HomeMy WebLinkAboutCONSENT Cascade Community inclusion srvcs 615 Sheridan Street
Port Townsend, WA 98368
9efl tson www.JeffersonCountyPublicHealth.org
Consent Agenda
Public Healt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh Peters, County Administrator
FROM: Apple Martine, Jefferson County Public Health Director
Bonnie Obremski, Intellectual and Developmental Disabilities (IDD) Coordinator
DATE: Ar'4' 3, Z S
SUBJECT: Agenda item —Professional Services Agreement between Jefferson County and
Cascade Community Connections for professional services to be provided in
connection with the provision of Community Inclusion to persons with intellectual
and/or developmental disabilities in Jefferson County; July 1, 2025 - June 30,
2026, $213,355.80.
STATEMENT OF ISSUE:
Jefferson County Public Health, the Intellectual and Developmental Disabilities program, requests Board
approval of agreement between Jefferson County and Cascade Community Connections for professional
services to be provided in connection with the provision of Community Inclusion to persons with intellectual
and/or developmental disabilities in Jefferson County.
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
Community Inclusion services are provided in integrated community settings with other individuals without
disabilities. Community Inclusion 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.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Cascade Community Connections continues to be the only provider of Community Inclusion services in
Jefferson County.
RECOMMENDATION:
Jefferson County Public Health management recommends approval of this agreement.
REVIEWED BY:
d-7/- -
Josh Peters, County Administrator Date
Community Health Environmental Public Health
Developmental Disabilities 360-385-9444
360-385-9400 (f) 360-379-4487
360-385-9401 (f) Always working for a safer and healthier community
DD-25-059
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Cascade Community Connections Contract No: DD-25-059
Contract For: Community Inclusion Services Term: July 1, 2025 to June 30, 2026
COUNTY DEPARTMENT: Public Health
Contact Person: Bonnie Obremski
Contact Phone: 360-385-7301
Contact email: bonnieo@co.jefferson.wa.us
AMOUNT: $213,355.80 PROCESS: Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: $213,355.80 Competitive Sealed Bid
Matching Funds Required: Small Works Roster
Sources(s) of Matching Funds Vendor List Bid
Fund # PH fund#127 RFP or RFQ
Munis Org/Obj HDD-640 12768064 Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMPL E WIT -J C .55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: • N/A: l August 18, 2025
Signature Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBA BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
417
CERTIFIED: � N/A: August 18, 2025
Signature Date
STEP 3: RISK MANAGEMENT REVIEW (will be added electronically through Laserfiche):
Electronically approved by Risk Management on 8/22/2025.
STEP 4: PROSECUTING ATTORNEY REVIEW (will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 8/22/2025.
PSA standard terms included.
STEP 5: DEPARTMENT MAKES REVISIONS & RESUBMITS TO RISK MANAGEMENT AND
PROSECUTING ATTORNEY(IF REQUIRED).
STEP 6: CONTRACTOR SIGNS
STEP 7: SUBMIT TO BOCC FOR APPROVAL
1
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 1 of 26
SUBCONTRACT FOR PROFESSIONAL SERVICES
COMMUNITY INCLUSION SERVICES
Agreement Between
JEFFERSON COUNTY PUBLIC HEALTH
And
CASCADE COMMUNITY CONNECTIONS
This agreement is made and entered into between Jefferson County Public Health(COUNTY)and Cascade Community
Connections (SUBCONTRACTOR) for provision of Community Inclusion Services to persons with developmental
disabilities in Jefferson County.The term of this agreement is July 1,2025 through June 30,2026.Total reimbursements
under this agreement shall not exceed $213,355.80 without express written amendment. Either party upon 60 days'
written notice may terminate this Contract.Termination of this Contract shall not constitute a breach.
It is agreed Upon by Both Parties as Named Herein as Follows:
A. PROFESSIONAL SERVICES
Professional services to be provided by SUBCONTRACTOR shall include:
(1) "Community Inclusion"or"CI":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,per Exhibit A-Statement of Work
attached hereto.
(2) Program management.
B. OBLIGATIONS
SUBCONTRACTOR shall fulfill the following obligations:
(1) SUBCONTRACTOR shall comply with all state and federal requirements regarding the confidentiality of
Client records. Client information is not disclosable to the public. Information acquired pursuant to RCW
71A.14.070 requires a signed Release of Information or a signed Oath of Confidentiality Form.
(2) SUBCONTRACTOR is required provide background checks, pursuant to RCW 43.43.830-845, RCW
74.15.030, and Chapter 388-06 WAC, which state that any prospective employee or volunteer who will or
may have unsupervised access to a vulnerable person with a developmental disability in the course of his or
her employment,or involvement with the business or organization,must have a background/criminal history
clearance before they have unsupervised access. The DSHS Background Check Central Unit(BCCU)must
be utilized to obtain background clearance.
(3) A"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 that required for individuals with
intellectual disabilities, which disability originates before the individual attains age eighteen, which has
continued or can be expected to continue indefinitely, and which constitutes a substantial limitation to the
individual.
(4) If SUBCONTRACTOR reviews the application and 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
DD-25-059
Cascade Community Connections Community Inclusion Contract 2025-2026
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for any subsequent services rendered by the disqualified individual provider. (The Developmental
Disabilities Administration or DDA means a Division within the Department of Social and Health Services.)
(5) COUNTY and its SUBCONTRACTOR are mandated reporters under RCW 74.34.020(13)and 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.
(6) SUBCONTRACTOR is required pursuant to RCW 74.15.030,that if any prospective employee who has not
resided in Washington State during the last three years, and who will or may have unsupervised access to a
vulnerable person with a developmental disability in the course of his or her employment,or involvement with
the business or organization,must have an F.B.I.Fingerprint Check before they have unsupervised access and
before prospective employer begins working. The DSHS Background Check Central Unit(BCCU)must be
utilized to obtain background clearance.
(7) SUBCONTRACTOR is required to repeat the background/criminal history clearance for all employees or
volunteers who will or may have unsupervised access to a vulnerable person with a developmental disability in
the course of his or her employment,or involvement with the business or organization,every three years.The
DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance in
accordance with RCW 43.43.830-845,RCW 74.15.030 and Chapter 388-06 WAC.
(8) SUBCONTRACTOR shall comply,as mandated reporters under RCW 74.34.020(11),with all state and federal
requirements under RCW 74.34.035, .040 Abuse and neglect of Vulnerable Adults; RCW 26.44, Abuse of
Children;the WACs:275-26 Division of Developmental Disabilities Services Rules;296-24 General Safety
& Health; 296-62 General Occupational Health Standards; WACs: 388-828 Developmental Disabilities
Administration, (DDA) Assessment; 388-845 Home and Community Based Waivers; Definitions 0001;
Criteria for HCBS Services 0030; Basic Waiver Services 0200; Basic Plus Waiver Services 0210; Core
Waiver Services 0215; Community Protection Waiver Services 0220; 0600-0610 Community Access
Service; Supported Employment Service 2100.
(9) SUBCONTRACTOR shall comply with the following Developmental Disabilities Administration, (DDA)
Policies: 3.01 Client Service Plans; 5.01 Criminal History Background Checks and Safeguarding Personal
Information; 5.02 Necessary Supplemental Accommodation (NSA); 5.03 Client Complaints; 5.05 Limited
English Proficiency(LEP)Clients;5.06 Client Rights;5.13 Protections From Abuse;5.14 Positive Behavior
Support;5.15 Use of Restrictive Procedures;6.08 Mandatory Reporting Requirements for Employment and
Day Program Services Providers; 6.13 Employment/Day Program Provider Qualifications; 9.07 Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS); 12.01 Incident
Management; 13.04 DRW Access Agreement,and County Guide to Achieve DDA's Guiding Values.
(10) The COUNTY staff who performs on-site evaluations of SUBCONTRACTOR work sites, will promptly
report to DSHS per DDA Policy 5.13,Protection from Abuse: Mandatory Reporting, if:
(a) 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,
(b) 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.
(11) SUBCONTRACTOR shall comply with the following referenced documents found at DDA Internet site
https://www.dshs.wa.gov/dda/county-best-practices under"Counties":
(a) DDA Policy 4.11,County Services for Working Age Adults;
(b) WAC 388-850, WAC 388-828, WAC 388-845-0001, 0030, 0205,0210,0215, 0220, 0600-0610, 1200-
1210, 1400-1410,2100,2110;and,
(c) Criteria for Evaluation:
https://www.dsh s.wagov/sites/defau It/fi les/D DA/dda/documents/Criteria%20for%20 Eval uation%2020
21-2023.docx
Cascade Community Connections Community Inclusion Contract 2025-2026
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(12) SUBCONTRACTOR shall meet the definition of Quality Assurance,by adherence to all Program Agreement
requirements and reasonably expected levels of performance,quality,and practice by adherence to:
(a) DDA Policy 6.13,Employment/Day Program Provider Qualifications,
https://www.dshs.wa.govidda/policies-and-rules/policy-manual;
(b) County Guide to Achieve DDA's Guiding Values;
(c) DDA Guidelines for Community Assessments within Employment and Vocational Programs.
(13) The DRW Access Agreement with DDA, assures that the COUNTY and SUBCONTRACTORS have
reviewed the Access Agreement. The Access Agreement covers DRW's access to individuals with
developmental disabilities, to clients, to programs and records, to outreach activities, to authority to
investigate allegations of abuse,neglect,and other miscellaneous matters,and it is binding for all providers
of DDA contracted services.
(14) SUBCONTRACTOR shall have written policies regarding sexual harassment and non-discrimination (said
policies must guarantee human/civil rights); regarding a person's right to privacy, regarding safeguarding
personal information and abuse of participants;regarding agency medication procedure;regarding respectful
staff-to-participant interactions(i.e.: including a person's right to be treated with dignity and respect free of
abuse).
(15) SUBCONTRACTOR shall have a County approved grievance policy for clients that:
(a) Is explained to clients and others in accordance with DDA Policy 5.02, Necessary Supplemental
Accommodation;
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/policy/policy5.02.pdf
(b) Negotiates conflicts;
(c) States advocates are available and clients are encouraged to bring advocates to help negotiate;
(d) Provides a mediation process using someone who is unaffected by the outcome if conflicts remain
unresolved a DDA Case Resource Manager may be included as an alternative option; (A DDA Case
Resource Manager(CRM)"means a case manager for DDA Clients);
(e) Prohibits retaliation for using the grievance process;and
(f) Includes a process for tracking and reporting grievance.
(16) SUBCONTRACTOR shall assure that clients and others,in accordance with DDA Policy 5.06,Client Rights,
have been informed of their rights, what services and benefits may be expected from the program, the
program's expectations of them,and if necessary,the client's family,guardian or advocate is also informed.
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/policy/policv5.06.pdf
(17) SUBCONTRACTOR shall assure that they have policies that protect individual rights; include but are not
limited:
(a) Respectful staff-to-client interactions
(b) A person's right to be treated with dignity,respect and free of abuse;
(c) A person's right to privacy;and
(d) Safeguarding personal information.
(18) SUBCONTRACTOR shall obtain and retain in the client's files signed proof of client's and/or family's
review of all policies, provider expectation, and receipt of information about services and benefits to be
provided by the program.The signed proof required by this section shall be reviewed and renewed,with new
documentation,annually.
(19) SUBCONTRACTOR will encourage participant involvement in policy development.
(20) SUBCONTRACTOR shall update Client Intake Forms every 6 months during the Client Review meeting.
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(21) SUBCONTRACTOR shall assure potential conflict of interest,real or apparent,will not arise. Such a conflict
will arise when: The employee, officer or agent, any member of immediate family, Guardian / decision
maker,or an organization that employs or is about to employ any of the above has financial or other interest
in the client(s).
(22) SUBCONTRACTOR shall have adequate staffing ratios and patterns to maintain quality and safety.
(23) All services for persons with developmental disabilities must be provided with attention to their health and
safety. SUBCONTRACTOR shall comply with all applicable federal,state and local fire,health,and safety
regulations.
(24) SUBCONTRACTOR shall make sure that all incidents involving injury,health or safety issues are reported
to DDA and the County;reference DDA Policy 6.08, Mandatory Reporting Requirements for Employment
and Day Program Services Providers.
https://www.dshs.wa.gov/sites/default/fi les/DDA/dda/documents/policy/policy6.08.pdf
(25) SUBCONTRACTOR shall track and analyze incident reports for potential trends and patterns.
(26) Current emergency contact and medical information (medications, diet, allergies, etc.) needed during the
hours of service is readily available for each participant.
(27) SUBCONTRACTOR shall provide evidence that it employs typical safety protection based upon the
environment the client is working or receiving services in.
(28) The COUNTY and all SUBCONTRACTORS are mandated reporters under RCW 74.34.020(11);Abuse of
Vulnerable Adults https://apps.leg.wa.gov/RCW/default.aspx?cite=74.34 and Chapter 26.44 RCW;Abuse of
Children.All parties must comply with reporting requirements described in RCW 74.34.035,040 and Chapter
26.44 and must adhere to DDA Policy, 6.08 Mandatory Reporting Requirements for Employment and Day
Program Service Providers. All service provider employees, contractors, and volunteers are mandatory
reporters and must report every incident of observed,reported, or suspected abuse, improper use of restraint,
neglect, self-neglect,personal or financial exploitation, abandonment and/or mistreatment of clients.
(29) The 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/dda/county-best-practices.
(30) SUBCONTRACTOR is required to maintain the following minimum organizational capacity in order to meet
the performance standards set forth in this agreement. Failure or inability of SUBCONTRACTOR to meet any
or all of these minimum capacity requirements,as determined solely by COUNTY,may be cause for termination
of this agreement as provided herein.
(a) Accreditation: SUBCONTRACTOR must be able to demonstrate conformance to Commission on
Accreditation of Rehabilitation Facilities (CARF) standards for quality assurance and CARF
accreditation.
(b) Confidentiality: SUBCONTRACTOR shall protect and maintain all Confidential Information gained by
reason of the Program Agreement against unauthorized use,access,disclosure,modification or loss.This
duty requires the COUNTY to employ reasonable security measures,which includes restricting access
to Confidential Information by following,DDA—Data Security Requirements.
(31) Authority. The security requirements described in this document reflect the applicable requirements of
Standard 141.10(https://ocio.wa.gov/policies)of the Office of the Chief Information Officer for the state of
Washington,and of the DSHS Information Security Policy and Standards Manual. Reference material related
to these requirements can be found here:https://www.dshs.wa.gov/fsa/central-contract-services/keeping-dshs-
Client-information-private-and-secure, which is a site developed by the DSHS Information Security Office
and hosted by DSHS Central Contracts and Legal Services.
(32) Administrative Controls. The Contractor must have the following controls in place:
(a) A documented security policy governing the secure use of its computer network and systems,and which
defines sanctions that may be applied to Contractor staff for violating that policy.
Cascade Community Connections Community Inclusion Contract 2025-2026
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(b) If the Data shared under this agreement is classified as Category 4 data,the Contractor must be aware of
and compliant with the applicable legal or regulatory requirements for that Category 4 Data.
(c) If Confidential Information shared under this agreement is classified as Category 4 data,the Contractor
must have a documented risk assessment for the system(s)housing the Category 4 Data.
(33) Authorization,Authentication,and Access. In order to ensure that access to the Data is limited to authorized
staff,the Contractor must:
(a) Have documented policies and procedures governing access to systems with the shared Data.
(b) Restrict access through administrative,physical,and technical controls to authorized staff.
(c) Ensure that user accounts are unique and that any given user account logon ID and password combination
is known only to the one employee to whom that account is assigned. For purposes of non-repudiation,
it must always be possible to determine which employee performed a given action on a system housing
the Data based solely on the logon ID used to perform the action.
(d) Ensure that only authorized users are capable of accessing the Data.
(e) Ensure that an employee's access to the Data is removed immediately:
1. Upon suspected compromise of the user credentials.
2. When their employment, or the contract under which the Data is made available to them, is
terminated.
3. When they no longer need access to the Data to fulfill the requirements of the contract.
(f) Have a process to periodically review and verify that only authorized users have access to systems
containing DSHS Confidential Information.
(g) When accessing the Data from within the Contractor's network(the Data stays within the Contractor's
network at all times), enforce password and logon requirements for users within the Contractor's
network,including:
1. A minimum length of 8 characters,and containing at least three of the following character classes:
uppercase letters,lowercase letters,numerals,and special characters such as an asterisk,ampersand,
or exclamation point.
2. That a password does not contain a user's name,logon ID,or any form of their full name.
3. That a password does not consist of a single dictionary word. A password may be formed as a
passphrase,which consists of multiple dictionary words.
4. That passwords are significantly different from the previous four passwords.
(h) When accessing Confidential Information from an external location(the Data will traverse the Internet
or otherwise travel outside the Contractor's network), mitigate risk and enforce password and logon
requirements for users by employing measures including:
1. Ensuring mitigations applied to the system do not allow end-user modification. Examples would
include but not be limited to installing key loggers, malicious software, or any software that will
compromise DSHS data.
2. Not allowing the use of dial-up connections.
3. Using industry standard protocols and solutions for remote access. Examples include, but are not
limited to RADIUS Microsoft Remote Desktop(RDP)and Citrix.
4. Encrypting all remote access traffic from the external workstation to Trusted Network or to a
component within the Trusted Network. The traffic must be encrypted at all times while traversing
any network,including the Internet,which is not a Trusted Network.
5. Ensuring that the remote access system prompts for re-authentication or performs automated session
termination after no more than 30 minutes of inactivity.
6. Ensuring use of Multi-factor Authentication to connect from the external end point to the internal
end point.All Contractors must be in compliance by 6/30/2020.
(i) Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication
mechanism, such as a biometric (fingerprint, face recognition, iris scan)or token(software, hardware,
smart card,etc.)in that case:
1. The PIN or password must be at least 5 letters or numbers when used in conjunction with at least
one other authentication factor
2. Must not be comprised of all the same letter or number (11111, 22222, aaaaa, would not be
acceptable)
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3. Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be
acceptable)
(j) If the contract specifically allows for the storage of Confidential Information on a Mobile Device,
passcodes used on the device must:
1. Be a minimum of six alphanumeric characters.
2. Contain at least three unique character classes(upper case, lower case,letter,number).
3. Not contain more than a three consecutive character run. Passcodes consisting of 12345,or abcd 12
would not be acceptable.
(k) Render the device unusable after a maximum of 10 failed logon attempts.
(34) Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect
the Data as described:
(a) Hard disk drives. For Data stored on local workstation hard disks,access to the Data will be restricted to
Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened
Password or other authentication mechanisms which provide equal or greater security,such as biometrics
or smart cards.
(b) Network server disks. For Data stored on hard disks mounted on network servers and made available
through shared folders,access to the Data will be restricted to Authorized Users through the use of access
control lists which will grant access only after the Authorized User has authenticated to the network
using a Unique User ID and Hardened Password or other authentication mechanisms which provide
equal or greater security,such as biometrics or smart cards. Data on disks mounted to such servers must
be located in an area which is accessible only to authorized personnel, with access controlled through
use of a key,card key,combination lock,or comparable mechanism.
For DSHS Confidential Information stored on these disks,deleting unneeded Data is sufficient as long
as the disks remain in a Secure Area and otherwise meet the requirements listed in the above paragraph.
Destruction of the Data, as outlined below in Section (31)Data Disposition, may be deferred until the
disks are retired,replaced,or otherwise taken out of the Secure Area.
(c) Optical discs(CDs or DVDs)in local workstation optical disc drives. Data provided by DSHS on optical
discs which will be used in local workstation optical disc drives and which will not be transported out of
a Secure Area. When not in use for the contracted purpose,such discs must be Stored in a Secure Area.
Workstations which access DSHS Data on optical discs must be located in an area which is accessible
only to authorized personnel,with access controlled through use of a key, card key, combination lock,
or comparable mechanism.
(d) Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by DSHS on
optical discs which will be attached to network servers and which will not be transported out of a Secure
Area. Access to Data on these discs will be restricted to Authorized Users through the use of access
control lists which will grant access only after the Authorized User has authenticated to the network
using a Unique User ID and Hardened Password or other authentication mechanisms which provide
equal or greater security,such as biometrics or smart cards. Data on discs attached to such servers must
be located in an area which is accessible only to authorized personnel, with access controlled through
use of a key,card key,combination lock,or comparable mechanism.
(e) Paper documents. Any paper records must be protected by storing the records in a Secure Area which
is only accessible to authorized personnel. When not in use, such records must be stored in a Secure
Area.
(f) Remote Access. Access to and use of the Data over the State Governmental Network(SGN)or Secure
Access Washington(SAW)will be controlled by DSHS staff who will issue authentication credentials
(e.g. a Unique User ID and Hardened Password)to Authorized Users on Contractor's staff. Contractor
will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is
terminated or otherwise leaves the employ of the Contractor,and whenever an Authorized User's duties
change such that the Authorized User no longer requires access to perform work for this Contract.
(g) Data storage on portable devices or media.
1. Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. If so authorized,the Data shall be given the following protections:
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a. Encrypt the Data.
b. Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical token or biometrics.
c. Manually lock devices whenever they are left unattended and set devices to lock automatically
after a period of inactivity, if this feature is available. Maximum period of inactivity is 20
minutes.
d. Apply administrative and physical security controls to Portable Devices and Portable Media by:
i. Keeping them in a Secure Area when not in use,
ii. Using check-in/check-out procedures when they are shared,and
iii. Taking frequent inventories.
2. When being transported outside of a Secure Area,Portable Devices and Portable Media with DSHS
Confidential Information must be under the physical control of Contractor staff with authorization
to access the Data,even if the Data is encrypted.
(h) Data stored for backup purposes.
1. DSHS Confidential Information may be stored on Portable Media as part of a Contractor's existing,
documented backup process for business continuity or disaster recovery purposes. Such storage is
authorized until such time as that media would be reused during the course of normal backup
operations. If backup media is retired while DSHS Confidential Information still exists upon it,
such media will be destroyed at that time in accordance with the disposition requirements below in
Section(31)Data Disposition.
2. Data may be stored on non-portable media(e.g. Storage Area Network drives, virtual media, etc.)
as part of a Contractor's existing, documented backup process for business continuity or disaster
recovery purposes. If so,such media will be protected as otherwise described in this exhibit. If this
media is retired while DSHS Confidential Information still exists upon it,the data will be destroyed
at that time in accordance with the disposition requirements below in Section(31)Data Disposition.
(i) Cloud storage. DSHS Confidential Information requires protections equal to or greater than those
specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor the
Contractor has control of the environment in which the Data is stored. For this reason:
1. DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following
conditions are met:
a. Contractor has written procedures in place governing use of the Cloud storage and Contractor
attest to the contact listed in the contract and keep a copy of that attestation for your records in
writing that all such procedures will be uniformly followed.
b. The Data will be Encrypted while within the Contractor network.
c. The Data will remain Encrypted during transmission to the Cloud.
d. The Data will remain Encrypted at all times while residing within the Cloud storage solution.
e. The Contractor will possess a decryption key for the Data, and the decryption key will be
possessed only by the Contractor.
f. The Data will not be downloaded to non-authorized systems, meaning systems that are not on
the contractor network.
g. The Data will not be decrypted until downloaded onto a computer within the control of an
Authorized User and within the contractor's network.
2. Data will not be stored on an Enterprise Cloud storage solution unless either:
a. The Cloud storage Provider is treated as any other Sub-Contractor, and agrees in writing to all
of the requirements within this exhibit;or,
b. The Cloud storage solution used is HIPAA compliant.
3. If the Data includes protected health information covered by the Health Insurance Portability and
Accountability Act(HIPAA),the Cloud Provider must sign a Business Associate Agreement prior
to Data being stored in their Cloud solution.
(35) System Protection. To prevent compromise of systems which contain DSHS Data or through which that
Data passes:
(a) Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of
being made available.
(b) The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied
within the required timeframes.
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(c) Systems containing DSHS Data shall have an Anti-Malware application, if available, installed.
(d) Anti-Malware software shall be kept up to date. The product,•its anti-virus engine, and any malware
database the system uses,will be no more than one update behind current.
(36) Data Segregation.
(a) DSHS category 4 data must be segregated or otherwise distinguishable from non-DSHS data. This is to
ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or
destruction. It also aids in determining whether DSHS Data has or may have been compromised in the
event of a security breach. As such, one or more of the following methods will be used for data
segregation.
1. DSHS Data will be kept on media(e.g.hard disk,optical disc,tape,etc.)which will contain no non-
DSHS Data.
2. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder
dedicated to DSHS Data.
3. DSHS Data will be stored in a database which will contain no non-DSHS data.And/or,
4. DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the
value of a specific field or fields within database records.
5. When stored as physical paper documents, DSHS Data will be physically segregated from non-
DSHS data in a drawer,folder,or other container.
(b) When it is not feasible or practical to segregate DSHS Data from non-DSHS data,then both the DSHS
Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit.
(37) Data Disposition.When the contracted work has been completed or when the DSHS Data is no longer needed,
except as noted above in Section (30. b.) DSHS Data shall be returned to DSHS or destroyed. Media on
which Data may be stored and associated acceptable methods of destruction are as follows:
Data stored on: Will be destroyed by:
Server or workstation hard disks,or Using a"wipe"utility which will overwrite the
Removable media(e.g.floppies,USB flash drives, Data at least three(3)times using either random or
portable hard disks)excluding optical discs single character data,or
Degaussing sufficiently to ensure that the Data
cannot be reconstructed,or
Physically destroying the disk
Paper documents with sensitive or Confidential Recycling through a contracted firm,provided the
Information contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential On-site shredding,pulping, incineration,or
Information requiring special handling(e.g. contractor
protected health information)
Optical discs(e.g.CDs or DVDs) Incineration,shredding,or completely defacing the
readable surface with a coarse abrasive
Magnetic tape Degaussing,incinerating or crosscut shredding
(38) Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS
shared Data must be reported to the DSHS Contact designated in the Contract within one(1)business day of
discovery If no DSHS Contact is designated in the Contract, then the notification must be reported to the
DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the
risk of loss and comply with any notification or other requirements imposed by laws.
(39) Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a
subcontractor,the Contract with the subcontractor must include all of the data security provisions within this
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Contract and within any amendments,attachments, or exhibits within this Contract. If the Contractor cannot
protect the Data as articulated within this Contract,then the contract with the sub-Contractor must be submitted
to the DSHS Contact specified for this contract for review and approval.
(40) Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS
shared Data must be reported to the DSHS Contact designated in the Contract within one(1)business day of
discovery If no DSHS Contact is designated in the Contract, then the notification must be reported to the
DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the
risk of loss and comply with any notification or other requirements imposed by law.
(41) SUBCONTRACTOR shall provide the following:
(a) Equal Access: SUBCONTRACTOR will assure equal access to persons who do not speak or have
limited ability to speak,read,or write English well enough to understand and communicate effectively
(reference: DDA Policy 5.05, Limited English Proficient (LEP) Clients).
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/policy/policy5.05.pdf
(b) Financial and Program Management: SUBCONTRACTOR will maintain an
administrative/organizational structure that clearly defines responsibilities; systems and personnel to
maintain accounting records that accurately reflect all program revenues and expenditures; prepare
monthly statements of activity(ADSA Reports);maintain appropriate client service records and progress
reports;and track key program performance indicators.
(c) Participants: SUBCONTRACTOR has a commitment to support integration of individuals with
developmental disabilities with people who are not disabled and has involved participants with
developmental disabilities in policy development.
(d) Partnerships: SUBCONTRACTOR has a history of working cooperatively with community-based
organizations including Employers, other Agencies, the COUNTY DD Program, the Division of
Vocational Rehabilitation(DVR),and the Schools.
(e) Performance Plan: SUBCONTRACTOR has a written performance plan which describes program
objectives, expected outcomes, how and when objectives will be accomplished, and that the plan is
evaluated at least biennially and revised based on actual performance. The performance plan must
include performance indicators that address diversity, equity and inclusion efforts. Document progress
on performance indicators identified in DDA Policy 6.13, Provider Qualifications for Employment and
Day Program Services.
https://www.dshs.wa.gov/sites/default/fi les/DDA/dda/documents/policy/pol icy6.13.pdf
(f) Quality Assurance Plan: SUBCONTRACTOR has a written quality assurance plan that evaluates Client
progress every 6 months by looking at:
1. Looking at Quantitative-(Data)vs.Qualitative-(Narrative)
(g) The COUNTY'S Service Evaluation System: shall serve as the method by which current Providers
demonstrate that they continue to be qualified as Providers. A copy of the COUNTY'S Service
Evaluation System shall be provided upon request,to DDA for review.
(h) Internal Control Systems: SUBCONTRACTOR will have an administrative/organizational structure that
clearly defines responsibilities.
1. SUBCONTRACTOR has sufficient policies and procedures for establishment and maintenance of
adequate internal control systems.
2. SUBCONTRACTOR 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 prolonged absences occur.
3. SUBCONTRACTOR will date all policies when they are implemented or date they are revised.
(i) Qualified Staff: SUBCONTRACTOR will provide adequate, qualified staff with skills and experience
in evaluation, training, supervision, counseling and support of adults with developmental disabilities
who are earning wages,per the attached Statement of Work.
1. SUBCONTRACTOR will assure that all direct service staff are trained and has experience in
accordance with DDA Policy 6.13 and that training is documented.
2. SUBCONTRACTOR will assure that each employee has a current (within three years) DSHS
background check in accordance with RCW 43.43.830-845,RCW 74.15.030 and WAC 388-825.
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3. SUBCONTRACTOR will provide COUNTY with information regarding staff qualifications upon
request.
(j) Safety: SUBCONTRACTOR will provide evidence that it employs safety protection based on the
environment in which the participant is working or receiving services.
(k) Integration: Employment and day services must showtvidence that the agency adheres to the Medicaid
Home and Community Based settings(HCBS)requirements of 42CFR 441 530(a)(1),including that
1. The setting is integrated in the greater community and supports individuals to have full access to the
greater community;
2. Ensures the individual receives services in the community to the same degree of access as
individuals not receiving Medicaid HCBS;
3. The setting provides opportunities to seek employment and work in competitive integrated settings;
and
4. The setting facilitates individual choice regarding services and supports,and who provides them.
(42) SUBCONTRACTOR shall identify settings that isolate people from the broader community or that have the
effect of isolating individuals from the broader community of individuals who do not receive Medicaid HCB
services.These settings are presumed not to be home and community-based.
(43) SUBCONTRACTOR shall provide an Adult Community Inclusion Plan that identifies and addresses the
individualized goals and support needs for each client.Plans must consider individualization,integration and
safety.
(a) The Community Inclusion Plan will:
1. Be developed by the SUBCONTRACTOR in collaboration with the COUNTY, the Client, their
DDA Case Manager, Residential Staff, Guardian/Family Members and others as appropriate (the
team).
2. Initial plans will be completed within 60 days from date of service authorization and must be signed
by the participant and their guardian if any.
3. Copies of the initial and subsequent revised plans will be distributed as appropriate to all team
members.
4. Plans will be reviewed and signed annually.
(b) The Community Inclusion Report Plans will also include the information listed below:
1. Current date:
2. Timeline for the Plan
3. Client's name: first and last
4. Client ADSA ID
5. The client's skills,gifts,interests,and preferred activities
6. The Community Inclusion goal. The goal needs to relate to one or more of the following(per the
County Guide to Achieve Developmental Disability Administration Guiding Values):
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/County%20Gu ide%20Guiding%
20Va1 ues%2020 1 8.docx
a. Identify integrated community places where the individual's interest, culture, talent, and gifts
can be contributed and shared with others with similar interests
b. Identify clubs,associations,and organizations where the individual can be a member and have
decision-making capacities
c. Identify opportunities where the individual can contribute to the community by participating in
new and interesting activities or activities the individual enjoys
d. Building and strengthening relationships between family members and members of the local
community,who are not paid to be with the person
e. The Support Assessment subscale that most relates to the goal (Community Living, Lifelong
Learning,Employment, Health& Safety, Social,and Protection&advocacy)
f. Measurable strategies(action steps and supports)to meet the goal
g. Identification of persons and/or entities available to assist the client in reaching their long-term
goal
h. Identification of other accommodations, adaptive equipment, and/or conditions critical to
achieve the goal
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(44) SUBCONTRACTOR will assure that each client is assisted to participate in typical and integrated activities,
events and organizations in the client's neighborhood or local community in ways similar to others of same
age.
(45) The SUBCONTRACTOR will assure that all services relate to the client's individually identified goal(s)as
outlined in their plan.
(46) SUBCONTRACTOR will assure that each client is assisted to take part in activities on an individualized
basis.
(47) SUBCONTRACTOR will assure that each client is provided the opportunity for connection and relationship
building between the client and people without disabilities and who are not paid to provide services to the
client.This also includes the development of natural supports and fading of paid staff support.
(48) SUBCONTRACTOR will assure that each client's service activities and the outcome of those activities are
documented.
(49) The SUBCONTRACTOR will invite the COUNTY to all six-month client meetings at least 20 days before
the meeting occurs.
(50) The SUBCONTRACTOR will provide six- month progress reports describing the progress made towards
achieving the client's goal, service activities and the outcome of those activities will be provided by the
service provider to the Case Resource Manager, client, and/or guardian if any within 30 days following the
six-month period.
(51) The SUBCONTRACTOR will document all services that relate to the participant's individually identified
goal(s)as outlined in their six-month plan.
(52) The SUBCONTRACTOR shall report any injury or accident that requires more than simple first aid,and any
extraordinary incident that requires intervention by the SUBCONTRACTOR to the DSHS/DDA Case
Manager for the individual involved, and then report the injury, accident, or extraordinary incident to the
COUNTY Coordinator. This includes serious physical or emotional harm or potential harm.
(a) Incidents involving injury,health or safety issues are reported to DDA and the County reference DDA
Policy 6.08,Mandatory Reporting Requirements for Employment and Day Program Services Providers.
(b) The initial report to the COUNTY may be done via documented telephone calls to the COUNTY
Coordinator.
(c) The SUBCONTRACTOR shall submit a written follow-up report within 10 days to the COUNTY
Coordinator. The report to the COUNTY Coordinator may be submitted by email,facsimile(FAX)to
360-385-9401, or by mail to Jefferson COUNTY Public Health 615 Sheridan Port Townsend, WA
98368.
(d) Serious and emergent incidents shall be handled in accordance with DSHS/DDA Policy 12.01, Incident
Management.
(e) Incident reports are tracked and analyzed for potential trends and patterns.
(f) Mandatory reporting is done in accordance with Chapter 74.34 RCW,Abuse of Vulnerable Adults and
Chapter 26.44 RCW,Abuse of Children.
(53) SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health and safety
regulations and the following:
(a) All services for persons with developmental disabilities must be provided with attention to their health
and safety.
(b) Current policies address confidential/private information for participant and their documents.
(c) Current emergency contact and medical information(medications,diet,allergies,etc.)needed during the
hours of service is readily available for each participant.
(54) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all
work sites;all client records;records on productivity and client wages;and all documents,reports,and other
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data applicable to this agreement. The COUNTY shall monitor services delivered,and conduct at least one
on-site visit with SUBCONTRACTOR during the period of this biennium to assure compliance with the
DDA State Work Order.
(55) Within 30 days of the effective date of this agreement and at least semi-annually thereafter,
SUBCONTRACTOR will provide (a) company (b) program financial reports to COUNTY, including all
revenues and expenses generated by SUBCONTRACTOR, in sufficient detail to demonstrate the uses of
funds provided under this agreement.
(56) AUDIT REQUIREMENTS. Independent Audit will be submitted annually to the Jefferson COUNTY DD
COUNTY Coordinator in the following manner:
(a) SUBCONTRACTOR must be able to maintain,account for and manage public funds in compliance with
Generally Accepted Accounting Principles "GAAP" provide financial statements within nine months
subsequent to the close of the subcontractor's fiscal year. An agency, for-profit or non-profit, who
receives in excess of$100,000 in DDA funds during its fiscal year from the County, shall provide
Certified Public Accountant reviewed or audited financial statements. Copies of the audit and
management letter shall be submitted to the Jefferson COUNTY Public Health within 9 months of the
end of the SUBCONTRACTOR'S fiscal year.
(b) The SUBCONTRACTOR shall provide an independent audit of the entire organization which:
1. Is performed by an independent Certified Public Accountant,the Washington State Auditor's Office,
or another entity the COUNTY and the SUBCONTRACTOR mutually approve.
2. Provide statements consistent with the guidelines of Reporting for Other Non-Profit Organizations
AICPA SOP 78-10,and is performed in accordance with generally accepted auditing standards and
with Federal Standards for Audit of Governmental Organizations, Programs, Activities, and
Functions,and meeting all requirements of OBM Circular A-133 or A-128,as applicable.
3. The SUBCONTRACTOR shall submit one (2)-copies of the audit and/or the summary and the
management letter directly to the COUNTY immediately upon completion. The audit must be
accomplished by documentation indicating the SUBCONTRACTOR'S Board of Directors has
reviewed the audit.
(57) If the COUNTY Coordinator finds indications of potential non-compliance during the contract monitoring
process or learns that the SUBCONTRACTOR is out of compliance with any of the terms or conditions of
this contract,the following process will be pursued:
(a) Informal Notification: Informal process wherein the COUNTY Coordinator alerts the
SUBCONTRACTOR in writing of the potential non-compliance and an agreeable solution is reached
within ten(10)days.
(b) Official Notification: If the informal notification does not result in resolution,the official notification of
possible non-compliance to establish a date, within ten (10) working days of notification, when
representatives of the COUNTY and the SUBCONTRACTOR shall meet to discuss areas of contention
and attempt to resolve the issues.
(c) Written Summary: Within ten(10)working days of such official notification,the COUNTY will provide
the SUBCONTRACTOR a written summary of the areas of non-compliance by certified mail. Notice
shall be sent to the address identified in the Agreement.
(d) Discussion: Within twenty(20)days of the date of the written summary,a discussion between COUNTY
and SUBCONTRACTOR shall be conducted to resolve areas of non-compliance or potential non-
compliance.
(e) Should the above procedures fail to resolve the compliance issue,the parties will obtain the services of
the Peninsula Dispute Resolution Center,or another agreed upon resource,and shall share equally in any
retainer fees or other costs of services.If no agreement is reached,the mediator's decision in the matter
will be binding on all parties,except that in no event will the COUNTY honor a financial determination
that is greater than the funds allowed in the scope of this Agreement.
(58) For six years following the end date of this agreement,SUBCONTRACTOR will maintain client records and
books, records, documents, reports and other evidence of accounting procedures and practices, which
sufficiently and properly reflect all direct and indirect expenditures of funds provided under this agreement.
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(59) Client records shall minimally include statement of client goals,documentation of training provided,training
hours,routine progress notes and semi-annual summary of progress toward meeting client goals.
(60) SUBCONTRACTOR will provide COUNTY with Adult Community Inclusion Plans (or Person-Centered
Plan/Profile),client goals,and a summary of progress towards meeting those goals on a bi-annual basis.
(61) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all
client records;and all documents,reports,and other data applicable to this agreement.
(62) SUBCONTRACTOR shall provide COUNTY with a copy of a signed DSHS Provider Agreement within 30
days of the effective date of this agreement.
(63) SUBCONTRACTOR agrees to assign to COUNTY its Medicaid Billing Rights for services to clients eligible
under Title XIX programs. Written documentation shall be available to COUNTY on request. If
SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX,COUNTY
agrees that funding intended for those clients shall be excluded from this agreement. If SUBCONTRACTOR
contracts directly with Social Security to provide covered services under a PASS/IRWE, COUNTY agrees
that funding intended for those clients shall be excluded from this agreement.
C. REIMBURSEMENTS
(1) For said services rendered under this agreement,COUNTY shall reimburse SUBCONTRACTOR$66.08 per
unit of service,as defined in Exhibit A,Statement of Work.
(2) SUBCONTRACTOR will bill COUNTY on a monthly basis,on or before the 5th day of the month,for units
of service provided under this agreement during the preceding month. SUBCONTRACTOR will submit a
Monthly DDA Services Report(ADSA)form for its billings.At no time shall the invoices for reimbursement
be submitted more than 60 calendar days following the last day of the month for which the services were
provided.
(3) COUNTY may, at its option, withhold reimbursement for any month for which required reports have not
been received or are inaccurate and/or complete.
(4) Total reimbursements for the fiscal year of 2025-2026 to the SUBCONTRACTOR by the COUNTY under
this contract shall not exceed$213,355.80 in completion of these services without express written amendment
signed by both parties to this Agreement. Work performed between July 1, 2025 and the execution of this
Agreement that is consistent with the provisions of this Agreement is hereby ratified. This total
reimbursement includes any amendment within the fiscal year of 2025-2026.
D. DEBARMENT
By signing this Agreement, the SUBCONTRACTOR certifies that it is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal
department or agency from participating in transactions (debarred). The SUBCONTRACTOR agrees to
include the above requirement in any and all subcontracts into which it enters,and also agrees that it will not
employ debarred individuals. The SUBCONTRACTOR must immediately notify the County if, during the
term of this Agreement, the SUBCONTRACTOR becomes debarred. The County may immediately
terminate this Agreement by providing the SUBCONTRACTOR written notice, if the SUBCONTRACTOR
becomes debarred during the term of this Agreement.
E. FUNDING WITHDRAWN,REDUCED OR LIMITED
If the COUNTY determines in its sole discretion that the,funds it relied upon to establish this Agreement
have been withdrawn,reduced or limited,or if additional or modified conditions are placed on such funding
after the effective date of this Agreement but prior to the normal completion of this Agreement, then the
COUNT,at its sole discretion,may: (1)Terminate this agreement;(2)Renegotiate this Agreement under the
revised funding conditions; or, (3) Suspend the SUBCONTRACTOR's performance under this Agreement
upon five (5)business days' advance notice to the SUBCONTRACTOR, if the COUNTY determines that
there is a reasonably likelihood that the funding insufficiency may be resolved in time to allow the
SUBCONTRACTOR's performance to resume prior to the normal completion date of this Agreement.
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F. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO SUBCONTRACTOR
If overpayments or erroneous payments have been made to the SUBCONTRACTOR under this Agreement,
the COUNTY will provide notice to the SUBCONTRACTOR and the SUBCONTRACTOR shall refund the
full amount of the overpayment within thirty (30)calendar days of the notice. If the SUBCONTRACTOR
fails to make timely refund,the COUNTY may charge the SUBCONTRACTOR one percent(1%)per month
on the amount due,until paid in full.
G. RECORDS AND DOCUMENTS REVIEW
(1) The SUBCONTRACTOR must maintain books,records, documents, magnetic media, receipts, invoices or
other evidence relating to this Agreement and the performance of the services rendered, along with
accounting procedures and practices,all of which sufficiently and properly reflect all direct and indirect costs
of any nature expended in the performance of this Agreement.At no additional cost,these records,including
materials generated under this Agreement,are subject at all reasonable times to inspection,review,or audit
by the Agency, the Office of the State Auditor, and state and federal officials so authorized by law, rule,
regulation,or agreement.
(2) The SUBCONTRACTOR must retain such records for a period of six(6)years after the date of final payment
under this Agreement.
(3) If any litigation,claim or audit is started before the expiration of the six(6)year period,the records must be
retained until all litigation,claims,or audit findings involving the records have been resolved.
H. RISK ASSESSMENT AND MONITORING FOR COMPLIANCE BY THE COUNTY.
(1) SUBCONTRACTOR shall immediately report to the COUNTY any failure to perform under this Agreement.
(2) Along with every request for reimbursement under this Agreement,the SUBCONTRACTOR shall submit a
Monitoring Certification using the form attached as Exhibit B for purposes of the County performing the risk
assessment of the SUBCONTRACTOR and compliance monitoring of this Agreement that is required under
the Program Agreement.
I. MISCELLANEOUS
(1) DSHS Developmental Disabilities Administration (DDA) shall determine client eligibility and service
referral are the responsibility of the DDA pursuant to Chapter 388-823 WAC(Eligibility)and Chapter 388-
825 WAC(Service Rules). Only persons referred by DDA shall be eligible for direct Client services under
this Program Agreement. It is DDA's responsibility to determine and authorize the appropriate direct
service(s) type. Direct Client services provided without authorization are not reimbursable under this
Program Agreement.
(2) DSHS Developmental Disabilities Administration (DDA) shall notify COUNTY of persons authorized for
services reimbursed under this agreement. Only persons referred to COUNTY by DDA through a County
Service Authorization,(CSA)shall be eligible for services reimbursed under this agreement.
(3) The SUBCONTRACTOR'S relation to the COUNTY shall at all times be that of independent
SUBCONTRACTOR.Any and all employees of the SUBCONTRACTOR,or other persons engaged in the
performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall be
considered employees of the SUBCONTRACTOR only,and any claims that may arise on behalf of or against
said employees shall be the sole obligation and responsibility of the SUBCONTRACTOR.
(4) The SUBCONTRACTOR shall not sublet or assign any of the services covered by this Agreement without
the express written consent of the COUNTY. Assignment does not include printing or other customary
reimbursable expenses that may be provided in an Agreement.
(5) The SUBCONTRACTOR, by signature to this Agreement, certifies that the SUBCONTRACTOR is not
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participating in this Agreement, or any Agreement by any Federal department or agency. The
SUBCONTRACTOR also agrees to include the above requirement to all subcontracts into which it enters.
•
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(6) The SUBCONTRACTOR shall obtain and keep in force during the terms of the Agreement, or as
otherwise required, the following insurance with companies or through sources approved by the State
Insurance Commissioner pursuant to RCW 48:05:
(a) Worker's compensation and employer's liability insurance as required by the State of Washington.
(b) Commercial Automobile Liability or Business Use Insurance providing bodily injury and property
damage liability coverage for all owned and non-owned vehicles assigned to or used in the performance
of the work for a combined single limit of not less than$1,000,000 each occurrence with the COUNTY
named as an additional insured in connection with the SUBCONTRACTOR'S performance of the
contract.
(c) General Commercial Liability Insurance in an amount not less than a single limit of one million dollars
($1,000,000.00)per occurrence and an aggregate of not less than two(2)times the occurrence amount
($2,000,000.00 minimum) for bodily injury, including death and property damage, unless a greater
amount is specified in the contract specifications. The insurance coverage shall contain no limitations
on the scope of the protection provided and include the following minimum coverage:
1. Broad Form Property Damage,with no employee exclusion
a. Personal Injury Liability, including extended bodily injury
b. Broad Form Contractual/Commercial Liability-including completed operations
c. Premises-Operations Liability(M&C)
d. Independent Contractors and Subcontractors
e. Blanket Contractual Liability
(7) All employees or subcontractors of the SUBCONTRACTOR who are required to be professionally certified
by the State in the performance of services under this agreement shall maintain professional liability
insurance in the amount of not less than one million dollars($1,000,000). In no case shall such professional
liability to third parties be limited in any way.
(8) It shall be the responsibility of the SUBCONTRACTOR to ensure that any and all persons engaged in the
performance of any work or service required of the SUBCONTRACTOR under this Agreement,shall comply
with the same insurance requirements that SUBCONTRACTOR is required to meet.
(9) Failure on the part of the SUBCONTRACTOR to maintain the insurance as required shall constitute a
material breach of contract upon which the COUNTY may, after giving five working days' notice to the
SUBCONTRACTOR to correct the breach, immediately terminate the contract or,at its discretion,procure
or renew such insurance and pay any and all premiums there with,with any sums so expended to be repaid
to the COUNTY on demand, or at the sole discretion of the COUNTY, offset against funds due the
SUBCONTRACTOR from the COUNTY.
(10) All cost for insurance shall be considered incidental to and included in the unit contract prices and no
additional payment will be made.
(11) Excepting the Workers Compensation insurance and any professional liability insurance secured by the
SUBCONTRACTOR,the COUNTY will be named on all certificates of insurance as an additional insured.
The SUBCONTRACTOR shall furnish the COUNTY with verification of insurance and endorsements
required by this Agreement. The COUNTY reserves the right to require complete, certified copies of all
required insurance policies at any time.
(12) All insurance shall be obtained from an insurance company authorized to do business in the State of
Washington. The SUBCONTRACTOR shall submit a verification of insurance as outlined herein within 14
days of the execution of this Agreement to the COUNTY. All insurance policies obtained by the
SUBCONTRACTOR shall be primary to any equivalent or applicable policies held by the COUNTY. All
insurance policies obtained by the SUBCONTRACTOR shall include a waiver of subrogation rights. Any
insurance self-insured retention,deductible or risk retention maintained,or participated in,by the COUNTY
shall be excess and shall be non-contributory to the insurance policies provided by the SUBCONTRACTOR
in order to comply with the insurance requirements of this Subcontract. All policies provided by the
SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract must be
endorsed to show this primary coverage.
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(13) The COUNTY will pay no progress payments under Section C until the SUBCONTRACTOR has fully
complied with this section. This remedy is not exclusive;and the COUNTY may take such other action as
is available to them under other provisions of this Agreement,or otherwise in law.
(14) Nothing in the foregoing insurance requirements shall prevent the COUNTY,at its option,from additionally
requesting that the SUBCONTRACTOR deliver to the COUNTY an executed bond as security for the faithful
performance of this contract and for payment of all obligations of the SUBCONTRACTOR.
(15) The SUBCONTRACTOR shall comply with all Federal,State,and local laws and ordinances applicable to the
work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with
the laws of the State of Washington and venue shall be in Jefferson COUNTY,WA.
(16) The SUBCONTRACTOR shall comply with the WA State Department of Labor and Industries Minimum Wage
Act, RCW 49.46,acknowledging persons with disabilities participating in job assessments are not considered
employees.
(17) The Contractor shall defend, indemnify and hold the County, its officers, officials, employees, agents and
volunteers (and their marital communities) harmless from any claims, injuries, damages, losses or suits,
including attorney's fees, arising out of or resulting from the acts, errors or omissions of the Contractor in
performance of this Agreement,except for injuries and damages caused by the sole negligence of the County.
Should a court of competent jurisdiction determine this Agreement is subject to RCW 4.24.115 if liability
for damages occurs arising out of bodily injury to persons or damages to property caused by or resulting from
the concurrent negligence of the Contractor and the County, its officers, officials, employees, agents and
volunteers(and their marital communities)the Contractor's liability, including the duty and cost to defend,
shall be only for the Contractor's negligence. It is further specifically understood that the indemnification
provided constitutes the Contractor's waiver of immunity under Industrial Insurance, Title 51 RCW, solely
for the purposes of this indemnification.This waiver has been mutually negotiated by the parties.This section
shall survive the expiration or termination of this Agreement.
(18) Claims against the COUNTY shall include, but not be limited to assertions that the use and transfer of any
software, book, document, report, film, tape, or sound reproduction of material of any kind, delivered there
under, constitutes an infringement of any copyright, patent,trademark,trade name, or otherwise results in an
unfair trade practice or an unlawful restraint of competition.
(19) The SUBCONTRACTOR specifically assumes potential liability for actions brought against the COUNTY by
SUBCONTRACTOR'S employees, including all other persons engaged in the performance of any work or
service required of the SUBCONTRACTOR under this Agreement and, solely for the purpose of this
indemnification and defense, the SUBCONTRACTOR specifically waives any immunity under the state
industrial insurance law,Title 51 RCW. The SUBCONTRACTOR recognizes that this waiver was specifically
entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation.
(20) SUBCONTRACTOR shall not discriminate against any person presenting themselves for services based on
race,religion,color,sex,age,or national origin.
(21) COUNTY reserves the right to terminate this contract in whole or in part,without prior written notice, in the
event that contractual terms are not fulfilled,or if expected or actual funding from the Department of Social and
Health Services Division of Developmental Disabilities is withdrawn,reduced,or limited in any way after the
effective date of this agreement. In the event of termination under this clause, COUNTY shall be liable only
for payment for services rendered prior to the effective date of termination.
(22) No portion of this contract may be assigned or subcontracted to any other individual,firm,or entity without the
express and prior written approval of COUNTY. If the COUNTY agrees in writing that all or a portion of this
Contract may be subcontracted to a third-party, then any contract or agreement between the
SUBCONTRACTOR and a third-party subcontractor must contain all provisions of this Agreement and the
third-party subcontractor must agree to be bound by all terms and obligations found in this agreement.
(23) The parties agree that:
(a) No representation or promise not expressly contained in this Agreement has been made.
Cascade Community Connections Community Inclusion Contract 2025-2026
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(b) They are not entering into this Agreement based on any inducement, promise or representation,
expressed or implied,which is not expressly contained in this Agreement.
(c) This Agreement supersedes all prior or simultaneous representations, discussions, negotiations, and
agreements,whether written or oral,within the scope of this Agreement.
(24) Provided it does not result in a material change in the terms of this Agreement, if any provision of this
Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or
unenforceable to any extent,the remainder of this Agreement and the application this Agreement shall not
be affected and shall be enforceable to the fullest extent permitted by law.
(25) No consent by either party to, or waiver of, a breach by either party, whether express or implied, shall
constitute a consent to,waiver of,or excuse of any other,different,or subsequent breach by either party.
(26) The Contractor shall not sell,assign,or transfer any of rights obtained by this Agreement without the express
written consent of the County.
(27) The parties do not intend, and nothing in this Agreement shall be construed to mean,that any provision in
this Agreement is for the benefit of any person or entity who is not a party.
(28) This Agreement may be amended or supplemented only by a writing that is signed by duly authorized
representatives of all the parties.
(29) This Agreement may be executed in one or more counterparts, each of which shall be deemed an original,
and all of which counterparts together shall constitute the same instrument which may be sufficiently
evidenced by one counterpart. Execution of this Agreement at different times and places by the parties shall
not affect the validity of this Agreement,so long as all the parties execute a counterpart of this Agreement.
(30) The parties agree that facsimile and electronic signatures shall have the same force and effect as original
signatures.
(31) Notwithstanding any provisions of this Agreement to the contrary, to the extent any record, including any
electronic, audio, paper or other media, is required to be kept or indexed as a public record in accordance
with the Washington Public Records Act,Chapter 42.56 RCW(as may be amended),the Contractor agrees
to maintain all records constituting public records and to produce or assist the County in producing such
records,within the time frames and parameters set forth in state law. The Contractor also agrees that upon
receipt of any written public record request,the Contractor shall,within two business days,notify the County
by providing a copy of the request per the notice provisions of this Agreement.
APPROVED AND ADOPTED this day of ,2025.
(SIGNATURES FOLLOW ON NEXT PAGE)
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 18 of 26
SIGNATURE PAGE
JEFFERSON COUNTY WASHINGTON CASCADE COMMUNITY CONNECTIONS
Board of County Commissioners
Jefferson County,Washington
By: By:
Heidi Eisenhour,Chair Taylor ebster
By: Title: Owner/Director
Greg Brotherton,Commissioner
Date: /0/0//2-02-6-
By:
Heather Dudley-Nollette,Commissioner
SEAL:
ATTEST:
Carolyn Gallaway,
Clerk of the Board
Approved as to for only:
22.7 for 08/22/2025
hilip C.Hunsucker. Date
Chief Civil Deputy Prosecuting Attorney
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 19 of 26
EXHIBIT A
STATEMENT OF WORK
COMMUNITY INCLUSION
I. WORK STATEMENT
SUBCONTRACTOR shall provide Community Inclusion services for program clients as described hereinafter.
SUBCONTRACTOR shall be reimbursed for such services on a unit of service basis, pursuant to Section E.,
Reimbursements,of this contract.
"Community Inclusion"or"CI":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.
II. PROGRAM DESCRIPTION
A. Program Goals
1. Transfer or reduction of specialized supports as a result of increased personal independence and/or
community support systems.
2. Frequent opportunities to participate in community social, recreational, commercial, and/or
volunteer/contribution activities also utilized by peer's/community members without disabilities.
3. Assisting individuals to participate in activities that promote individualized skill development,
independent living,and Community Inclusion.
4. Activities that provide individuals with opportunities to develop personal relationships with others
in their local communities and to learn to practice and apply life skills that promotes greater
independence and community inclusion.
5. Development of social contacts,friendships,and support systems with people without disabilities.
6. Frequent outings on an individual basis away from their home setting.
7. An opportunity to acquire supplemental training in a volunteer/job situation to enhance versatility and
individualized education/self-advocacy skill development necessary for new tasks in order to address
growth and interaction needs.
B. Definitions
1. Community Inclusion is:
• an opportunity to experience choice,power,and status in the community
• an opportunity to build relationships,to contribute and,to feel a sense of belonging to the
community
• opportunities to learn,to practice and apply life skills that promotes greater independence and
community inclusion
• an opportunity to access generic resources with peers without disabilities
• an opportunity to access volunteer opportunities in order to enhance versatility
•
Cascade Community Connections Community Inclusion Contract 2025-2026
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• an opportunity for self-advocacy and skill development for new tasks,and to contribute to the
community
C. Program Requirements
1. SUBCONTRACTOR shall provide Community Inclusion Services. These services, as defined in
Section II.B above&are in the Community Inclusion Billable Activities Form.
2. SUCONTRACTOR shall provide Monthly Community Inclusion service support hours that are
based on the Client's Community Inclusion service level per WAC 388-828-9310.
3. SUBCONTRACTOR will assure that the initial Community Inclusion Plan and all 6-month Reports,
adhere to the criteria detailed in this contract.
4. SUBCONTRACTOR shall provide an Individual Program Plan and/or Person-Centered
planning/profiles delineating individual skills and needs within 30 days of the beginning of services
with all program clients. The SUBCONTRACTOR will use the Community Inclusion Plan Report
Form, which will serve as an aid in matching program clients to appropriate services in the
community;and will serve as a transition tool towards the advancement of the individual's increased
personal independence in the community;an opportunity to build relationships;to contribute and to
feel a sense of belonging to the community, while accessing volunteer opportunities in order to
enhance versatility and develops skills necessary for new tasks.
5. SUBCONTRACTOR shall provide evidence that volunteer opportunities comply with U.S.
Department of Labor standards and applicable state standards.
https://www.dol.gov/sites/dol gov/fi les/WH D/legacy/files/whdfs 14a.pdf
https://www.dol.gov/whd/forstatelocalgovernments.htm
6. SUBCONTRACTOR shall schedule a six-month review of meetings for all program participants.
The review shall include an assessment of the need for continued Community Inclusion services
and an evaluation of the Individual Program plan goals and objectives in the form of a Semi-Annual
Progress Report. The SUBCONTRACTOR shall use the Community Inclusion Plan Report Form,
to report on the semi-annual progress of the client.
7. The 6-month Community Inclusion progress reports shall demonstrate the implementation strategy,
client goals,and how the individual is advancing towards meeting the outcomes of his or her goals;
training provided and a written synopsis showing progress toward meeting objectives or a
description of the reasons for any shortfall concerning the outcomes and proposed actions for
correction.
8. COUNTY shall receive the dates for the 6-month reviews for program clients 20 days before the
required meetings.
9. SUBCONTRACTOR will assure that 6-month progress reports describe the service activities and
outcomes of those activities by documenting them in each Client's progress reports; and that the
reports are sent to the COUNTY, DDA Case Management, Residential Provider, Parent/Guardian
and others as appropriate. The report will summarize the progress made towards the Client's
individualized goals.
10. The SUBCONTRACTOR will use the Community Inclusion Report Form, to report on the six-
month progress of the client.
11. The SUBCONTRACTOR will review Quality Assurance questions during each six-month review.
12. The frequency of the Semi-Annual Progress Reports for this contractual period will be one every
six(6)months after the initial plan.
13. SUBCONTRACTOR will contact every Client according to Client need and at least once per month.
Cascade Community Connections Community Inclusion Contract 2025-2026
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14. Services shall promote the use of natural supports, which means personal associations and
relationships typically developed in the community that enhance the quality and security of life for
people, including but not limited to friendships reflecting the diversity of the neighborhood and the
community, associations with fellow students in community classes, and associations developed
through participation in clubs,organizations,and civic activities.
15. Evidence that the opportunity is provided for connection and relationship building between the
participant and people without disabilities who are not paid to provide services to the participant.
16. Community Inclusion services will focus on activities that are typically experienced by the general
public. Evidence that each participant is assisted to participate in typical and integrated activities,
events and organizations in the individual's neighborhood or local community in ways similar to
others of same age. Support to participate in segregated activities and/or specialized activities will
not be reimbursed.
17. Services shall provide support to those individuals wishing to seek volunteer activities;such as using
public transportation, assisting with referrals to the appropriate agencies, and other agreed upon
vocationally related goals in preparation for volunteering.
18. The SUBCONTRACTOR shall provide coordination of activities to develop a diverse schedule of
activities based on the client's needs and interests as connected to their Community Inclusion
Program plan. Each participant is assisted to take part in activities on an individualized basis.
19. The SUBCONTRACTOR shall provide Community Inclusion services in the community that
promote and achieve:
(a) health and safety,
(b) a positive image,
(c) relationships,
(d) increased competence,
(e) individualized skill-building
(f) and other expected benefits of Community Inclusion.
20. The SUBCONTRACTOR shall assess and document in the Community Inclusion Plan Report Form
each participant's transportation needs. The Provider shall assist each participant to access public
or specialized transportation for some activities sponsored as a part of Community Inclusion
services. It is expected that public or specialized transportation will be utilized, except as detailed
in the transportation plan.The cost of transportation is included in the fee for service that a Provider
receives.
21. Program participants must be authorized for service by the Developmental Disabilities
Administration(DDA)and referred to the COUNTY. Only persons referred to COUNTY by DDA
through a County Service Authorization, (CSA) shall be eligible for services reimbursed under this
agreement.
22. A client receiving Community Inclusion services will not receive Employment services
simultaneously.
23. A client receiving Community Inclusion services may at any time choose to leave Community
Inclusion to pursue work and to receive Individual Employment services.
24. If a client is not satisfied with employment services after nine (9) months in an employment
program,(an unsuccessful job search),the client may choose Community Inclusion services.
25. SUBCONTRACTOR must ensure there is a legal requirement and a clear delineation for staff
qualifications and proof of background criminal history clearance in accordance with RCW
43.43.830-845 and RCW 74.15.030 and Chapter 388-06 WAC on all staff.
26. SUBCONTRACTOR will provide COUNTY with information regarding staff qualifications and
documented trainings upon request.
Cascade Community Connections Community Inclusion Contract 2025-2026
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27. SUBCONTRACTOR shall submit a written Program Staff Training Plan to COUNTY for approval
or disapproval within 30 days of the effective date of this agreement,semi-annually thereafter or when
reorganization occurs,which minimally includes:
(a) SUBCONTRACTOR's procedure to train new direct service staff,training must include,
• DDA Policies&Competencies(see Section C-Number 23-29)
• RCW's & WAC's referenced on page .1 & 2 of the County Contract under Section B.
Obligations
• agency policies&procedures
• skills on how to instruct/teach clients
• skills on how to document data collection,daily/weekly notes,&6-month reports in client
files
(b) skills on how to write Community Inclusion Client Plans and/or Person-Centered Plans(creating
client goals/objectives)
(c) SUBCONTRACTOR's plan to provide staff who are skilled in applying training techniques to
enhance the work-related skills of program clients
(d) FTE levels,job descriptions,and organization chart pertaining to program staff
(e) SUBCONTRACTOR is required to send four direct service staff to a minimum of 16 hours of
workshops,trainings, and/or conferences about developmental disabilities. The COUNTY will
reimburse the SUBCONTRACTOR at the rate of$40.00 an hour for every hour of training
accessed for direct service staff(not more than a total of$640.00 for each staff person or
$2,560.00 total).
28. SUBCONTRACTOR must assure new staff are informed specifically of all agency
policies/procedures and have documentation that assures all direct service staff 18 years of age or
older are trained in the following DDA Policies Prior to Working with Clients: ADA training,APS
Reporting Requirements, client confidentiality, current individual instruction and Action
StepsNocational Plans for each client with whom the employee works;DDA Policy 4.11 Working
Age Adult(adult services only);DDA Policy 5.06 Client Rights;DDA Policy 5.13 Protection from
Abuse,Mandatory Reporting; DDA Policy 12.0 Incident Management.
29. SUBCONTRACTOR must ensure that new direct service staff demonstrate the following
competencies:
(a) Values that support the abilities of individuals
(b) Effective Communication—The ability to effectively listen and to make oneself understood
(c) Planning methods
(d) Crisis Prevention and Intervention
30. Within one month of employment: SUBCONTRACTOR must ensure that direct service staff
received training and are knowledgeable in the following areas: Overview of DDA Policies
including: DDA Policy 3.01 Service Plans;DDA Policy 5.03 Client Complaints;DDA Policy 5.17
Physical Intervention Techniques; DDA Policy 6.13 Employment/Day Program Provider
Qualifications; DDA Policy 13.04 DRW Access Agreement; DDA Policy 15.03 Community
Protection Standards for Employment/Day Programs;and all reporting requirements related to these
DDA Policies.
31. Within six months of employment: SUBCONTRACTOR must ensure that direct service staff
received training and are knowledgeable in the following areas: Program skill development, DDA
Policy 5.02 Necessary Supplemental Accommodation;DDA Policy 5.14 Positive Behavior Support;
DDA Policy 5.15 Use of Restrictive Procedures; DDA Policy 9.07 HIV and AIDS and Program
Skill Development.
32. SUBCONTRACTOR will have signed documentation that staff training took place within the
timelines listed above in Section C-Number 26-30.
33. Within 30 days of the effective date of this agreement, and annually thereafter,
SUBCONTRACTOR will develop and submit to COUNTY a Community Inclusion program-
Cascade Community Connections Community Inclusion Contract 2025-2026
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operating budget detailing the projected allocation of contract funds,other sources and amounts of
funding,program staffing expenses and other cost allocations. Within 30 days of the effective date
of this agreement and at least semi-annually thereafter,SUBCONTRACTOR will provide company
and program operating financial reports to COUNTY,including all revenues and expenses generated
by SUBCONTRACTOR, in sufficient detail to demonstrate the uses of funds provided under this
agreement.
34. Every six months, SUBCONTRACTOR will develop and submit to COUNTY, Community
Inclusion financial reports reflecting the actual revenues received and expenses incurred compared
to the projected program budget submitted,along with the overall operating budget.
D. Performance Standards
1. SUBCONTRACTOR shall provide Community Inclusion services for up to three program clients who
are authorized for service by DSHS/DDA and have been referred by COUNTY.
E. Service Level Guidelines
1. Client Acuity is determined through the DDA assessment. Acuity reflects conditions typically
related to individual disabilities that are not likely to change, and are generally not impacted by
outside factors.Client acuity is determined as"High","Medium",or"Low"as defined within WAC
388-828.
2. Prior to beginning service or prior to an expected change in service, the provider will clearly
communicate to the Client and the County the maximum service hours per month the Client can
expect to receive. Service changes will not occur until the Client has received proper notification
from DDA.
(a) That services the client is receiving relate to the client's Individual Habilitation Plan (IHP)
(ICF/ID), PASRR Level II Assessment, DDA Assessment including the Person-Centered
Service Plan(PCSP)and/or Individualized Family Service Plan(IFSP).
(b) The Client's DDA Plan is the driver for service.The County Service Authorization and updated
Planned Rates information will not exceed the Client's DDA County Service Authorization
(CSA).
(c) The amount of service the Client receives should match with the County Service Authorization
(CSA)and updated Planned Rates information
(d) All Clients will have an individualized plan to identify Client's preferences. Minimum plan
elements are outlined in the reference document"Criteria for an Evaluation." A copy of the
Client's individualized plan will be provided to their CRM,guardian and others as appropriate.
(e) A copy of the current annual DDA Assessment,Service Summary,and Employment Summary
or PASRR Level II Assessment or IHP or IFSP if applicable,will be maintained in the client's
file.
3. Service Level Guidelines reflect Client Acuity and other considerations, (see Table below); the
assigned support levels typically reflect direct service staff time provided to or on behalf of the client
on an individual basis, to participate in age-appropriate community activities similar to those
without disabilities. Allowable activities are defined in the Community Inclusion Billable Activities
document.
4. The expectation is that all hours reported are documented specific to the client,authorized and relate
to the goals and supports outlined within the client's Community Inclusion Plan.
COMMUNITY INCLUSION-ASSIGNED SERVICE LEVEL-
Monthly Support HOURS
ACUITY LEVEL Monthly Support Hours
Level A Up to 3 hours
Level B Up to 6 hours
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 24 of 26
Level C Up to 9 hours
Level D Up to 12 hours
Level E Up to 15 hours
Level F Up to 18 hours
Level G Up to 20 hours
F. Community Inclusion Unit of Service
1. One UNIT of Community Inclusion service is defmed as one(1)or more"HOUR"of direct service or
ASSIGNED SERVICE LEVEL to one eligible client. A UNIT is defmed as an"HOUR"which is at
least fifty(50)minutes of direct service;(partial hour to the quarter may be recorded),ten(10)minutes
of every"HOUR"can be used for documentation and/or meeting times.
2. Community Inclusion service support hours per month will be based on the client's Community
Inclusion Acuity Level per WAC.
3. SUBCONTRACTOR will provide a UNIT of service at$66.08 an HOUR.
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 25 of 26
EXHIBIT B—COMPLIANCE AND RISK MONITORING FORM
This Compliance and Risk Monitoring Form shall be submitted before the Subrecipient Agreement can be approved
and also shall be submitted along with every request for reimbursement.
AGENCY CONTRACT NO: DD-25-059
DATE: /O//W2O25
NAME OF SUBRECIPIENT: Cascade Community Connections/Taylor Webster
By signing below,I declare under penalty of perjury of the laws of the State of Washington and the United States
that the forgoing is true and correct. (Check the applicable boxes.)
DATE CERTIFICATION ITEM YES NO
Subrecipient is not presently debarred,suspended,proposed for
/%(/.W25 debarment,declared ineligible,or voluntarily excluded from
transactions by any Federal,State,or local department or agency
Subrecipient has not within a 3-year period preceding the submission of
this Compliance and Risk Monitoring Form been convicted of or had a
/o//6/20.- civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining,attempting to obtain,or
performing a public(Federal,State,or local)transaction or contract
under a public transaction;violation of Federal or State antitrust
statutes or commission of embezzlement,theft,forgery,bribery,
falsification or destruction of records,making false statements,or
receiving stolen property
Subrecipient is not presently indicted for or otherwise criminally or
civilly charged by a governmental entity(Federal,State,or local)with
0//6/2o2,5- commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain,or performing a public(Federal,State,or local)
transaction or contract under a public transaction;violation of Federal
or State antitrust statutes or commission of embezzlement,theft,
forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property
Subrecipient has not within a 3-year period preceding the submission of
io//6/zozs this Compliance and Risk Monitoring Form one or more public
transactions(Federal,State,or local)terminated for cause or default
Subrecipient has provided all written reports required by the Agency
io//6/2.oz5- Contract and this Subrecipient Agreement as of the submission of this
Compliance and Risk Monitoring Form
Subrecipient has provided any audit report received by it from any
government agency since the last certification for its performance
tQ6/2o45- related to the Program Agreement
Subrecipient certifies that all of the deliverables and other work
fQ6/2C required since the last certification have been completed
All the work being billed for in the invoice being certified by this
(%6/2O25 Compliance and Risk Monitoring Form actually has been performed,
including any timesheet or other backup
Subrecipient agrees to submit to an audit within 30 days of a request
/0//6/2-o2-5- from the County V
Subrecipient has corrected any deficiencies identified since the last
f%6/2D25 certification V
Signed at Port Townsend_ , Washington
CITY STATE
Cascade Community Connections Community Inclusion Contract 2025-2026
Page 26 of 26
SUBRECIPIENT SIGNATURE DATE
Taylor Webster
WRI I I EN NAME OF PERSON SIGNING CERTIFICATION
APPROVED BY THE COUNTY:
COUNTY APPROVALSIGNATURE DATE
WRITTEN NAME OF PERSON APPROVING CERTIFICATION