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Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street · Port Townsend · Washington · 98368
www.jeffe rso n C ou n typ ubi ic he a Ith .0 rg
August 12, 2010
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO:
Board of County Commissioners
Philip Morley, County Administrator
FROM:
DATE:
Jean Baldwin, Director
A/A.6U.Sl 23 I ,J. 0 I 0
SUBJECT: Agenda Item - Agency Agreement - DDD County Services Program
Agreement, #0963-67987, Amendment #1; July 1, 2010 -
June 30, 2011; add'l $351,890 total $661,240
STATEMENT OF ISSUE:
Jefferson County Public Health, Developmental Disabilities Division, is requesting Board approval of the
Agency Agreement - ODD County Services Program Agreement, #0963-67987, Amendment #1;
July 1, 2010 - June 3D, 2011; add1 $351,890 total $661,240
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
This is an amendment to the contract with DSHS for continuation of services to clients with developmental
disabilities in Jefferson County. The services include administration, training expenses (volunteers, board
members, and staff), community information activities, consumer support (Early intervention services for
Child development services for Birth to 3), Group Supported Employment, Pre Vocational Services,
Individual Supported Employment, Parent to Parent, Community Access, Individual & Family Assistance,
and other Activities (special projects). The statement of work requires a qualified coordinator, advisory
board, Intermediate Care Facilities agreement (where applicable) and assignment of Medicaid billing rights
under Title XIX. Jefferson County has a professional service agreement with agencies or organizations
representing each group.
The developmental disabilities pre-vocational, community access, individual and family assistance programs
support the strategic plan by providing educational opportunities and life long learning and training to a
specific workforce which allows for natural interactions, equal opportunity, and integrated participation with
non disabled community members. The individual employment program supports the strategic effort of
sustainable economic base by recognizing the need for more integrated employment opportunities for
persons with disabilities in order to bring up their economic reach.
COMMUNITY HEALTH
DEVELOPMENTAL DISABiliTIES
MAIN: (360) 385-9400
FAX: (360) 385-9401
PUBLIC HEALTH
ALWAYS WORKING FOR A SAFER AND
HEALTHIER COMMUNITY
ENVIRONMENTAL HEALTH
WATER QUALITY
MAIN: (360) 385-9444
FAX: (360) 379-4487
Consent Agenda
Administrative and community information activity programs support the strategic plan by supporting
programs that emphasize and address prevention, early intervention, recovery, and provide opportunities in
overcoming community complexity by providing community outreach and activities in recognition of
significant health issues for the disabled community.
This amendment also adds simplified language changes.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This is an ongoing contract through Department of Social and Health Services. This amendment represents
funding for 2010-2011 and adds $351,890 to the existing revenue for a total of $661,240.
RECOMMENDATION:
JCPH management request approval of the Agency Agreement - DDD County Services Program Agreement,
#0963-67987, Amendment #1; July 1, 2010 - June 30, 2011; add'l $351,890 total $661,240
9;//7/'D
Date
(Routed to all Public Health Managers)
~7~Washington State
DEPARTMENT OF
SOClAL&HEALTH
SERVICES
CONTRACT AMENDMENT
ODD County Services
DSHS CONTRACT NUM,BER:
0963-67987
Amendment No. 0963-67987-01
This Contract Amendment is between the State of Washington Department of
Social and Health Services (DSHS) and the Contractor identified below.
Program Contract Number
Contractor Contract Number
CONTRACTOR NAME
CONTRACTOR doing business as (DBA)
Jefferson County
CONTRACTOR ADDRESS
WASHINGTON UNIFORM
BUSINESS IDENTIFIER (UBI)
DSHS INDEX NUMBER
615 Sheridan St
161-001-169
1223
Port Townsend, WA 98368-
CONTRACTOR CONTACT
CONTRACTOR TELEPHONE CONTRACTOR FAX
CONTRACTOR E-MAIL ADDRESS
cavery@co ,jefferson. wa. us
DSHS CONTRACT CODE
1769CS-63
Cathy Avery
DSHS ADMINISTRATION
Aging and Disability Services Administration
(360) 385..9438 Ext: (360) 385-9401
DSHS DIVISION
Division of Developmental
Disabilities
DSHS CONTACT ADDRESS
DSHS CONTACT NAME AND TITLE
Wendi Winchel
Regional Business Manager
PO BOX 45315
Olympia, WA 98504
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS
(360) 725-4264 (360) 586-6502 winchwa@dshs.wa.gov
IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? I CFDA NUMBERS
No
AME:NDME:NT'STARTIfATE
7/1/2010
-- .. -.. ..... ....... -.... ....----.
P'RtOR MAXIMUM GONTRACrAMOtJNT
$309,350.00
J3130t2011. __ ___
AMouNf OF. IN GREASE OR DECREASE
$3,51,890.-00
':'fOT~L.-MAX:IMLJMCONTRACT'AMOUNT
'$€)6 1. ,240~OO
-. ..... ... .. -
~EA$ON FOR A'ME]\JOMEJs4T;
c;HANGt;: ..O.R C;.(J~,:~:;~~I.Ot.t-1'~R:.. ,$Ef;.PAG1;TVY.O ':'.:>:.
ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into
this Contract Amendment by reference:
D Additional Exhibits (specify):
This CcmttactAmehdnlemt,i~aiI1Q aflExhil>its an€l.0Ile1 dOcunle.rts incorpOrat~~.~ltefe~Q_\.contain$ allot the terms
and c0ntf.itiQns'a'greeaupGnuoythepartres aschan'ges tCl th~ origina'I' C()ntr~ot .... :N('l'()lrt,ef-U~cJ:er~tandi:Flgs....or
representations, oratorotherwis.e, regarding the subj,ect maler of this Contract 'Amendmentshallbecfe,em.ed to exist or
bind the paJtie;$. Another terms and conditions' of-the ortg:il'la:l Contract remain infuU farce and effect. The partie's signing
below warrant that they have reael and understand this Contract Amendment,and have ,authority to enter into this Contract
Am en'drn-ent.
CONTRACTOR SIGNATURE PRINTED NAME AND TITLE DATE SIGNED
DSHS SIGNATURE
PRINTED NAME AND TITLE
DATE SIGNED
Chrsity R. Hoosier, ADSA Contract Manager
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Appro1.'ed as to form only:
fJ. ~ ~ h<#J ) 10
Jefferson C()~Pr05ecuwr'8 flee
Page 1
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 $351 ,890 for a new Contract
Amount of $661,240. This amount is for services provided during the added fiscal year.
2. The Program Agreement end date is extended to June 30, 2011.
3. Paragraph 5. Credential and Minimum Requirements, sub-paragraph c. is replaced in its entirety with the
following:
c. Qualified Subcontractors: The County assures that all subcontractors meet quality assurance
standards. The County will pass on the entire contractual requirements that are between ODD and
the County to the subcontractor.
4. Paragraph 6. Statement of Work, sub-paragraph f. (2) is replaced in its entirety with the following:
2) Direct Client Services
i. Child Development Services: Counties that provide Child Development Services to
eligible children, birth to three, and their families, must provide those services under the
regulations implementing the Individuals with Disabilities Education Act (IDEA), Part C and
Washington State's Infant Toddler Early Intervention Program Federally Approved Plan.
This information can be viewed at http://www1.dshs.wa.gov/iteip. The services will be
provided in collaboration with the Local Lead Agency and in accordance with the local
early intervention plan and interagency agreement(s) per Chapter 70.195 RCW
To be eligible for Child Development Services a child must meet DDD eligibility
requirements set out in WAC 388-823-0800 through 850.
ii. Community Access: Community Access services are for people with developmental
disabilities who are retired or in post employment-and need assistance to access services
in the community. Services are provided in the community to enhance or maintain the
persons' competence, integration, physical or mental skill. Services assist individuals to
participate in integrated activities, events and organizations in the local community in ways
similar to. others of similar age.
iii. Individual Supported Employment: These services are part of an individual's pathway to
employment and are tailored to individual needs, interests, abilities, and promote career
development. These services help a person with developmental disabilities obtain and
continue integrated, individual employment in the general workfaree-. These services may
include intake, discovery, assessment, job preparation, job marketing, job supports,
record keeping and support to maintain a job.
iv. Group Supported Employment: These services are a part of an individual's pathway to
integrated jobs in typical community employment. These services include the activities
outlined in Individual Supported Employment. These are supervised. employment activities
for groups of no more than eight (8) workers with disabilities. The workers are individuals
who have a demonstrated need for ongoing supervision and support in order to maintain
employment. Typical program examples include enclaves, mobile crews, and other
business-based programs employing small groups of workers with disabilities in integrated
employment.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 2
v. Pre-Vocational Services: These services are a part of an individual's pathway to
integrated jobs in typical community employment. Pre-Vocational services, often called
sheltered workshops because of the segregated setting in which the work takes place;
generally provide training and skill development to groups of people with disabilities in the
same setting. Services can include many of the elements described in Individual
Supported Employment.
vi. Person- to- Person: - These services are a part of an individual's pathway to individual
employment. A client exclusively in Person- to- Person is not yet employed or is not
stable in employment. If stable, the client should move to the appropriate service
category. Person to Person supports and services may be needed to assist people with:
(a) Initial Planning: System overview, development of a person centered employment plan
and/or preparing an individualized budget.
(b) Technical Assistance Services: These services are provided by professionals
specialized in an area that would benefit a client to move further on their pathway to
employment. An example is assistive technology or a behavior specialist.
(c) Discovery: Job preparation, exploration and/or volunteering in the community to achieve
integration and employment.
5. Paragraph 7. Consideration, sub-paragraph d. the following requirement will be added to "The DDD
Region shall:"
. Inform client through Plan Action Notice(s);
6. Paragraph 7. Consideration, sub-paragraph d. the second bullet is revised to "The County shall:"
. Assist with Informing the Region of any. potential service level changes not documented in
the individuals DDD Assessment prior to any changes.
7. Paragraph 8. Billing and Payment, sub-paragraph e is replaced in its entirety with the following
e. Administration: The County will provide program administration and may bill for administrative costs
allowed under BARS 568.10. Administrative costs will not exceed 6.50/0 of the total County Program
Agreement, unless the director of ODD makes an exception under WAC 388-850-045 or the
Contractor is exempt per 388-850-040. Monthly claims for administrative costs will be 1/12 of the
maximum 6.50/0 of the total County Program Agreement budget, unless an exception for a higher
percentage is in place.
8. Exhibit A - Budget is hereby replaced with the following Budget Revision:
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 3
EXHIBIT A
Program Agreement Budget
Agreed budget between County/Counties and the Division of Developmental Disabilities for
Contract Number 0963-67987
D Original Budget xD Budget Revision
REVENUES
Fiscal
Year Fund Source Original 1 stRevision 2nd Revision 3rd Revision
201.0 State $159,202 $159,202
Federal $150,149 $150,149
Total $309,350 $309,350
2011 State $0 $185,618
Federal $0 $166,272
T ota I $0 $351,890
All other terms and conditions of this Contract remain in full force and effect.
DSHS Central Contract Services
6024PF Contract Amendment (3-31-06)
Page 4
DSHS Agreement Number
~ 7~. ~shington StIlte
~ DEPARTMENT OF
SOCIAL & HEALTH
SERVICES
COUNTY
0963-67987
PROGRAM AGREEMENT
ODD County Services
This Program Agreement is by and between the State of Washington Department of
Social and Health Services (DSHS) and the County identified below, and is issued in
conjunction with a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference.
Administration or Division
Agreement Number
County Agreement Number
DSHS ADMINISTRATION
DSHS DIVISION
DSHS INDEX NUMBER DSHS CONTRACT CODE
Aging and Disability Services
Administration
DSHS CONTACT NAME AND TITLE
Division of Developmental 1223
o isabi I ities
1769CS-63
DSHS CONTACT ADDRESS
Wendi Winchel
Regional Business Manager
PO BOX 45315
DSHS CONTACT TELEPHONE
360 725-4264
COUNTY NAME
DSHS CONTACT E-MAIL
winchwa@dshs.wa. OV
Jefferson County
615 Sheridan St
COUNTY FEDERAL EMPLOYER IDENTIFICATION
NUMBER
Port Townsend, WA 98368-
COUNTY CONTACT NAME
916001322
COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX
360 385-9438 Ext: 360 385-9401
IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM
AGREEMENT?
Cathy Avery
No
PROGRAM AGRE;EMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
7/1/2009 6/30/2010 $309,350.00
EXHIBITS. The following Exhibits are attached:
Exhibit A: Pro ram A reement Bud at.
COUNTY SIGNATURE(S) ~RINTED NAME(S) AND TITLE(S) DATE(S) SIGNED
i)o..:-J'C\ ~\ \. , ~ OX'\
C\llo.-L'( ifY\O.J(\ 4 \'Z.D) Cf=\
~ L"{:k'\(~ GJu..Y\~
LC)(V\ VV\ t ~b \ ~ V
~-
PRINTED NA~.~~p TI;~~
DATE SIGNED
f -t-c
ADSf~, t'>la nager
Budget, Fiscal & Contracts
as to form O;~~J':
l\q~~
Page 1
AUG 0 6 Z009
DSHS Central Contract Services
1769CS County Agreement (6-17-09)
Special Terms and Conditions
1. Definitions
a. "CMIS" means the Case Management Information System.
b. "County" means the county or counties entering into this Program Agreement.
c. "ODD" means the Division of Developmental Disabilities within DSHS.
d. "DDD Region" means the DDD regional office.
e. "DSHS" means the state Department of Social and Health Services.
f. "Quality Assurance" means an adherence to contract minimum requirements as well as a focus on
reasonably expected levels of performance, quality, and practice.
g. "Quality Improvement" means a focus on activities to improve performance above minimum
standards and reasonably expected levels of performance, quality and practice.
h. "Subcontractor", also referred to as the provider, is a vendor with whom the County contracts for
services.
2. Purpose: This Program Agreement is entered into between the DDD and the County in accordance
with Chapter 71 A.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 DDD pursuant to
Chapter 388-823 WAC (Eligibility) and WAC 388-825 (Service Rules). Only persons referred by the
DDD shall be eligible for direct client services under this Program Agreement. It is the ODD'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. References. Links to all documents incorporated by reference in this Program Agreement can be
found at the DDD/Counties Internet site: htto://www1.dshs.wa.aov/ddd/counties.shtml. These
documents are:
a. ODD Policies identified in 6.13
b. WAC 388-845 - 0001 ,0030,0205,0210,0215,0220,0600-0610,1200-121 0,1400-1410,2100,2110.
e. Criteria for Evaluation
f. County Guidelines
g. County Billing Instructions
h. Employment Outcomes Instructions
DSHS Central Contract Services
1769CS County Agreement (6-17-09)
Page 2
Special Terms and Conditions
5. Credentials and Minimum Requirements.
a. Compliance with .DDD Policy 6.13
b. Qualified Coordinator: Either by way of a county employee or by subcontract the County agrees to
provide or designate a coordinator who has training and experience in delivery of developmental
disabilities services. The county coordinator shall not have a contract with the County to provide
Training, Community Information Activities, Consumer Support, or Other Services as defined in the
ODD BARS Supplement, and shall not be a board member, an officer, or an employeeof an
agency contracting with the county to provide such services. Counties which provide direct client
services only with county employees are exempted from this provision.
c. Qualified Subcontractors: The County assures that all subcontractors meet quality assurance
standards.
d. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County
assures that subcontractor has agreed to assign to the County its Medicaid billing rights .for
services to ODD clients eligible under Title XIX programs in this agreement. Written documentation
shall be available to DSHS on request.
e. Qualified Advisory Board Members: The County, if it has 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 Inform'ation Activities,
Consumer Support, or Other Services as defined in the ODD BARS Supplement, and shall not be a
board member, officer, or employee of an agency contracting with the County.to provide such
services.
f. Background / Criminal History Check: A background criminal history clearance is required every
three years for all employees, subcontractors, and/or volunteers who may have unsupervised
access to vulnerable DSHS clients, in accordance with RCW 43.43.830-845, RCW 74.15.030, and
chapter 388.06 WAC. If the 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 ODD
shall deny payment for any subsequent services rendered by the disqualified individual provider.
The DSHS Background Check Central Unit (BCCU) shall be utilized to obtain background
clearance.
g. Reporting Abuse and Neglect: The County and its subcontractors are mandated reporters under
RCW 74.34.020(1), and must comply with reporting requirements described in RCW 74.34.035 and
040 RCW and 26.44 RCW. If a 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 contract.
County developmental disability staff who perform on-site evaluations of subcontractor work sites
will promptly report to DSHS per Policy 5.13 (Protection from Abuse), incorporated by reference, 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 71 A.1 0.020) has occurred.
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.
DSHS Central Contract Services
1769.CS County Agreement (6-17..09)
Page 3
Special'T erms and Conditions
6. Statement of Work.
a. Program Agreement Budget: The total funding for services will not exceed Exhibit A - Program
Agreement Budget.
b. Client Funding: Funds will follow clients if they move and/or choose a qualified provider in a
different county. The client funding amount will be based on that client's historical employment or
day program support costs. Negotiation for client funding between the receiving and sending
counties is permissible.
c. Biennial Spending Plan: The County' shall submit for approval a Biennial Spending Plan (spending
plan) within 30 days of execution of this County Program Agreement. The spending plan shall be
distributed at the BARS expenditure element code level as well as allocated under State, Medicaid
and Proviso and shall function as a line item budget for expenditures under this agreement. The
allocation and planned expenditures for Consumer Support (BARS 60 series) should be based on
client numbers and Proviso allocations. The state will provide a written response to the County's
Biennial Spending Plan (including any amendments to the plan) within 30 calendar days from time
of receipt at the ODD Regional office. Once approved, the spending plan may only be modified by
mutual agreement of the parties in writing.
d. 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 the ODD, to indicate the
estimated number of people to be served, targeted outcomes, and identified goal(5) that focus on
quality improvement within the categories of Community Information, Direct Client Services, and
Other Activities within 30 days of execution of the County Program Agreement.. Once approved
the SIF outcomes may be modified only by mutual agreement of the Cou-nty and the ODD Region.
e. Limitation to the Waiver services: Counties will act in accordanc_e with WAC 388-845-0110 by
monitoring yearly waiver limits for Basic and Basic Plus employment Iday program service.
f. Program Services: The Contractor may provide Indirect Client services, either itself or through sub-
contractors. Direct Client services must be provided by a qualified Contractor or through qualified
sub-contractors.
(1) Indirect Client Services:
(a) ,Training: The County may provide 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. Training may also be provided for County board and
advisory committee members.
(b) Information and Education: The County may provide activities to inform and/or educate the
general public about developmental disabilities and related services. If a County chooses to
provide these services then activities must include outreach efforts to federally recognized
local tribes. These may include information and referral services; activities aimed at
promoting public awareness and involvement; and community consultation, capacity
building and organization activities.
(c) Special Projects: The County may provide special projects and demonstrations. These
projects will be described in the Service Information Form and approved in writing by ODD
prior to project implementation. Special projects are categorized into the following types:
i. Infrastructure projects: Projects in support of clients (services not easily tracked back to
DSHS Central Contract Services
1769CS County Agreement (6-17-09)
Page 4
Special Terms and Conditions
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: Provides funding to counties to develop collaborative partnerships
with school districts, employment providers, DVR, families, employers and other
community collaborators needed to provi'de the employment supports and services
young adults with developmental disabilities require to become employed during the
school year they turn 21.
(2) .Direct Client Services
(a) Child Development Services: Counties that provide Child Development Services to eligible
children, birth to three, and their families, must provide those services under the regulations
implementing the Individuals with Disabilities Education Act (IDEA), Part C and Washington
State's Infant Toddler Early Intervention Program Federally Approved Plan. This information
can be viewed at http://www1.dshs.wa.gov/iteip. The services will be provided in
collaboration with the Local Lead Agency and in accordance with the local early intervention
plan and interagency agreement(s) per Chapter 70.195 RCW
(b) To be eligible for Child Development Services a child must meet DDD eligibility
requirements set out in WAC 388-823-0800 through 850.
(c) Community Access: Community Access services are for people with developmental
disabilities ages 62 and older who have retired or who choose not to work and need
assistance to access services in the community. Services are provided in the community to
enhance or maintain the persons' competence, integration, physical or mental skill.
Services assist individuals to participate in integrated activities, events and organizations in
the local community in ways similar to others of similar age.
(d) Individual Supported Employment: These services are part of an individual's pathway to
employment. Individual Supported Employment services help a person with developmental
disabilities obtain and continue integrated, individual employment in the local community.
These services may include creating work opportunities through job development, support
to the employee's supervisors and/or peer workers to enable them to support the person on
the job, on-tha-job training, and modification of work site or tasks, employment retention
and follow along support, and development of career and promotional opportunities.
(e) Group Supported Employment: These services are a part of a pathway to Individual
Supported Employment. Group Supported employment service includes the activities
outlined in Individual Supported Employment. These are supervised employment activities
for groups of no more than eight (8) workers with disabilities. The workers are individuals
who have a demonstrated need for ongoing supervision and support in order to maintain
employment. Typical program examples include enclaves, mobile crews, and other
business-based programs employing small groups of workers with disabilities in integrated
employment.
(f) Pre-Vocational Services: These services are a part of a pathway to Individual Supported
Employment Pre-Vocational services, often called sheltered workshops because of the
segregated setting in which the work takes place, generally provide training and skill
DSHS Central Contract Services Page 5
1769CSCounty Agreement (6-17..09)
Special Terms and Conditions
development to groups of people with disabilities in the same setting.
(g) Person.. to- Person: - These services are a part of an individual's pathway to Individual
Supported Employment. A client exclusively in Person- to- Person is not yet employed or is
not stable in employment. If stable, the client should move to the appropriate service
category. Person-to-Person supports and services may be needed to assist people with:
i. Initial Planning: System overview, development of a person centered employment plan
and/or preparing an individualized budget.
ii. Technical Assistance Services: These services are provided by professionals
specialized in an area that would benefit a client to move further on their pathway to
employment. An example is assistive technology or a behavior specialist.
iii. Discovery: Job preparation, exploration and/or volunteering in the community to achieve
integration and employment.
g. Program Outcomes:
(1) Direct Client Services:
(a) Clients in Community Access should average fifteen (15) hours of service and or activities
per month. The amount of service a client receives should be based on his/her
demonstrated need and acuity level. A client receiving Community Access services will not
receive employment support simultaneously. A client may choose to move to an
employment service at any time.
(b) Clients in an employment programs 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 or her living
expenses. Clients should average twenty (20) hours work per week or eighty-six (86)
hours per month. The amount of service a client .receives should be based on his/her
demonstrated need and acuity level.
(c) Prior to beginning service the provider will clearly communicate to the client the minimum
and maximum service hours per month they can expect to receive. The service provider will
also communicate the service hour information to the County. If a change in the minimum
and/or maximum service hour(s) is expected, the client will be. informed prior to the change.
The client minimum and maximum service hour(s) will correlate with the CMIS Planned
Rates information. The client semi-annual progress reports currently referenced in ODD
Policy 4.11 (County Services for Working Age Adults) will also include the client service
hours received from the provider.
(d) All clients will be contacted by their service provider according to client need or at least once
per month. Clients in Person-ta-Person will be considered stable in their job if they have
been employed consecutively for six months.
(e) If clients in Individual Employment or Person-to-Person have not obtained paid employment
within six (6) months the County will assure the following steps are taken:
i. Review of the progress towards employment goals;
ii. Consultation with the family/client; and
DSHS Central Contract Services
1769CS County Agreement (6-17-09)
Page 6
Special Terms and Conditions
iii. Development of additional strategies with the family/client, county staff, and 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/new strategies
will be documented for each client and kept in the client's file(s).
(f) 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 can choose to remain in an employment program.
7. Consideration.
8. Approval of Fees - ODD Responsibility: The ODD Region reserves the right to approve fees/rates
for the services being provided. The rate schedule should align to a client's demonstrated need and
acuity level. The County will submit a fee/rate schedule with the initial County Program agreement.
The County will submit updated fee/rate schedules to the ODD Region for approval as changes
occur. In the event the DDDRegion intends to disapprove the Rate schedule it will consult with the
County prior to taking action.
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 Levels II or III
services (Adult Day Health). Level II and III services are licensed rehabilitation and skilled nursing
services along with socialization. Levell services (Adult Day Care) are supervised day programs
where frail and disabled adults can participate in social, educational, and recreational programs
without the need for skilled nursing. These clients may be referred to services defined in the
statement of work, or to an Adult Day Care service other than Level II or III. If a client is no longer
needing and wanting services, the funds are available for other clients who are not part of the
original group of 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. Exhibit A - Budget: Budget amount listed in Exhibit A - The County.may not exceed the state
revenue dollar amount or the Total revenue dollar amount indicated on the Program Budget
Agreement "Exhibit A". The federal revenue dollar amount maybe exceeded to accommodate
client's moving from state only employment and day to waiver employment and day services.
d. Changes Impacting the County:
Change Notification:
(1) The ODD Region shall:
(a) Inform and include the County in the discharge planning of individuals leaving institutions
and returning to the community, and who will need program funding;
(b) Inform the County of individuals who are no longer eligible;
(c) Inform the County of individuals who have had their waiver status changed;
(d) Work with the County when referring individuals for services;
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Special T arms and Conditions
(e) Work with the County to document planned services;
(f) Work with the County when terminating services; and
(g) Work with the County on Spending Plan adjustments.
(2) The County shall:
(a) Work with the ODD Region when individuals are referred for services;
(b) Work with the ODD Region to document planned services;
(c) Inform the Region of any potential service level changes not documented in the individuals
DO Assessment;
(d) Work with the DDD Region-regarding service termination;
(e) Work with the DDD Region on Spending Plan adjustments, and
(f) Inform the ODD Region of new providers to be included on the eMIS system.
8. Billing and Payment.
a. County Program Agreement Budget: DSHS shall pay the County all allowable costs, as defined in
the current DDD Budget Accounting and Reporting System (BARS) Manual Supplement.
Reimbursement for the Fiscal Year shall not exceed the total contract amount listed in Exhibit A to
this Program Agreement. However, with a program agreement amendment, the parties may
increase or decrease the program agreement amount.
b. Compliance with BARS Policies: The County shall take any necessary and reasonable steps to
comply with the currently effective DDD BARS Supplement manual incorporated by reference
herein.
c. Monthly Invoices with Documentation: All requests for reimbursement by the County for
performance hereunder must be submitted on a DSHS A-19 invoice with required.documentation
that includes the County Billing Summary generated through the CMIS system. AU req-uests for
reimbursement amounts must be entered into the CMISsystem The County may submit a
combined claim of all progra.ms/services covered by this agreement. The A-19 and the County
Billing Summary amounts must match or the Region may request a corrected billin<g. DSHS shall
make all payments due to, the County for all invoices submitted pursuant to this section within sixty
(60) days following receipt of each such invoice.
d. A claim for each individual is made on the CMIS system documents by indicating the number of
service units delivered to each individual listed and the fee per unit. A unit is defined as:
(1) An "Hour" is at least fifty (50) minutes of direct service. Partial hour to the quarter may be
recorded; or
(2) A "Day" is at least four (4) hours of direct service; or
(3) A IIMonthl1 is at least fifteen (15) days of direct service (a day is a least 4 hours of direct
service), or a documented range of service hours (to include in the fee/rate schedule).
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Special Terms and Conditions
e. Administration: The County will provide program administration and may bill for administrative costs
allowed under BARS 568.1 O. Administrative costs will not exceed 70/0 of the total County Program
Agreement, unless the director of ODD makes an exception under WAC 388-850-045 or the
Contractor is exempt per 388-850-040. Monthly claims for administrative costs will be 1/12 of the
maximum 70/0 of the total County Program Agreement, unless an exception for a higher percentage
is in place.
f. Timeliness of and Modification to Billings: All initial invoices with documentation must be received by
the ODD Region within sixty (60) calendar days following the last day of the month in which the
service is provided. Corrected invoices and documentation will be accepted throughout the fiscal
year as long as they are received within sixty (60) calendar days of the associated fiscal year unless
an extension is.approved by the OOD Regional Administrator or designee. Payment will not be made
on any invoice submitted past the 60 calendar days of the contract fiscal year.
9. Duplicative Funding. Client services shall not be reimbursed under this County Program Agreement
when the same services are paid for under the Rehabilitation Act of 1973 (OVR), P .L. 94-142 (Public
Education), or any other source of public or private funding.
10. Recovery of Fees: If the County bUls and is paid fees for services that DSHS later finds were (a) not
delivered or (b) not delivered in accordance with applicable standards, OSHS shall recover the fees for
those services and County shall fully cooperate during the recovery.
11. Quality Assurance.& Evaluation.
a. Service Review and Evaluation System: The County shall develop and have available for review a
Service Review and Evaluation System. The evaluation system shall include the Quality Assurance,
Criteria for an Evaluation System of July 1,2009, and Quality Improvements. A copy of such
evaluation system shall b~ provided upon request to the ODD for review and approval.
b. County On-Site Evaluation and Review: The County shall evaluate.and review services delivered to
reasonably assure compliance with this County Program Agreement. 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 and reviews of on-site visits. Copies of such documentation will be
provided to the ODD Office upon request.
12. Sub-Contract - Provider I Sub-contractor Solicitation: Request for Proposals "RFPs", Request for
Qualifications "RFQ's" or Request for Information "RFI's" for direct services will be issued at a minimum
of once every four years. Counties will establish a clear process for soliciting new providers. If a
client's needs cannot be met by the current qualified providers, then the .County may issue an RFQ
prior to the four year cycle. If upon the effective date of this agreement the County has not issued
RFPs, RFQs,or RFls for direct services within the preceding four years, it shall have six months to
comply with the requirement.
a. Conveyance of Subcontractor Information.: The County shall provide the name, address, contact
person, telephone number, and service type for each service provider not currently listed on the
CMIS data system under active providers, within 30 days receipt of the County Program
Agreement.
b. Regional Approval of Subcontractors: The DDD Region shall review subcontractors and shall
immediately notify the County of any disapproval of the subcontractors identified by the County.
c. Subcontractors: The County shall immediately notify the DDD Region of the County's intent to
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Special Terms and Conditions
terminate a subcontractor who is serving a DDD referral.
d. Availability of Contract: Upon written request from the ODD Region, the County shall provide a copy
of each subcontractor's contract.
13. Intermediate Care Facilities for Mentally Retarded (ICF/MR) Agreement. If applicable per 42 CFR
483.410, the County shall assure that all county-operated or subcontracted programs serving persons
living in ICF/MR facilities develop a plan and coordinate their services with the facility on behalf of the
ICF/MR resident. DDD will supply a list of ICF/MR residents who have a day program to the County.
14. Single State Medicaid Agency-DSHS. OSHS, as the single state Medicaid Agency, has
administrative authority for Title XIX coverage of services for people with developmental disabilities per
42 CFR 431.10. The County only has responsibility for services covered in this agreement.
15. DSHS/DRW Access Agreement: The DRW February 27,2001 Access Agreement with the DDD 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 activi.ties, authority to investigate allegations of
abuse and neglect, other miscellaneous matters, and is qinding for all providers of DDD contracted
services.
16. Management Information System.
a. The County will provide all data described in the County Billing Instructions and in the Employment
Outcomes Instructions.
b. The County will use the CMIS data system for all billing requests, service provider address and
phone number maintenance, evaluation dates and to provide employment outcome information.
c. The County will be responsible to assure the integrity of data submitted. When data is submitted
and rejected due to errors they will be corrected and r~submitted within thirty days.
d. The ODD agrees to provide a helpline on the use of the data system.
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Program Agreement Budget
Agreed budget between Jefferson County County/Counties and the Division of Developmental
Disabilities for Contract Number 0963-67987
[g] Original Budget 0 Budget Revision
REVENUES
Fiscal
Year Fund Source Oriainal 1 st Revision 2nd Revision 3rd Revision
2010 State $159,202
Federal $ 150,149
Total $309,350
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EXHIBIT A
Page 11
lPdtECtEllWtElVJ
JUL 2 3 2009
DDD REG 6 TUMWATER OffiCE