (hereinafter "DDA") responsibilities from the attached Program Agreement
despite DDA 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.
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.
5. Accounting and Payment for Contractor Services:
Professional Services Agreement
Page 3
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 will 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 and Subcontractin :
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.
7. Independent Contractor:
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 acknowledges that the entire compensation for this Agreement is specified
in Attachment "B" and the Contractor is not entitled to any County benefits including, but
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
Professional Services Agreement
Page 4
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
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 six (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;
Professional Services Agreement
Page 5
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 reasonable 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.
12.2 The County may, at any time, by advance 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
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Page 6
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.
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
Professional Services Agreement
Page 7
by providing at least fifteen (15) calendar days written notice to the Contractor. 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
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
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. This Agreement shall be governed by the law
of the State of Washington.
19. Withholding 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.
Professional Services Agreement
Page 8
21. Contractor Commitments, Warranties and Representations:
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 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.
21.4 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.
21.5 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
or assets in the State of Washington, or its ability to perform its obligations
under this Agreement.
21.6 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 Contractor shall be notified promptly in writing by County of any notice of
such claim.
22.2 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
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Page 9
such claim of infringement is made, provided no reduction in performance or
loss results to the County.
23. Disputes:
23.1 General
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.
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. Ownership of Items Produced:
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.
25. Confidentiality:
The Contractor, its employees, Sub -Contractors, and their employees shall maintain the
confidentiality of all information provided by the County or acquired by the Contractor in
Professional Services Agreement
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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 as defined by information protected from disclosure
under federal or state law, 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 defined by personal and
sensitive information that if improperly used or released may do
significant harm to a patient's interests in privacy, health care, other
interests, or 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
security measures, which include restricting access to the Confidential
Information 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:
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25.2.4(1) Use a Trusted System
25.2.4(2) 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
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 rendered, and to the Kittitas County
Commissioners, 205 W 5t' Ave, Suite 108, Ellensburg, WA 98926. Notice to the
Contractor for all purposes under this Agreement shall be given to the addresses reflected
on the signature page. Notice may be given by delivery or by depositing in the U.S. Mail,
first class, postage prepaid.
Professional Services Agreement
Page 12
27. Severability:
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.
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
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Page 13
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 pay or 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
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
Professional Services Agreement
Page 14
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.
Professional Services Agreement
Page 15
ATTACHMENT "A"
SCOPE OF WORK
Funding is provided for the following activities and deliverables:
Administer the Ages and Stages Questionnaire (ASQ) to aid in early identification of
children with developmental disabilities.
a. Deliverable: Through June 30, 2019, maintain participation in the ASQ program
at an average of twenty (20) children throughout the contract year.
b. Deliverable: Through June 30, 2019, provide the County with quarterly reports
summarizing the number of children participating in the ASQ program and the
number of referrals generated to the Birth to Three program.
2. Conduct outreach activities with primary referral sources to provide support,
information, and assistance to families and children with developmental disabilities.
a. Deliverable: Through June 30, 2019, conduct quarterly outreach activities with
primary referral sources.
3. Enhance direct services by purchasing appropriate curriculum, tools, therapeutic toys
and manipulatives for early intervention staff to utilize during home visits and
maintained in the lending library.
a. Deliverable: By June 30, 2019, provide a report to the County describing the
curriculum, therapeutic toys and manipulatives that are purchased for staff and
children participating in the Birth to Three program.
4. Provide ongoing developmental screenings, outreach and referrals at Early Learning
Coalition, STEM events and other community events.
a. Deliverable: By June 30, 2019, attend a minimum of 15 community events
where staff provides developmental screenings, outreach and referrals.
5. Provide staff training to improve services to children with developmental disabilities.
a. Deliverable: By June 30, 2019, three staff in the ESIT program will obtain a
minimum of sixteen hours of professional development training each.
6. Provide quarterly reports to the County.
a. Quarterly reports to the County shall be due by the following dates:
i. July 15, 2019 (for April 1 -June 30, 2019)
b. Quarterly reports shall include, at a minimum:
i. A narrative of progress on the deliverables outlined above.
ii. Number of children participating in the ASQ program.
iii. Number of ASQ participants referred to the Birth to Three
program.
iv. Number of outreach activities with primary referral sources.
V. Number of Referrals from Birth to Three program generated from
outreach activities with primary referral sources.
Professional Services Agreement
Page 16
vi. Number of children screened at Early Learning Coalition, STEM
events and other community events.
vii. Number of ASQ participants and Birth to Three program referrals
generated from attending Early Learning Coalition, STEM events
and other community events.
viii. Number of staff attending training, training hours, and description
of training.
ix. A description of manipulatives/toys, books, and tools purchased.
7. Provide a report and/or presentation of progress of these deliverables to the Kittitas
County Mental Health/Developmental Disabilities Board and the Board of County
Commissioners prior to the end of the contract period.
Professional Services Agreement
Page 17
ATTACHMENT "B"
COMPENSATION
As full compensation for satisfactory performance of the work as described herein, the
County shall pay Contractor compensation in an amount not to exceed $7,025.03
annually. The Contractor agrees to:
Submit invoices, at least quarterly, to the County within thirty (30) days following
the last day of the month or quarter being invoiced.
Submit invoices for actual expenses incurred during the billing period. (The
County will not pay invoices for an equal monthly or quarterly amount based on
full contract compensation.)
® Provide detail of expenses being billed for, and supporting documentation for
those expenses. Supporting documentation can include, but is not limited to,
receipts, invoices, or purchase orders. For payroll expenses, supporting
documentation needs to show exact salary and benefit expenses and/or
timesheets from the billing period.
Amount
$2,100.04
$930.00
$3,224.99
$770.00
$7,025.03
Professional Services Agreement
Page 18
Activit
Non Administrative Staff wages and
benefits
Therapeutic manipulatives and books
Training registrations, travel, hotel, and
meals per diem
Administrative staff wages and benefits
TOTAL
TTACHMENT "C"
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.
Contractor's insurance policies shall be occurrence -based, be primary insurance and
shall be non-contributing with any other insurance maintained by Kittitas County.
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 General Liability Insurance.
■ Coverage limits not less than:
• $1,000,000 per occurrence per project
$2,000,000 general 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
• Sixty (60) days written notice to the County of cancellation
of the insurance policy.
2) Stop Gap/Employers Liability.
• 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
of the insurance policy.
3) Commercial Automobile Liability Insurance.
Professional Services Agreement
Page 19
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:
A $1,000,000 combined single limit
Thirty (30) days written notice to the County of cancellation
of the insurance policy.
4) Workers' Compensation.
a Workers' Compensation in amounts required by law.
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 20
ATTACHMENT "D"
Program Agreement between DSHS and the County for DDA County Services
Professional Services Agreement
Page 21
Kittitas County
Review Form
Grants & Contract Agreement
I Quay b UaLe
08/02/2017
Fund/Department
116 -Public Health
Contract/Grant Information
Contract /Grant Agency: DSHS DDA County Services
Period Begin Date: 07/01/2017
Total Grant/Contract Amount: $820,341.00
Agenc
vfi.r
ement
Period End Date: 06/30/2018
Grant/Contract Number: 1763-98187
Contract/Grant Summary:
The amendment to the contract between the State of Washington Department of Social and Health
Services and Kittitas County. The agreement provided a maximum program agreement amount of
$820,341.00. The agreement allows the county to provide services and allow staff to administer DD
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:
�/ F
, Zfc
/}
Signat e o Prosecutor's ce Date
4� !
Sig a r of Auditor's Office Date
Signature of Board of Health member Date
Financial Information
Total Amount $ 1 State Funds $ _ Federal Funds $ _
Percentage County Funds I Matching Funds $ CFDA#
Grant/Contract Review Page 1
In -Kind $
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring —rep
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed? Yes ❑ attach budget form
New Division Created?
Revenue Code
105-568.334.04.68 - $820,341.00
.... ........ _
Pass Through Information
Agency to Pass Through 4
Amount to Pass Through $
Sub -Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement?
requirements
No ❑ Why not
Will only need if actual amount billed exceeds
lcontract amount — will do at year end.
I Yes No
County DepartmentsImpacted
Auditor _ Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
RECEIVED
OCT 11 2017
■ %L—%-0S—S X71.—"
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DSHS Central Contract Services Page 1
1769CS County Agreement 6-15-2017 DDA SPOKANE-
U�
DDA SPOKANE
DSHS Agreement Number
rnglon
or social
V iie'a
t."�'i'"""'1763-98187
'Illan ; ,�� ; ; �t:-, AUNTYeartment
7 lthservices
PROGRAM AGREEMENT
Transforming lives
DDA County Services
This Program 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 with a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference.
County Agreement Number
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE
Developmental Disabilities Division of Developmental 1225 1769CS-63
Admin Disabilities
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Seanna Woodard 1611 W Indiana Ave
Operations Manager
Spokane, WA 99205
DSHS CONTACT TELEPHONE
DSHS CONTACT FAX
DSHS CONTACT E-MAIL
(509)329-2952
509 568-3037
woodas dshs.wa. ov
COUNTY NAME
COUNTY ADDRESS
Kittitas County
507 North Nanum Street Suite 102
Kittitas County DDA County Services
Ellensburg, WA 98926
COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME
NUMBER
Joann Schaan
COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX „COUNTY C NTACT EMAIL
0A
509 933-8233 �. tr:. G C
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM
CFDA NUMBERS
AGREEMENT?
No
PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE
MAXIMUM PROGRAM AGREEMENT AMOUNT
07/01/2017 06/30/2018
I
$820,341.00
EXHIBITS. The following Exhibits are attached: Exhibit A — Data Security Requirements; Exhibit B — Budget and
Spending Plan; Exhibit C -Fund Match Certification
By their signatures 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 Program Agree ent.
COUNTY SIGNATURE(S)
PRINTED NAME(S) AND TITLE(S)
DATE(S) SIGNED
DSHS SIGNATURE
PRIMED NAME AND TITLE
elissa Diebert
DATE SIGNED
Contract Manager
■ %L—%-0S—S X71.—"
SEP 15't'017
DSHS Central Contract Services Page 1
1769CS County Agreement 6-15-2017 DDA SPOKANE-
U�
Special Terms and Conditions
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 ALTSA Web Access also referred to as the CMTS.
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. "BARS" means DDA Budget and Accounting Reporting System.
e. "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.
f. "CMTS" means the Case Management Information System also referred to as AWA.
g. "County" means the county or counties entering into this Program Agreement.
h. "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
development, independent living and community integration for persons' to learn how to actively
and independently 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
DSHS Central Contract Services Page 2
1769CS County Agreement 6-15-2017
Special Terms and Conditions
(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 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.
(3) "Individual Supported Employment" or "IF: services are a part of an individual's pathway to
employment and are tailored to individual needs, interests, and abilities, 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.
i. "CRM" means the DDA Case Resource Manager.
j. "CSA" means County Service Authorization.
k. "DD" means developmental disabilities.
I. "DDA" means the Developmental Disabilities Administration within DSHS.
m. "DDA Region" means the DDA Regional office.
n. "DVR" means the Division of Vocational Rehabilitation.
DSHS Central Contract Services Page 3
1769CS County Agreement 6-15-2017
Special Terms and Conditions
o. "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.
p. "HCBS" means the Medicaid Home and Community Based Services.
q. "ISP" means the Individual Support Plan, a document that authorizes and identifies the DDA paid
services to meet a Client's assessed needs.
r. "PASRR" means Preadmission Screening and Resident Review,
s. "PCSP" means Person Centered Service Plan, a document that authorizes and identifies the DDA
paid services to meet a Client's assessed needs. Formerly referred to as the Individual Support
Plan.
t. "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, and
practice.
u, "Quality Improvement" means a focus on activities to improve performance above minimum
standards and reasonably expected levels of performance, quality and practice.
v. "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.
w. "Service Provider" is a qualified Client service vendor who is contracted to provide Employment and
Day Program services.
x. "Subcontractor" is the service provider contracted by the County to provide services.
2. Purpose: This Program Agreement is entered into between DDA 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. 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
DDA 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.
4. 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 coordinator administers more than one program
area (e.g. Chemical Dependency, Mental Health, Developmental Disabilities), training and
experience in administration and/or a related Human or Social service may be considered.
DSHS Central Contract Services Page 4
1769CS County Agreement 6-15-2017
Special Terms and Conditions
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.
Background/Criminal History Check: A background/criminal history clearance is required every
three years for all employees (including DD program County staff), 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 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, and Consumer Support as
defined in this Program 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 Program 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(13) must comply with reporting requirements described in RCW 74.34.035,
.040 and Chapter 26.44 RCW. If the County is notified by DSHS that a subcontractor staff member
is cited or on the registry for a substantiated finding, then that associated staff will be prohibited
from providing services under this Program Agreement.
j. Counties who provide Child Development Services (birth to three early intervention services), must
provide those services under the regulations implementing the Individuals with Disabilities
Education Act (IDEA), Part C, and Washington State's Early Support for Infant and Toddler
Federally Approved Plan.
k. The County staff who perform on-site evaluations of subcontractor work sites will promptly report to
DSHS per DDA Policy 5.13, Protection from Abuse: Mandatory Reporting, if:
(1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or
neglect (as defined in RCW 74.34.020) of a person who has a developmental disability (as
defined in RCW 71A.10.020) has occurred, and,
(2) If they have reason to suspect that sexual or physical assault of such a person has occurred,
DSHS Central Contract Services Page 5
1769CS County Agreement 6-15-2017
Special Terms and Conditions
they shall also immediately report to the appropriate law enforcement agency.
5. Duty to Disclose: Under 42 CFR §455.104, the Administration must obtain certain disclosures and
complete required screenings to ensure the State does not pay federal funds to excluded person or
entities. The County is required to provide disclosures from managing employees, specifically the
persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. the
person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS
Form 27-094, should be submitted to the Administration to complete the required screenings.
Disclosures must be provided at contract renewal and within thirty-five (35) days whenever there is a
change in the staff holding these management positions (42 CFR 455.104 (c)(1)].
6. Statement of Work: The County shall provide the services and staff, and otherwise do all things
necessary for or incidental to the performance of work, as set forth below. Working collaboratively, the
parties shall administer DD services within the county as set forth below:
a. The DDA region shall:
(1) Review subcontractors and shall immediately notify the County of any disapproval of the
subcontractors identified by the County;
(2) Inform and include the County in the discharge planning of individuals leaving institutions and
returning to the community who will need program funding;
(3) Inform the County of individuals who have had their waiver status changed;
(4) Work with the County when referring individuals for services;
(5) Inform Clients of service changes through Planned Action Notice(s);
(6) Work with the County to document planned services in the Individual's Support Plan including
notification of assessment dates;
(7) Work with the County when terminating services;
(8) Work with the County on Spending Plan adjustments; and
(9) Work with the County in participating in on-site evaluation of direct service providers.
b. The County shall:
(1) Work with the DDA Region when individuals are referred for services;
(2) Work with the DDA Region to document planned services in the Individual's Support Plan;
(3) Assist with informing the DDA Region of any potential service level changes not documented in
the individual's DD Assessment prior to any changes;
(4) Work with the DDA Region regarding service termination;
(5) Work with the DDA Region on Spending Plan adjustments;
(6) Inform the DDA Region of new providers to be included on the CMIS system;
DSHS Central Contract Services Page 6
1769CS County Agreement 6-15-2017
Special Terms and Conditions
(7) Notify the DDA Region of any intent to terminate a subcontractor who is serving a DDA 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
https:t/www.dshs.wa-gov/dda/county-best-prectice under "County Best Practices":
(1) DDA Policy 4.11, County Services for Working Age Adults;
(2) WAC 388-850, WAC 388-828, WAC 388-845-0001, 0030, 0210, 0215, 0220, 0600-0610, 1030-
1040, 1400-1410, 2100, 2110;
(3) Criteria for Evaluation;
(4) DDA Guiding Values;
(5) County Guide to Achieve Developmental Disability Administration's Guiding Values;
(6) 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.
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://www.dshs.wa.gov/ddalcounly-best-practicc:sto indicate the estimated number of people to
be served, targeted outcomes, and identified goal(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, excluding Child Development, will be open continuous enrollment.
h. Qualified Providers: A qualified provider must be a county or an individual or agency contracted
with a county or DDA.
i. Technical Assistance: DDA contracts with Technical Assistance providers that may be utilized by
Counties with prior written approval.
j. 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.
k. 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
DSHS Central Contract Services Page 7
1769CS County Agreement 6-15-2017
Special Terms and Conditions
the County's intent to terminate a subcontractor who is serving a DDA referral. Individuals or
agencies contracted with a county or DDA may not subcontract for services with the exception of
Technical Assistance providers.
I. 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.
(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.
(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 PCSP is the driver for service. The CMIS CSA and updated Planned
Rates information will not exceed the Client's DDA PCSP.
(b) The amount of service the Client receives should match with the CMIS CSA 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.
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Special Terms and Conditions
(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 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 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 hours staff actually provided.
(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
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Special Terms and Conditions
(d) The setting facilitates individual choice regarding services and supports, and who provides
them.
m. 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 objective
measures at a minimum will include performance indicators, by acuity, that include the number of
new jobs; job loss and reasons for job loss; the percentage employed earning minimum wage or
better; and the average number of hours worked. 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.
n. 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
documentation will be provided to the DDA upon request.
o. The County shall work with local developmental disability advisory groups to plan for and coordinate
services.
p. The County shall participate in regularly scheduled meetings between County DD staff and DDA
staff to remain updated and current including ACHS and Regional Meetings.
q. 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.
7. Consideration:
a. County Millage Funds: Per RCW 71.20.110, a County may elect to declare all or part of millage
funds 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 HCBS 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) Each Month complete a separate A-19 identifying the amount of total expenditures by category,
the amount of millage contributed, and the expected amount of federal match. Additionally
enter this information into AWA/ CARE County billing summary.
(3) Submit a Funds Match Certification (Exhibit C) with the final contract billing.
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Special Terms and Conditions
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 fee/rate 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:
(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 $55.00/hour.
(b) Community Access services will not exceed an hourly rate of $35.00.
(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. Level I services (Adult Day Care) are supervised day programs where frail
and disabled adults can participate in social, educational, and recreational programs without the
need for skilled nursing. These Clients may be referred to services defined in the statement of
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Special Terms and Conditions
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.
8. 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
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 agency administrative support.
iii. 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
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Special Terms and Conditions
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 II or III services (Adult Day Health). Level II and III 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
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
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Special Terms and Conditions
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 Signed 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 Program Agreement. DSHS shall make all payments due to the
Contractor for all invoices submitted pursuant to this section within sixty (60) days following posting
of required information.
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 CMIS system 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 reimbursement.
(3) A "Month" represents a minimum of one service visit which is at least fifty (50) minutes of direct
service for CDS reimbursement.
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 unless millage
has been declared or the Assistant Secretary of DDA approves a request for an exception under
Chapter 388-850 WAC. Monthly claims 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
haps://www. d shs. wa.aov/dda/county-best-practices.
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
htips://www.dshs.wa.gov/dda/county-best-g)factices.
I. Timeliness of and Modification to Billings: All initial invoices with signed documentation must be
DSHS Central Contract Services Page 14
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Special Terms and Conditions
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 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 with Program Agreement standards, DSHS shall
recover the fees for those services and the County shall fully cooperate during the recovery.
k. PASRR Administration: The County may bill for administration costs as identified in Exhibit B.
Monthly claims for administration cost will be based on the actual PASRR expenditures multiplied
by 7%.
9. Intermediate Care Facilities for Intellectual Disabilities (ICF/ID) Agreement. If applicable per 42
CFR 483.410, the County shall assure that all county -operated or subcontracted programs serving
persons living in ICF/ID facilities develop a plan and coordinate their services with the facility on behalf
of the ICF/ID resident. DDA will supply to the County a list of ICF/ID residents who attend a day
program.
10. Single State Medicaid Agency—Health Care Authority (HCA): 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.
11. DSHS/DRW Access Agreement: The DRW 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 DRW'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 DDA contracted
services.
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Exhibit A
Data Security Requirements
Definitions. 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 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.
c. "Unique User ID" 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. Data Transport. When transporting DSHS Confidential Information electronically, 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. Encrypting 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. All Electronic Data must be encrypted using at least an encryption
standard of AES 128 bit. Electronic Data can be on desktops, laptops and other portable devices,
servers, and external media:
a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID
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 Data 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 ID and Hardened 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 personnel, 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. Data Disposition may be
deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area.
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1769CS County Agreement 6-15-2017
Exhibit A
c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS
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.
d Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by
DSHS on optical discs 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 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 ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as biometrics or smart
cards. Data 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, combination 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.
Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or
Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's 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 authorized 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) Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical 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-in/check-out procedures when they are shared, and
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1769CS County Agreement 6-15-2017
Exhibit A
(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 limited to; smart phones, tablets, flash memory devices
(e.g. USB flash drives, personal media players), portable hard disks, and
laptop/notebook/netbook computers if those computers may be transported outside of a
Secured Area.
(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, SD, 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 disaster recovery purposes. Such storage is
authorized until such time as that media would be reused during the course of normal backup
operations. If backup media is retired while DSHS Confidential Information still exists upon it,
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.
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1769CS County Agreement 6-15-2017
Exhibit A
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
Removable media (e.g. floppies, USB flash drives,
portable hard disks) excluding optical discs
Will be destroyed by:
Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
character data, or
Degaussing sufficiently to ensure that the Data cannot
be reconstructed, or
the disk
Paper documents with sensitive or Confidential Recycling through a contracted firm provided the
Information contract with the recycler assures that the
confidentiality of Data will be orotected.
Paper documents containing Confidential Information
requiring special handling (e.g. protected health
information)
Optical discs (e.g. CDs or DVDs)
On-site shredding, pulping, or incineration
Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
I
Ma netic tape j 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 designated in the Contract within one (1)
business day of discovery. If no DSHS Contact is designated in the Contract, then the notification must
be reported to the DSHS Privacy Officer at dshsprivacyofficer@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 with the subcontractor must include all of the data security provisions within
this Contract and within 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 Page 19
1769CS County Agreement 6-15-2017
Exhibit B
Program Agreement Budget
X Original Budget Budget Revision
REVENUES
Fiscal
Year
Fund Source
State only
Original 'It Revision
413,416
2nd Revision
3'd Revision
2018
2019
Waiver
Local
27,251
22_,_297
49,548
Waiver
Medicaid Match to Local
464
Local
$ $
Total Rev.
$820,341
$
$
$
Total Rev_
$
$
Fiscal
Year
Fund Source
Original
18t Revision
2nd Revision
3rd Revision
2019
State
27,251
22_,_297
49,548
Waiver
464
Local
$ $
6,644
Child Development
Medicaid Match to Local
Total Rev_
$
$
COUNTY FY 18 SPENDING PLAN
1
Planned Expenditures
Local PASRR Medicaid
Funds Funds State Funds Funds TOTAL
ADMINISTRATION (CMIS/AWA
BARS 11)
OTHER CONSUMER SUPPORTS
(CMIS/AWA Code 31, 32, 41, 92,
93, 94
CONSUMER SUPPORT
STATE -ONLY
651
29,159
23,858
53,668
27,251
22_,_297
49,548
464
6,180
6,644
Child Development
MEDICAID CLIENTS
8829 350,826
350,826
710,481
ROADS to COMMUNITY LIVING
TOTAL
9944
413,416
366,9811
820,341
DSHS Central Contract Services Page 20
1769CS County Agreement 6-15-2017
Exhibit C
Funds Match Certification
(This form must be submitted with final contract billing.)
PRINT NAME
TYPE AND SOURCE OF PRIVATE / LOCAL FUNDS / ITEMS
TYPE AND SOURCE OF NON-PROFIT FUNDS / ITEMS
TYPE AND SOURCE OF FEDERAL FUNDS / ITEMS
and were used to match funds paid during the time period of
TYPE OF SERVICE/CONTRACT
c edify that local funds and/or in-kind items
- were provided in the amount of
- were provided in the amount of $
_ were provided in the amount of $
_.. through
NAME OF ENTITY
NAME OF AUTHORIZED AGENT CONTRACT / VENDOR NUMBER
AUTHORIZED REPRESENTATIVE'S SIGNATURE DATE TITLE OR POSITION
PRINTED NAME OF AUTHORIZED REPRESENTATIVE TELEPHONE NUMBER
Instructions
for
Name:
Printed name of the entity's agent authorized to complete certification form.
Type and source of funds:
The type and source of funds used. Please break out different types of funding sources. Not
all funding sources will be necessary to complete each certification. In-kind sources need
specific identification showing who donated the item(s) (e.g., volunteers, building use, etc.).
Dollar amount:
Dollars that were used to match funds paid during the time period. Dollars reported m ust
agree with amount on the final billing.
Time frame:
Period of time the services were provided.
Type of service/Contract:
Services eligible for matching.
Name of entity:
Name of entity that is providing the funding match.
Name of authorized agent:
Name of agent, if different than "name of entity" above, that is authorized to act on behalf of
entity.
Contract/vendor number:
The contractor vendor number of the entity.
Authorized representative's signature:
The signature of the entity authorized representative.
Date:
Date when form was completed.
Title or position:
Title or position of 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
Page 21
1769CS County Agreement 6-15-2017
Kittitas County
Review Form--�
Grants & Contract Agreement
Today's Dateg
06/1%2018 A enda Date
Fund/Department
116 -Public Health
Contract/Grant Information
Contract /Grant Agency: Kittitas County DDA County Services Amendment 3
Period Begin Date: 07/01/2018 1 1Period End Date: 06/30/2019
Total Grant/Contract Amount: $ 1,628.424.00
Grant/Contract Number: 1763-98187
Contract/Grant Summary:
Change or correct period of performance and max contract amount.
Contract amendment end date 06/30/2019; increased fund +$801.577
Recommendation for Board of Health and Board of Health Review an
Department Head Signature: � �{ ,Administrator Date: � ;f
Kittitas County Prosecutor, Auditor, and Board of Health Review and Comment:
,natu a of ros cutor's
uditor's Office
n
Signature of Board of Health member
l_
Financial Information
Total Amount $ 801,577
Percentage Countv Funds
Date
fV
Date
Date
State Funds $ 801,577
Matching Funds $
In -Kind $
Federal Funds
CF DA#
Is Equipment being purchased? Who owns equipment?
New Personnel being hired? Contact HR hiring — reporting requirements
Grant/Contract Review Page 1
Future impacts or liability to Kittitas County:
Budget Information
Budget Amendment Needed?
New Division Created?
Revenue Code
105.568.334.04.68
Yes E] attach budget foro why not
Amount Increase New Total
+$801,577 $1,628,424
Pass Through Information
Agency to Pass Through
Amount to Pass Through $
Sub -Contract Approved Date:
Prosecutor Review
Has the Prosecutor reviewed this agreement? YesEl No
County Departments Impacted
Auditor Facilities Maintenance
Information Services Human Resource
Prosecutor Treasurer
Submitted
Signature: Date:
Department:
Assignment of Tracking Information
Auditor's Office
Human Resource
Prosecutor's Office
Who Signed the grant application
Reviewer Date
Grant/Contract Review Page 2
l�
DSHS CONTRACT NUMBER:
slate tial CONTRACT AMENDMENT 1763-98187
Department
Department of Social
& Health Services
L
_ Amendment No. 03
Transforming lives
This Contract Amendment is between the State of Washington Department of Program Contract Number -
1
Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text
Contractor Contract Number
CONTRACTOR NAME CONTRACTOR doing business as (DBA)
Kittitas County Kittitas County DDA County Services
CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER
507 North Nanum Street Suite 102 IDENTIFIER (UBI) 1225
192-002-673
Ellensbur , WA 98926-2886
_
CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS
Joann Schaan (509 933-8233 Click here to enter text. Click here to enter text.
DSHS ADMINISTRATION
DSHS DIVISION DSHS CONTRACT CODE
Developmental Disabilities Admin
Division of Developmental 1769CS-63
Disabilities
DSHS CONTACT ADDRESS
DSHS CONTACT NAME AND TITLE
'Seanna Woodard
1611 W Indiana Ave
Operations Manager
S okane, WA 99205
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
509 329-2952 (509)568-3037 1 woodaq@dshs.wa.gov
IS THE CONTRACTOR A SUSRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS
No
AMENDMENT START DATE CONTRACT END DATE
07/01/2018 06/30/2019
PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL, MAXIMUM CONTRACT AMOUNT
$826,847.00 $801,577.00 $1,628,424.00
REASON FOR AMENDMENT;
CHANGE OR CORRECT PERIOD OF PERFORMANCE AND MAX CONTRACT AMOUNT
ATTACHMENTS, When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference:
❑ Additional Exhibits s ecif .
This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms
and conditions agreed upon by the parties as changes to the original Contract. No other understandings or
representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or
bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing
below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract
Amendment.
PRINTFD ^0AIAC""'^""'rDATE SIGNED
A
*CONTRAAICT-06R—SIGNATUIRE
PRINTE@irt DATE SI NED
1AA 'Ai r
Contract Manager
Budget, Finance &
DSHS Central Contract Services Page 1
6024PF Contract Amendment (1-26-2018)
This Contract between the State of Washington Department of Social and Health Services (DSHS) and the
Contractor is hereby amended as follows:
1. The Total Maximum Contract Amount is hereby increased in the amount of $801,577 for a new
Contract Amount of $1,628,424.
2. The Program Agreement end date is extended to June 30, 2019.
3. Special Terms and Conditions, Section 8, Billing and Payment is amended as follows:
a. Prog+-arn Agreement Budget; DSHS shall pay the County all allowable costs, which are defined by
DDA as costs incurred by the program for:
Program Administration : The County will provide program administration and may bill for
administrative costs up to the identified amount in Exhibit B. Administrative costs reimbursement
will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer
Support services unless millage has been declared or the Assistant Secretary of DDA approves a
request for an exception under Chapter 388-850 WAC. Monthly claims for administrative costs will
be for allowable expenditures incurred or 1/12 of the maximum Administration amount identified in
Exhibit B, or the lessor of the two.
4. Exhibit B. Program Agreement Budget is hereby replaced with the following Budget Revision:
All other terms and conditions of this Contract remain in full force and effect.
EXHIBIT B
Program Agreement Budget
❑ Original Budget X Budget Revision
REVENUES
Fiscal
Year
�`--
Fund Source
---------_ __
Originalj_
413,416
1'� Revision
421,051
--- -
2"d Revision
3d Revision
2018
State Only
Waiver
Local _
Medicaid Match to
Local
$801,577
Local
Total Rev.
.
Medicaid Match to
Local
$835,289
$826,847
Total Rev.
$820,341
Fiscal
Year Fund Source
Original
19t Revision
2nd Revision 3`d Revision
2019 State Only
408,462
Waiver
Local _
Medicaid Match to
Local
$801,577
Total Rev.
DSHS Central Contract Services Page 2
6024PF Contract Amendment (1-26-2018)
ADMINISTRATION
CMIS/AWA BARS 11)
OTHER CONSUMER
SUPPORTS
(CMIS/AWA Code 31, 32, 41,
_92,93,94)
CONSUMER SUPPORT
STATE -ONLY
Child Development
MEDICAID CLIENTS
ROADS to COMMUNITY
LIVING
TOTAL
COUNTY FY 2019 SPENDING PLAN
Planned Expenditures
Local PASRR Medicaid
Funds FundsState Funds Funds TOTAL
7s _ _
_1 28800 23564 52440
---- _IE- ---
1079
1155
25915 22022
6372
346374 346374
48938
6372
693827
408462 P 391980 1 801,577
DSHS Central Contract SeMces Page 3
6024PF Contract Amendment (1-2&2018)