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HomeMy WebLinkAboutDSHS DDD Services Agreement Amendment 2 01.01.2023-06.30.2023Kittitas County Review Form NTTTITMfill14 Grants &Contract Agreement Today's Date PA Camas Request #:04/17/2023 Fund/Department Agenda Date116-Public Health Contract/Grant Information Contract /Grant Agency:DSHS DDD Services Agreement Amendment 2 Period Begin Date:01/01/2023 Period End Date:06/30/2023 Total Grant/Contract Amount:Increase of $89,756.00 for a new maximum of $1,351,040.00 Grant/Contract Number: Contract/Grant Summary: This amendmentis for a budget increase of $89,756.00 for a new maximum of $1,351,040.00. Recommendation for Board of Health Review on Department Head Signature:,Director Date: Kittitas County Prosecutor,Auditor,and Board of Health Review and Comment: APPROVED AS TO FORM: Signature of Prosecutor's Office Date Signature of Auditor's Office Date Verification the Contracting Agency is not Suspended/Disbarred: Agency is not suspended/disbarred Not Checked (reason) Grant/Contract Review Page 1 Financial Information Total Amount State Funds $Federal Funds $ Percentage County Funds Matching Funds $CFDA# In-Kind $ Explain 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 [X]why not New Division created? Revenue Code 105.568.334.04.68 Expense Code 105.568.54101/54122 Pass Through Information Agency to Pass Through Amount to Pass Through Expense Code: M-Contract Approved Date: Prosecutor Review Has the Prosecutor reviewed this agreement?Yes No County Departments impacted Auditor Facilities Maintenance Information Services Human Resource Prosecutor Treasurer BOCC Approval Needed? Yes O No O Staff Member Presenting: Assignment of Tracking Information Auditor's Office Human Resource Prosecutor's Office Who Signed the grant application Reviewer Date Grant/Contract Review Page 2 DSHS Agreement Number wasmoton s ste COUNTY PROGRAM AGREEMENT 2163-24876 Department of Social I &Health services AMENDMENT Amendment No. Transforming lives DDD County Services 02 This Program Agreement Amendment is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS)and the County identified below.Agreement Number Click here to enter text. County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODEDevelopmentalDisabilitiesDivisionofDevelopmental12251225 Admin Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Seanna Woodard 1611 W Indiana Ave Spokane,WA 99205 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL(509)329-2952 (509)568-3037 woodas@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Kittitas County 507 North Nanum Street Suite 102 Kittitas County DDA County Services Ellensburg,WA 98926-2886 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Kasey Knutson COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL(509)962-7090 (509)962-5883 kasey.knutson@co.kittitas.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERSAGREEMENT? No AMENDMENT START DATE PROGRAM AGREEMENT END DATE 01/01/2023 06/30/2023 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM PROGRAM AGREEMENTAMOUNTAMOUNT $1,261,284.00 $89,756.00 $1,351,040.00 REASON FOR AMENDMENT; CHANGE OR CORRECT OTHER:SEE PAGE TWO EXHIBITS.When the box below is marked with a check (4)or an X,the following Exhibits are attached and areincorporatedintothisProgramAgreementAmendmentbyreference: Exhibits (specify):Exhibit B-1,Program Agreement Budget. This Program Agreement Amendment,including all Exhibits and other documents incorporated by reference,contains allofthetermsandconditionsagreeduponbythepartiesaschangestotheoriginalProgramAgreement.No other understandings or representations,oral or otherwise,regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties.All other terms and conditions of the original Program Agreement remain in full force and effect.The parties signing below warrant that they have read and understand this Program Agreement Amendment,and have authority to enter into this Program Agreement Amendment. COUNTY SIGNATURE(S)PRINTED NAME(S)AND TITLE(S)DATE(S)SIGNED DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 1 This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS)is hereby amended as follows: A.Exhibit B,Program Agreement Budget,is revised and replaced with Exhibit B-1,Program Agreement Budget,which is attached hereto and incorporated herein. B.The Special Terms and Conditions are revised and replaced with the following (excluding Exhibit A - Exhibit A remains the same): 1.Definitions Specific to Program Agreement:The words and phrases listed below,as used in this Program Agreement,shall each have the following definitions: a."Acuity Level"means the level of a Client's abilities and needs as determined through the DDA assessment. b."ADSA Web Access (AWA)"means a web-based portal to the Developmental Disabilities Administration CARE system designed to support county services for DDA clients. 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,orinterningstudentsintheprovisionofservicestopeoplewithdevelopmentaldisabilities.Also toenhanceprogramrelatedskillsofboardoradvisoryboardmembers. (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 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."Budget and Accounting Reporting System (BARS)"means a master classification of balance sheet,revenue and expenditurelexpense accounts. 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."Competitive Integrated Employment"means work performed by a Client on a part-time or full-time basis,within an integrated setting within the community that meets HCBS settings requirements. DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 2 The Client must be compensated at minimum wage or higher,using the higher of the Federal, State,or local rate,and at a rate comparable to the wage paid to non-disabled workers performing the same tasks,including receiving the same benefits and opportunities for advancement. g."Consumer Support"refers to direct Client service types as follows: (1)"Community Inclusion"or "Cl":means individualized services provided in integrated community settings with other individuals without disabilities.The activities are based on Client interests and provide opportunities typically experienced by the general public of similar age in their local community,accessible by public transit or a reasonable commute from their home.The goal of the service is to support clients to participate,contribute,and develop relationships with community members who are not paid staff.These services may be authorized for individuals age 62 and older.These services may be authorized in addition to or instead of employment support (Individual Employment or Group Supported Employment)for working age individuals who have received nine months of employment support. (2)"Child Development Services"or "CDS":Birth to three services are designed to meet thedevelopmentalneedsofeacheligiblechildandtheneedsofthefamilyrelatedtoenhancing the child's development.Services may include specialized instruction,speech-language pathology,occupational therapy,physical therapy,assistive technology,and vision services.Services areprovidedinnaturalenvironmentstothemaximumextentappropriate. (3)"Individual Supported Employment"or "lE":services are a part of a Client's pathway toemploymentandaretailoredtoindividualneeds,interests,and abilities,and promote careerdevelopment.These are individualized services necessary to help persons with developmentaldisabilitiesobtainandcontinueintegratedemploymentatorabovethestate's minimum wage in the general workforce.These services may include intake,discovery,assessment,jobpreparation,job marketing,job supports,record keeping and support to maintain a job. (4)"Individualized Technical Assistance"or "ITA":services are a part of a Client's pathway toindividualemploymentorcommunityinclusion.This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion.This is in addition to supports received through supported employment or community inclusion services for Clients who have not yet achieved their goal. (5)"Group Supported Employment"or "GSE":services are a part of a Client'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 careerdevelopmentinintegratedemploymentatoraboveminimumwage.Examples include enclaves,mobile crews,and other business models employing small groups of workers withdisabilitiesinintegratedemploymentincommunitysettings. h."County"is the political subdivision of the state of Washington and the county or counties entering into this Program Agreement. i."DDA Case Resource Manager (CRM)"means a case manager for DDA Clients. j."County Service Authorization (CSA)"means an authorization for county services. k."Developmental disabilities (DD)"means a disability attributable to intellectual disability,cerebral palsy,epilepsy,autism,or another neurological or other condition of an individual found by the secretary to be closely related to an intellectual disability or to require treatment similar to thatrequiredforindividualswithintellectualdisabilities,which disability originates before the individual DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 3 attains age eighteen,which has continued or can be expected to continue indefinitely,and which constitutes a substantial limitation to the individual. I."Developmental Disabilities Administration DDA"means a division within the Department of Social and Health Services. m."DDA Regional office (DDA Region)"means the regional DDA office that supports DDA clients. n."Division of Vocational Rehabilitation (DVR)"means a division within the Department of Social and Health Services o."Employment Outcome Payment"means a payment to providers for transition students born between specific dates;have high acuity;are authorized for Individual employment;and student obtains a competitive integrated job within a specific timeframes.If the job is a minimum of ten hours of work per week an additional amount will be include in the payment. p."General Terms and Conditions"means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. q."Medicaid Home and Community Based Services (HCBS)"means services that occur in a Client's home or community rather than institutions or other isolated settings.These programs serve a variety of targeted populations groups,such as people with intellectual or developmental disabilities,physical disabilities,and/or mental illnesses r."Job Foundation Report"is a document derived from employment readiness activities performed by students who are between ages 19 through 20 that identifies actionable next step for employment. The employment service providers developing the Job Foundation report will be supporting students with employment activities on average of 35 hours. s."Preadmission Screening and Resident Review (PASRR)"means individuals with intellectual disabilities or related conditions (IDIRC)who have been referred for nursing facility (NF)care. t."Person Centered Service Plan or PCSP"means 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. u_"Quality Assurance"means an adherence to all Program Agreement requirements,including DDA Policy 6.13,Provider Qualifications for Employment and Day Program Services,County Guidelines and the Criteria for Evaluation,as well as a focus on reasonably expected levels of performance, quality,and practice. v."Quality Improvement"means a focus on activities to improve performance above minimum standards and reasonably expected levels of performance,quality and practice. 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 the Developmental Disabilities Administration 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 DDA under chapter 388- DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 4 823 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 a current County Service 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. c.Administration Responsibility:The County must demonstrate the ability to administer the program agreement including contract oversight and monitoring,community outreach and education activities,and regular communication with the DDA Regional Office (DDA region)and contracted providers. d.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. e.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.Policies shall be dated and include dates when updated. f.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. g.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. h.Qualified Service Providers:The County assures that all service providers meet qualifications as outlined in the DDA Policy 6.13,Program Qualifications for Employmentand Day Program Providers. i.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. j.Reporting Abuse and Neglect:The County staff and its subcontractors who are mandated reporters DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 5 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. k.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. l.The County staff who perform evaluations of subcontractor work sites will promptly report to DSHS per DDA Policy 6-08,Incident Management and Reporting Requirements for County and County- Contracted Providers,if: (1)They have reasonable cause to believe that abandonment,abuse,financial exploitation or neglect (as defined in RCW 74.34.020)of a person who has a developmental disability (as defined in RCW 71A.10.020)has occurred,and, (2)If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement agency. m.Contractors are specifically authorized to have data storage on portable devices or media in accordance with the Data Security Requirements. n.Order of Precedence:In the event of any inconsistency in this Program Agreement and any attached exhibits,unless otherwise provided herein,the inconsistency shall be resolved by giving precedence,in the following order,to: (1)County Program Agreement;and (2)Attached Exhibits. 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 and sharing information as needed for service coordination,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 concerns with the subcontractors identified by the County; (2)Inform and include the County in the discharge planning of Client's leaving institutions and returning to the community who will need program funding; (3)Inform the County of Client's who have had their waiver status changed; DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 6 (4)Work with the County when referring Client's for services and will withdraw referrals when authorization is not issued; (5)Authorize new service within 5 working days and will extend existing service authorization before expiration date; (6)Inform Clients of service changes through Planned Action Notice(s); (7)Work with the County to document planned services in the Client's Person Centered Service Plan including notification of assessment dates; (8)Work with the County when terminating services; (9)Work with DDA Head Quarters and the County on Spending Plan adjustments;and (10)Work with the County in participating in evaluation of direct service providers. b.The County shall: (1)Work with the DDA Region when Clients are referred for services,authorized services,and/or for support modifications; (2)Work with the DDA Region to document planned services in the Client's Person Centered Service Plan; (3)Assist with informing the DDA Region of any potential service level changes not documented in the Client's DD Assessment prior to any changes; (4)Work with the DDA Region regarding service termination; (5)Work with the DDA Head Quarters on Spending Plan adjustments; (6)Inform the DDA Region of new providers to be included on the ALTSA Web Access (AWA) system; (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 DDA;and (9)Notify and work with the DDA Regional Employment Specialist when performing evaluations of direct service providers. c.Compliance with Budget and Accounting Reporting System Policies:The County shall take any necessary and reasonable steps to comply with BARS Policies. d.The County shall comply with the following referenced documents found at DDA Internet site https://www.dshs.wa.gov/ddalcounty-best-practices under "County Best Practices": (1)DDA Policy 4.11,County Services for Working Age Adults; (2)Chapter WAC 388-850,chapter 388-828 WAC,WAC 388-845-0001,0030,0210,0215,0220, 0600-0610,1030-1040,2100,2110; (3)Criteria for Evaluation; DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 7 (4)DDA Guidinq Values; (5)County Guide to Achieve DDA's Guidinq Values; (6)DDA Guidelines for Community Assessments within Employment and Vocational Programs;and (7)Disability Rights Washington (formerly Washinqton Protection and Advocacy System)Access Aqreement. e.The County shall develop and submit a comprehensive plan for the County DD Services as required by WAC 388-850-020. f.Conveyance of The Estimated Number of People to be Served and Targeted Outcomes:The County shall submit the Service Information Forms (SIF's)(provided by DDA at Internet site https://www.dshs.wa.gov/ddalcounty-best-practices)to 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 Applications (RFAs),Requests for Information (RFl'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.Subcontractors:The County will pass on all applicable contractual requirements that are between DDA and the County to the subcontractor.The County shall immediately notify the DDA Region of the County's intent to terminate a subcontractor who is serving a DDA referral.Individuals or agencies contracted with a county or DDA may not subcontract for Employment or Community Inclusion services. k.The County shall provide or contract with qualified Employment and Day Program Service Providers for consumer support services that include the following program outcomes: (1)Monthly Community Inclusion (CI)service support hours will be based on the Client's CI service level per WAC 388-828-9310 for all Clients who began receiving CI services July 1,2011 and fonNard. (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 Cl,services will occur individually or in a group of no more than two (2)or three (3) Client's with similar interests and needs. (b)CI 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. (2)Clients in an employment program will be supported to work towards a living wage.A living wage is the amount needed to enable a Client to meet or exceed living expenses.Clients DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 8 should be supported to average twenty (20)hours of community work per week or eighty-six (86)hours per month;however,each person's preferred hours of employment should be taken into consideration.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)The Client's DDA PCSP is the driver for service.The AWA County Service Authorization (CSA)and updated Planned Rates information will not exceed the Client's DDA PCSP.Service changes will not occur until the Client has received proper notification from DDA. (4)All Clients will have an Individualized Employment and/or Community Inclusion 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 the Client,their DDA Case Resource Manager (CRM),guardian and others as appropriate. (5)Six-month progress reports describing the progress made towards achieving Client's goal will be provided by the service provider to the CRM,Client,and/or guardian,if any,within 30 days following the six-month period.The report will summarize activities and outcomes made towards the Client's individualized goal(s).All Clients will be contacted by their service provider according to Client need and at least once per month. (6)All Clients will be contacted by their service provider according to Client need and at least once per month. (7)If Clients in Individual Employment or Group Supported Employment,have not obtained paid employment at minimum wage or higher 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 Client/guardian;and (c)Develop additional strategies with the Client/guardian,county staff,employment support staff,case manager,and others identified by the Client.Strategies may include providing technical assistance,changing to a new provider,and/or providing additional resources as needed to support the Client'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.When requesting to participate in CI,the Client shall communicate directly with his or her DDA Case Manager.The DDA Case Manager is responsible for authorizing CI 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 or DDA issues prior written approval for the service provider to continue to provide long-term supports if needed.If the County or DDA approves the continuation of long-term supports where the service provider is also the Client's employer, the County or DDA will regularly monitor these positions to assure fading efforts occur when appropriate and any potential conflict of interest is addressed. DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 9 (10)Individual Employment staff hours must be attributed to the "Individual Employment and Billable Activity Phase(s)". (11)For Group Supported Employment (GSE),Clients must have paid work.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. (a)The collective group's individual hours should be the minimum staff hours delivered to support the group. (b)A GSE Client must be on-sitelat work at least their base individual hours as a minimum per month.If a Client is not on-sitelat work for all of their base hours,the county should verify that the provider delivered the collective group's individual hours to the group (what was the number of staff hours provided to the group during the month?If it was less than the collective group's total the provider can only bill for the staff hours that were provided). (c)A GSE agency may not bill for a GSE Client who does not receive services during an entire service month. (d)A GSE agency must have a record of which staff is supporting which Clients on any given day. (e)A GSE agency must have supportive documentation that provides clear evidence of support helping with specific activities as identified in the Client plan to move a Client on their pathway towards their employment goal(s). (f)Running a GSE service is a part of the business operation and not billable to Clients (contract procurement,contract maintenance,or administration functions associated with GSE). (g)Individual time in the community working towards the individual employment goal,separate from the group time,must include phase information (refer to Employment Phases and Billable Activities -see Phases 1 --4 for element /activity description). (12)Employment and day services must adhere to the Home and Community Based settings (HCBS)requirements of 42 C.F.R.Section 441.301(c)(4),including that: (a)The setting is integrated in the greater community and supports Client's to have full access to the greater community; (b)Ensures the Client receives services in the community to the same degree of access as individuals not receiving Medicaid HCBS; (c)The setting provides opportunities to seek employment and work in competitive integrated settings;and (d)The setting facilitates individual choice regarding services and supports,and who provides them. I.Quality Assurance and Service Evaluation:The County shall develop and have available an evaluation system to review services.The evaluation system must have both a Quality Assurance and a Quality Improvement component,and both must include objective measures.The objective measures at a minimum will include performance indicators,by acuity,that include the number of DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 10 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 description of such evaluation system shall be provided upon request to DDA for review. m.Evaluation:The County shall evaluate and review services delivered to reasonably assure compliance and quality.The County shall conduct at least one visit to each subcontractor every two (2)years.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. n.The County shall work with local developmental disability advisory groups to plan for and coordinate services. o.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. p.AWA Data System:In compliance with the AWA Traininq Manual,the County shall use the AWA data system for all: (1)Billing requests; (2)Service provider address and phone number maintenance; (3)Evaluation dates; (4)Employment outcome information;and (5)Monthly provide all data described in the Billing Instructions and in the Employment Outcomes Instructions,which is hereby incorporated by reference. q.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. r.Review and respond the AWA "Work List"items within 5 working days including Referrals and pending Authorization. s.Review the AWA "Ticklers"Planned Rate tab and update the planned rate within 5 working days after the Planned Rate start date. t.Partnership Project. (1)A Job Foundation document will be completed per guidelines for eligible students.Eligible students are DDA clients who were born between: (a)For fiscal year 2021 9/1/00 through 8/31/01 (b)For fiscal year 2022 9/1/01 through 8/31/02 (c)For fiscal year 2023 9/1/02 through 8/31/03 (d)For fiscal year 2024 9/1/03 through 8/31/04 DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 11 These students currently attending school and have completed an application to participate in this Value Based Payment (VPB)project.The VBP project application will include the following minimum criteria identified in the sample application found at: https://www.dshs.wa.qovlsites/defauft/files/DDAldda/documents/Job%20Foun_dation%20Applica tion 040720%20%28002%29.docx (2)Qualified providers will collaborate with School District staff to complete the Job Foundation document and then provide a copy to the County.To be a qualified provider for the Partnership Project the Counties must require the provider to have a current contract with the Division of Vocational Rehabilitation;a contract in good standing with the County and cannot be in provisional status;a minimum of two years'experience providing Individual Employment with demonstrated job placement skills.The Job Foundation recommendation will only have actionable next steps towards integrated competitive employment. (3)County participating in the Partnership Project must have the ability to work collaboratively with School Districts to identify DDA students in high school,collect and track information,be proficient in electronic spreadsheets,and ability to evaluate if completed Job Foundation document(s)meet quality standards. u.Employment Outcome Payment.--Providers,with transition students born between: (1)For fiscal year 2023 9/1/00 through 8/31/01 (2)For fiscal year 2024 9/1/01 through 8/31/02 (3)For fiscal year 2025 9/1/02 through 8/31/03 (4)For fiscal year 2026 9/1/03 through 8/31/04 High acuity Clients who are authorized for Individual employment,may receive one outcome payment if student obtains a competitive integrated job approved by the County within timeframes described in the chart in the DDA Billing Instructions.If the County is also the service provider DDA will provide the job approval.If the job is at a minimum of ten hours of work per week an additional amount will be include in the payment. 7.Consideration: a.Fees: (1)Approval of fees is the responsibility of the DDA.The DDA Region reserves the right to approve fees/rates for the services being provided.The County will submit a feelrate schedule with the initial Program Agreement.The County will submit updated feelrate schedules to the DDA Regional Employment Specialist 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,CI,ITA,CDS)and its associated rate. (2)Fee Limitations:The DDA Billing Instructions found on the County Best Practices site provides limitations on the Hourly Rate for each direct service.Hourly rates must be divisible by four. b.Budget and Spending Plan,attached as Exhibit B: DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 12 (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 /Program Agreement Budget /Exhibit B.Funding shall be distributed under State and Medicaid in the revenue section.The planned expenditures for Consumer Support are based on authorized Clients,their acuity level and work history for a given point in time.To determine the Additional Consumer Support amount,the Consumer Support amount is multiplied by a percentage.The spending plan may only be modified by mutual agreement of the parties in writing and shall not require a program agreement amendment. (a)Funds Designated for Additional Consumer Services:If a County provides Community Information and Education services under additional consumer services,then activities must include outreach efforts to federally recognized local tribes. (b)Funds Designated for Adult Day Care Consumers:Funds designated for Adult Day Care Consumers are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level II or Ill services (Adult Day Health).Level II and Ill services are licensed rehabilitation and skilled nursing services along with socialization.Level I services (Adult Day Care)are supervised day programs where frail and disabled adults can participate in social,educational,and recreational programs without the need for skilled nursing.These Clients may be referred to services defined in the statement of work,or to an Adult Day Care service other than Level II or Ill.If a Client no longer needs and wants services,the funds are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003.An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the local Area Agency on Aging.Adult Day Care service is not a waiver approved service. c.Program Agreement Amendments:A County can request an amendment at any time.An amendment for additional Client(s)may be supported when clients exceed the number used to develop the contract.An amendment for additional service hours authorized may be supported when county provides evidence.An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers. d.Exemptions:The 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 cost incurred by the program for: (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.For a County whose DSHS Central Contract Services 1769CP Contract Amendrnent (12-10-21)Page 13 designated coordinator manages multiple programs,the County must be able to provide evidence of the time the coordinator spent working on the Developmental Disabilities program. (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 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,Division of Vocational Rehabilitation (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).Supports provided should complement and not replace what the student(s)receive through the Individualized Education Program (IEP). (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 Inclusion Services are individualized and provided in integrated community settings with other individuals without disabilities.The activities are based on Client interests and provide opportunities typically experienced by the general public of similar age in their local community,accessible by public transit or a reasonable commute from their home.The goal of the service is to support Clients to participate,contribute,and develop relationships with community members who are not paid staff.These services may be authorized for individuals age 62 and older.These services may be authorized in addition to or instead of employment support (Individual Employment or Group Supported Employment) DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 14 for working age individuals who have received nine months of employment support. (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 a Client'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 (per the Individual Employment Phases &Billable Activities) (e)Individualized Technical Assistance services are a part of a Client's pathway to employment or community inclusion.This service provides assessment and consultation to the provider to identify and address existing barriers to employment or community inclusion.This is in addition to supports received through supported employment or community inclusion services for individuals who have not yet achieved their goal. (f)Group Supported Employment services are a part of a Client'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. b.Reimbursement for the state 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.Counties will work with DDA HQ on amendments to the Program Agreement. c.Monthly Invoice with Signed Documentation:All requests for reimbursement amounts must beenteredandpostedintotheAWAsystem.The Contractor may post a combined claim of all programs/services covered by this Program Agreement.DSHS shall make all payments due to theContractorforallinvoicessubmittedpursuanttothissectionwithinforty-five (45)days following posting of required information. d.Clients will be assisted in accessing DVR services per the DDA/DVR MOU.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 Client is made on the AWA system by indicating the number of service units delivered to each Client listed and the fee per unit.Units aredefinedas: (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 DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 15 Day Care reimbursement. (3)A "Month"represents a minimum of at least fifty (50)minutes of direct service for CDS reimbursement. f.Program Administration:The County will provide program administration and coordination including such activities as planning,budgeting,contracting,monitoring,and evaluation.Monthly claims for administration can be 1/12 of the maximum amount identified in Exhibit B under Administration or for the actual costs incurred in the given month but the total Administration billed will be the lesser of the two.Administration cost reimbursement will not exceed 7%unless the Assistant Secretary of DDA approves a request for an exception under chapter 388-850 WAC. g.The Individual 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 https //www.dshs.wa.gov/ddalcounty-best-practices. h.The Community Inclusion Billable Activities document defines the individual Client services DDA reimburses.That document is located on the DSHS DDA County Best Practices Web site at https://www.dshs.wa.gov/ddalcounty-best-practices. i.Timeliness of and Modification to Billings:All initial invoices with signed documentation must be received by the DDA Region within forty-five (45)calendar days following the last day of the month in which the service is provided.Corrected invoices and documentation including re-posted billinginformationwillbeacceptedthroughoutthefiscalyearaslongastheyarereceivedwithinsixty(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.Preadmission Screening and Resident Review (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%. I.Reimbursement for Partnership project:A claim of $2,400 per student for each completed Job Foundation document that is at a satisfactory or above rating will be requested through the AWA system as other monthly cost. m.Job Foundation report line item 95 and 96 as identified in the ADSA Web Access (AWA)billing system.King,Snohomish and Pierce Counties will use line item 95,all other participating Counties will use line item 96 (OSPI).A copy of the completed Job Foundation document will be sent electronically to the shared mailbox located at:DDAJobFoundationReports@dshs.wa.gov n.Job placement verification for transition students:The AWA Employment Output for Individual Employment will be completed and submitted with payment request to verify employer,job start date,job type,etc. o.Job Foundation Administration:The County may bill for administration costs as identified in Exhibit B.Monthly claims for administration cost will be based on the actual expenditures multiplied by 7%. King,Snohomish and Pierce Counties will use line item 13,all other participating Counties will use line item 14 (OSPI). DSHS Central Contract Services 1769CP Contract Arnendment (12-10-21)Page 16 9.Intermediate Care Facilities for Intellectual Disabilities (ICFlID)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 ICFllD 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. 12.Confidential Information.All Counties and their subcontractors must: a.Ensure the security of Confidential Information,and b.When transporting client records containing Confidential Information outside a Secure Area,one or more of the following as appropriate: (1)Using a Trusted Network;or (2)Encrypting the Confidential Information,including: (a)Email and/or email attachments (b)Confidential Information when it is stored on portable devices or media including but not limited to laptop computers and flash memory devices. 13.Data Security Requirements.Exhibit A shall only apply to the County if the County possesses 150 or more DSHS records across all programs or services throughout their organization,or transmits more than 5 records at one time. 14.Supersession of Prior Data Security Agreement.If the Parties hereto have previously entered into a Standalone Data Security Requirements Agreement,both Parties hereby agree that upon mutual execution said Agreement shall take precedence as the sole Data security Agreement between the Parties. All other terms and conditions of this Program Agreement remain in full force and effect. DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 17 Exhibit B1 Program Agreement Budget Original Budget X Budget Revision REVENUES Fiscal Year Fund Source Original 16*Revision 2nd Revision 3rd Revision 2022 State only 316,726 Medicaid 313,916 Total Rev.$630,642 $$$ Fiscal Year Fund Source Original 1st Revision 2nd Revision 3rd Revision 2023 State only 316,726 392,273 Medicaid 313,916 328,125 Total Rev.$630,642 $720,398 $$ FY22 Job Foundation Funds PASRR Medicaid Funds State Funds Funds TOTAL ADMINISTRATION 336(CMIS/AWA BARS 11)22494 18405 41,235 OTHER CONSUMER SUPPORTS (CMIS/AWA Code 31,336 32,41,92,93,94)21023 17200 38,559 CONSUMER -r SUPPORT STATE-ONLY Child Development MEDICAID CLIENTS 4800 273024 273024 550,848 ROADS to COMMUNITY LIVING TOTAL 5,472 316,541 308,629 630,642 DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 18 FY23 Job Foundation Funds PASRR Medicaid Funds State Funds Funds TOTAL ADMINISTRATION 336(CMIS/AWA BARS 11)25724 21047 47,107 OTHER CONSUMER SUPPORTS (CMIS/AWA Code 31,336 32,41,92,93,94)25150 20577 46,063 CONSUMER SUPPORT STATE-ONLY Child Development MEDICAID CLIENTS 4800 281214 281214 567,228 Start -Up 60000 60,000l¯ÕADS to COMMUNITY LIVING TOTAL 5,472 392,088 322,838 720,398 DSHS Central Contract Services 1769CP Contract Amendment (12-10-21)Page 19