HomeMy WebLinkAboutConcerned Citizens Child Development Services - 090826 SUBAWARD AGREEMENT
BETWEEN THE COUNTY OF JEFFERSON
AND
CONCERNED CITIZENS
This Subaward Agreement ("Agreement") is made and entered into between the County of Jefferson, a
municipal corporation, ("the County") and Concerned Citizens ("Subaward Recipient") for the purpose
of dispensing funds from the Washington State Department of Social and Health Services (DSHS) to the
County in Contract No. DD-26-039 DSHS-DDA County Svcs. ("Agency Contract").
IT IS AGREED UPON BY THE PARTIES AS FOLLOWS:
A. INTENT OF THE PARTIES
(1) It is the intent of the County to dispense funds via fee-for-service to Subaward Recipient for
"Consumer Supports"number 2,which is described in Section"1," Subsection"g"of the Agency
Contract, attached as Appendix A. Consumer Support 2 is labeled"Child Development Services"
("CDS").
(2) Subaward Recipient may bill up to but not more than a total budget of$16,125 for CDS under this
Agreement.
(3) The total budget is determined by DSHS as the estimated amount needed to serve the number of
County residents enrolled and/or eligible for CDS at the beginning of this Agreement term.
(4) Total budget is subject to change during the term of this Agreement to ensure all County residents
enrolled for CDS may access those supports via the qualified in-county provider of their choosing
and to ensure the County's ability to adhere to the Agency Contract.
(5) The County will notify the Subaward Recipient of County-assigned budget changes with ten(10)
days written notice. Changes will result in an amendment to this Agreement.
(6) CDS will be reimbursed with Fees described in Section "7," Subsection "a," of the Agency
Contract and for work described in Section"8," Subsections"a.(3)(c.)" and"e.(3)" of the Agency
Contract. The following is the maximum allowable fee/rate for CDS at the beginning of this
Agreement term and is subject to change:
a. CDS: $500 per unit of service
(7) Maximum allowable fees/rates are determined by the Washington State Developmental
Disabilities Administration (DDA), which is overseen by the Washington State Department of
Social and Health Services (DSHS) and are subject to change. The County will always follow
DDA instructions regarding rate reimbursement.
(8) The County's standard practice is to reimburse qualified providers at maximum allowable
fees/rates. However, the County reserves the right to reimburse at a lower rate without an
amendment to this Agreement if:
a. There are insufficient funds to reimburse the Subaward Recipient at maximum allowable
fees/rates.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 1 of 39
DD-26-058
b. Lowering the rate enables the Subaward Recipient to invoice for the remainder of funds in
a County-assigned budget line item when and if those funds reach an amount that is not
evenly divisible by the maximum allowable rate.
(9) Fees reimbursement may never exceed the amount of funds listed in the Child Development line-
item total in Exhibit B of the Agency Contract unless otherwise agreed upon.
(10) The County will notify the Subaward Recipient of amendments to the Agency Contract with ten
(10) days written notice.
(11) At the beginning of this Agreement term, the Subaward Recipient is Jefferson County's sole
Qualified Service Provider of CDS. The County continuously solicits applications from additional
Qualified Service Providers, as required in Section"6," Subsection"g" of the Agency Contract.
(12) It is the intent of Subaward Recipient to accept reimbursement for the purpose of completing CDS
according to Agency Contract Fees and the total budget without any additional contribution by the
County.
(13) It is the intent of the Subaward Recipient to provide eligible clients with the maximum allowable
units of CDS, as Subaward Recipient and client capacity permits.
(14) It is the intent of the County to conduct its every-third-year Evaluation of the Subaward Recipient
during the term of this Agreement. Evaluation is described in Section "6," Subsection "m" of the
Agency Contract.
B. TERM OF THIS AGREEEMENT
The term of this Agreement shall be from July 1, 2026-June 30, 2027.
C. TERMINATION
(1) Should a party default in providing services under this Agreement or materially breach any of its
provisions,the other party may terminate this Agreement upon ten(10)days written notice.A party
shall have the right and opportunity to cure any such material breach within the ten(10)day period.
(2) The County may terminate this Agreement upon immediate notice to Subaward Recipient in the
event that the funding for the project ceases or is reduced in amount. Subaward Recipient will be
reimbursed for services expended up to the date of termination.
(3) This Agreement may be terminated without cause at any time by either party subject to a sixty (60)
day advance written notice of such termination to the other party.
(4) Termination of this Agreement, pursuant to the processes described herein shall not constitute a
breach of this Agreement.
D. SUBAWARD RECIPIENT'S OBLIGATIONS
Subaward Recipient shall fulfill the following obligations:
(1) Subaward Recipient shall adhere to all the requirements of the Agency Contract. For the avoidance
of doubt, Subaward Recipient understands and agrees that it shall furnish all the necessary personnel,
material, equipment or services and shall otherwise do all things necessary or incidental to the
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 2 of 39
performance of the work and the full provision of CDS. Failure to comply with requirements of the
Agency Contract shall constitute material breach of this Agreement.
(2) The payments for CDS shall be made by DSHS pursuant to the Agency Contract, as limited to the
amounts listed in Exhibit B of the Agency Contract, unless modified by DSHS and the County.
Subaward Recipient understands and agrees that payment by DSHS for reimbursement on the
satisfactory performance of the work may not exceed the above-noted amounts unless the parties
mutually agree in writing to a higher amount prior to the commencement of any work which causes
the maximum payment to be exceeded.
(3) Subaward Recipient shall submit invoices to the County in a manner that adheres to Billing and
Payment requirements in section 8 of the Agency Contract. In addition:
(a) Subaward Recipient shall submit invoices by the 10th of the month for the previous
month's expenses. Such invoices will be checked by the County, and upon approval
thereof, payment will be made to Subaward Recipient in the amount approved.
(b) Subaward Recipient shall submit invoices to publichealthap(c cojefferson.wa.us.
(4) Subaward Recipient shall comply with the requirements for Confidential Information contained in
section 12 of the Agency Contract, as if it were the County.
(5) Subaward Recipient shall comply with Data Security Requirements in Exhibit A of the Agency
Contract.
(6) Subaward Recipient 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).
(7) Subaward Recipient shall have a grievance policy that:
(a) Negotiates conflicts and advises participants of grievance procedures;
(b) Is explained to participants;
(c) Prohibits retaliation for using the grievance process;
(d) Includes a non-retaliation statement;
(e) Assures that advocates are available and encourages participants to bring advocates to help
negotiate;
(f) Includes a mediation process that promotes the use of someone who is unaffected by the
outcome if conflicts remain unresolved; and,
(g) Includes a process for tracking and reporting grievances.
(8) Subaward Recipient shall comply with all applicable federal, state and local regulations.
(9) Subaward Recipient shall comply with all the policies of the Jefferson County department managing
this Agreement.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 3 of 39
E. DEBARMENT
By signing this Agreement, Subaward Recipient 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). Subaward
Recipient 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. Subaward Recipient must immediately
notify the County if, during the term of this Agreement, Subaward Recipient becomes debarred. The
County may immediately terminate this Agreement by providing Subaward Recipient written
notice,if Subaward Recipient becomes debarred during the term of this Agreement.
F. 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 County, at its sole discretion, may: (1) Terminate this Agreement; (2)
Renegotiate this Agreement under the revised funding conditions; or, (3) Suspend Subaward
Recipient's performance under this Agreement upon five (5) business days' advance notice to
Subaward Recipient,if the County determines that there is a reasonably likelihood that the funding
insufficiency may be resolved in time to allow Subaward Recipient's performance to resume prior
to the normal completion date of this Agreement. Nothing in this section shall have the effect of
limiting or preventing the County from executing any remedy set forth at 2 CFR § 200.339 or any
other federal regulation governing the dispensation of grant funding, if applicable.
G. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO SUBAWARD RECIPIENT
If overpayments or erroneous payments have been made to Subaward Recipient under this
Agreement,the County will provide notice to Subaward Recipient and Subaward Recipient shall
refund the full amount of the overpayment within thirty (30) calendar days of the notice. If
Subaward Recipient fails to make timely refund,the County may charge Subaward Recipient one
percent(1%)per month on the amount due, until paid in full.
H. RECORDS AND DOCUMENTS REVIEW
(1) Subaward Recipient shall 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 [See 42 USC 1396a(a)(27)(B);
42 USC 1396a(a)(37)(B);42 USC 1396a(a)(42(A);42 CFR 431, Subpart Q;and 42 CFR 447.202].
(2) Subaward Recipient shall 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.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 4 of 39
RISK ASSESSMENT AND MONITORING FOR COMPLIANCE BY THE COUNTY
(1) Subaward Recipient shall immediately report to the County any failure to perform under this
Agreement.
(2) Along with every request for reimbursement under this Agreement, Subaward Recipient shall submit
a Monitoring Certification using the form attached hereto as Appendix B for purposes of the County
performing the risk assessment of Subaward Recipient and compliance monitoring of this
Agreement that is required of the County by the Agency.
J. GENERAL TERMS AND CONDITIONS
(1) Subaward Recipient's relation to the County shall at all times be that of independent Subaward
Recipient. Any and all employees of Subaward Recipient, or other persons engaged in the
performance of any work or service required of Subaward Recipient under this Agreement, shall
be considered employees of Subaward Recipient only, and any claims that may arise on behalf of
or against said employees shall be the sole obligation and responsibility of Subaward Recipient.
(2) Subaward Recipient shall obtain and keep in force during the terms of this Agreement, or as
otherwise required, the following insurance with companies or through sources approved by the
State Insurance Commissioner pursuant to Chapter 48:05 RCW:
(a) Worker's compensation and employer's liability insurance. Subaward Recipient will
participate in the Worker's Compensation and Employer's Liability Insurance Program as
may be 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
Subaward Recipient's performance of this Agreement.
(c) Insurance. Recipient shall maintain commercial general liability coverage in a form
acceptable to Jefferson County Risk Management for bodily injury, personal injury, and
property damage, with a limit in the amount of at least two million dollars($2,000,000.00)
per occurrence, for bodily injury, including death, and property damage. The insurance
coverage shall contain no limitations on the scope of the protection provided and include
the following minimum coverage:
(i) Broad Form Property Damage, with no employee exclusion.
(ii) Personal Injury Liability, including extended bodily injury.
(iii) Broad Form Contractual/Commercial Liability - including completed operations.
(iv) Premises - Operations Liability (M&C).
(v) Independent Contractors and Subaward Recipients.
(vi) Blanket Contractual Liability.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 5 of 39
(3) All employees or Subaward Recipients of Subaward Recipient who are required to be
professionally certified by the State in the performance of services under this Agreement shall
maintain professional liability insurance/error and omissions 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.
(4) It shall be the responsibility of Subaward Recipient to ensure that any and all persons engaged in
the performance of any work or service required of Subaward Recipient under this Agreement,
shall comply with the same insurance requirements that Subaward Recipient is required to meet.
(5) It shall be the responsibility of Subaward Recipient to ensure that any and all persons engaged in
the performance of any work or service required of Subaward Recipient under this Agreement
shall comply with the terms and conditions set forth in the Agency Contract at Appendix A.Failure
of any persons engaged by Subaward Recipient in the performance of any work or service required
by Subaward Recipient under this Agreement, whether such person or entity is an employee,
Subaward Recipient, independent contractor, or volunteer of Subaward Recipient,to comply with
the requirements set forth in Agency Contract shall constitute material breach of this Agreement
as if Subaward Recipient had caused the breach directly.
(6) Failure of a Subaward Recipient to perform is no defense to a breach of this Agreement. Subaward
Recipient assumes responsibility for and all liability for the actions and quality of services
performed by any Subaward Recipient. Every Subaward Recipient must agree in writing to follow
every term of this Agreement. Subaward Recipient must provide every Subaward Recipient's
written agreement to follow every term of this Agreement before the Subaward Recipient can
perform any services under this Agreement. The head of the County department primarily
responsible for overseeing Subaward Recipient's performance under this Agreement or that
department head's designee must approve any proposed Subaward Recipients in writing. Any
dispute arising between Subaward Recipient and any Subaward Recipients or between any Subaward
Recipients must be resolved without involvement of any kind on the part of the County and without
detrimental impact on the delivery of contracted goods or services.
(7) Failure on the part of Subaward Recipient 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
Subaward Recipient to correct the breach, immediately terminate this Agreement or, at its
discretion,procure or renew such insurance and pay any and all premiums in connection therewith,
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 Subaward Recipient from the County.
(8) All cost for insurance shall be considered incidental to and included in the unit contract prices and
no additional payment will be made.
(9) Excepting the Workers Compensation insurance and any professional liability insurance secured
by Subaward Recipient, the County will be named on all certificates of insurance as an additional
insured. Subaward Recipient 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.
(10) All insurance shall be obtained from an insurance company authorized to do business in the State
of Washington. Subaward Recipient 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 Subaward Recipient shall be primary to any equivalent or applicable policies held by the
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 6 of 39
County. All insurance policies obtained by Subaward Recipient shall include a waiver of
subrogation rights. Any self-insured retention, deductible or risk retention maintained, or
participated in,by the County coverage for third-party liability claims provided to the county,shall
be excess and shall be non-contributory to the insurance policies provided by Subaward Recipient
in order to comply with the insurance requirements of this Subcontract. All policies provided by
Subaward Recipient in order to comply with the insurance requirements of this Subcontract must
be endorsed to show this primary coverage.
(11) The County will pay no progress payments under this Agreement until Subaward Recipient 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.
(12) Nothing in the foregoing insurance requirements shall prevent the County, at its option, from
additionally requesting that Subaward Recipient deliver to the County an executed bond as security
for the faithful performance of this Agreement and for payment of all obligations of Subaward
Recipient.
(13) It is understood and agreed that this Agreement is entered into in the State of Washington. This
Agreement shall be governed by and construed in accordance with the laws of the United States,
the State of Washington and the County of Jefferson, as if applied to transactions entered into and
to be performed wholly within Jefferson County, Washington between Jefferson County residents.
No party shall argue or assert that any state law other than Washington law applies to the
governance or construction of this Agreement.
(14) Should either party bring any legal action, each party in such action shall bear the cost of its own
attorney's fees and court costs.The venue for any legal action shall be solely in the appropriate state
court in Jefferson County,Washington,subject to the venue provisions for actions against counties
in RCW 36.01.050.
(15) Subaward Recipient shall comply with the WA State Department of Labor and Industries Minimum
Wage Act, chapter 49.46 RCW, acknowledging persons with disabilities participating in job
assessments are not considered employees.
(16) Subaward Recipient shall indemnify and hold the County, and its officers, officials, employees,
agents and volunteers(and their marital communities)harmless from and shall process and defend
at its own expense, including all costs, attorney fees and expenses relating thereto, all claims,
demands,or suits at law or equity arising in whole or in part,directly or indirectly, from Subaward
Recipient's negligence or breach of any of its obligations under this Agreement; provided that
nothing herein shall require a Subaward Recipient to indemnify the County and its officers,
officials, employees, agents and volunteers (and their marital communities) against and hold them
harmless from claims, demands or suits based solely upon the conduct of the County, its officers,
officials, employees, agents and volunteers (and their marital communities), and provided further
that if the claims or suits are caused by or result from the concurrent negligence of:
(a) Subaward Recipient's agents or employees; and,
(b) The County, its officers, officials, employees, agents and volunteers (and their marital
communities),this indemnity provision with respect to: (i)claims or suits based upon such
negligence,or(ii)the costs to the County of defending such claims and suits, etc., shall be
valid and enforceable only to the extent of Subaward Recipient's negligence or the
negligence of Subaward Recipient's agents or employees.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 7 of 39
(c) Subaward Recipient specifically assumes potential liability for actions brought against the
County by Subaward Recipient's employees, including all other persons engaged in the
performance of any work or service required of Subaward Recipient under this Agreement
and, solely for the purpose of this indemnification and defense, Subaward Recipient
specifically waives any immunity under the state industrial insurance law, title 51 RCW.
Subaward Recipient recognizes that this waiver was specifically entered into pursuant to
provisions of RCW 4.24.115 and was subject of mutual negotiation.
(d) The provisions of this section shall survive the expiration or termination of this Agreement.
(17) Subaward Recipient shall not discriminate against any person presenting themselves for services
based on race,religion, color, sex, age, or national origin.
(18) No portion of this Agreement may be assigned or subcontracted to any other individual,firm,or entity
without the express and prior written approval of County. If the County agrees in writing that all
or a portion of this Agreement may be subcontracted to a third-party,then any contract or agreement
between Subaward Recipient and a third-party Subaward Recipient must contain all provisions of
this Agreement and the third-party Subaward Recipient must agree to be bound by all terms and
obligations found in this Agreement.
(19) This Agreement memorializes the entire agreement of the parties. No representation or promise
not expressly contained in this Agreement has been made. The parties are not entering into this
Agreement based on any inducement,promise or representation,expressed or implied,which is not
expressly contained in this Agreement. This Agreement supersedes all prior or simultaneous
representations, discussions, negotiations, and agreements, whether written or oral, within the
scope of this Agreement.
Subaward Recipient is responsible for meeting all terms and conditions of this Agreement
including standards of service,quality of materials and workmanship,costs,and schedules.
(20) Subaward Recipient's employees shall not perform any of the work required in section A of the
Agency Contract while under the influence of drugs or alcohol,and if discovered,may be reported
to the appropriate law enforcement agency.
(21) Any form of harassment, discrimination, or improper fraternization with any County employee or
a participant is strictly prohibited.
(22) 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. No term or provision of this Agreement will be considered waived by either party,
and no breach excused by either party,unless such waiver or consent is in writing signed on behalf
of the party against whom the waiver is asserted. Failure of a party to declare any breach or default
immediately upon the occurrence thereof, or delay in taking any action in connection with, shall
not waive such breach or default.
(23) The terms of this Agreement are not severable. 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 enforceable.
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 8 of 39
(24) This Agreement shall be binding upon and inure to the benefit of the parties' successors in interest,
heirs and assigns.
(25) 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.
(26) 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.
(27) The parties agree that facsimile and electronic signatures shall have the same force and effect as
original signatures.
(28) The parties agree that this Agreement has been negotiated at arms-length, with the assistance and
advice of competent, independent legal counsel.
(29) 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), Subaward Recipient 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. Subaward Recipient also agrees that upon receipt of any written public record
request, Subaward Recipient shall, within two business days, notify the County by providing a
copy of the request per the notice provisions of this Agreement.
(30) All notices or other communications which any party desires or is required to give shall be given
in writing and shall be deemed to have been given if hand-delivered, sent by facsimile, email, or
mailed by depositing in the United States mail, prepaid to the party at the address listed below or
such other address as a party may designate in writing from time to time. Notices to the County
shall be sent to the following address:
Jefferson County Public Health
do Bonnie Obremski, Intellectual and Developmental Disabilities Coordinator
615 Sheridan Street Port Townsend, WA 98368
Bonnie0@co.j efferson.wa.us
Notices to Subaward Recipient shall be sent to the following address:
Lambros M. Rogers, Executive Director
Concerned Citizens
945 S Forks Ave.
Forks, WA 98331
(360)374-9340 Office
(360)374-4346 Fax
Lrogers@ccpnw.org
ccpnw.org
(SIGNATURES FOLLOW ON THE NEXT PAGE)
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 9 of 39
SIGNATURE PAGE
ADOPTED THIS SI day of90-eivi et-, 2026
JEFFERSON COUNTY WASHINGTON CONCERNED CITIZENS
Board of County Commissioners
Jefferson County, Was ngton
By: I I E-�zL '_ � .1 .4.---
Greg B otherton, Lambros M. Rogers,
Chair Executive Director
By: 1leidi --eZ, t✓� Date: .- 31- Z f�
Eisenhour,
Commissioner
By:
Heat r ley-Nollette,
Commissioner """"",."«M.
,,.•,` FFERSO%
SEAL: .•.oMMiss. c,
;1 6 m•• G =
ATTEST: 7q ••.......•o '
0,e-
` '•
CA - ( ycaC (J'V t-� INM
Carol 1 alloway, CMC 0
Clerk . e Board
Approved as to form only:
0�
1a'+ 07-31-2026
Jerem B. �ther, Date
Civil Deputy Prosecuting Attorney
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 10 of 39
APPENDIX-A
AGENCY CONTRACT
COUNTY DSHS Agreement Number
• SHS PROGRAM AGREEMENT 2663-69501
'�rriYMSMWGTON VATt''S.,.V 1department of Social
MA lNRM Services
DDCS County Services
This Program Agreement is by and between the State of Washington Department of Administration or Division
Social and Health Services(DSHS)and the County identified below,and is issued in Agreement Number
conjunction with a County and DSHS Agreement On General Terms and Conditions,
which is incorporated by reference. County Agreement Number
DD-26-039
DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE
Developmental Disabilities Division of Developmental 1223 1769CS-63
Admin Disabilities t
DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS
Wendi Wrnchel PO BOX 45315
Regional Business Manager
Olympia,WA 98504-5315
DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL
(360)725-4264 (360)586-6502 wendi.winchel@fdshs,wa.gov
COUNTY NAME COUNTY ADDRESS
Jefferson County 615 SHERIDAN STREET
Jefferson County DDA County Services Port Townsend,WA 98368
COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME
NUMBER
Bonnie Obremski
COUNTY CONTACT TELEPHONE 1 COUNTY CONTACT FAX COUNTY CONTACT E-MAIL
(360)385-9410 (360)385-9401 BonnieOt co.jefferson.wa.us
IS THE COUNTY A SUBRECIP1ENT FOR PURPOSES OF THIS PROGRAM ASSISTANCE LISTING NUMBERS
AGREEMENT?
No
PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT
07/01/2026 06/30/2027 $974,829.00 _
EXHIBITS. The following Exhibits are attached. Exhibit A—Data Security Requirements;Exhibit B—Budget and
Spending Plan
By their signatures below,the parties agree to the terms and conditions of this County Program Agreement and all
documents incorporated by reference. No other understandings or representations,oral or otherwise, regarding the
subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify
that they are authorized to sign this Program Agreement.
COUNTY SIGNATURE(S) PRINTED NAME(S)AND TITLE(S) DATE(S)SIGNED
1�
Greg Brotherlon,Chair if
Board of County Commissioners
tjp
Jefferson County Washington ('a
DSHS S ATURE PRINTED NAME AND TITLE DATE SIGNED
'LCt all Jessica Barbour, Contract Specialist 07/10/2026
Approval as to form only:
�106-16-2026
Jere +lrer. Date Page 1
DSHS Central Contract Services Civil Deputy Prosecuting Attorney
1769CS County Agreement(12-26-2025) Jefferson County Washington
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 11 of 39
Special Terms and Conditions
1. Definitions Specific to Program Agreement: The words and phrases listed below, as used in this
Program Agreement, shall each have the following definitions:
a. "Acuity Level"means the level of a Client's abilities and needs as determined through the DDCS
assessment.
b. "ALTSA Web Access(AWA)"means a web-based portal to the Developmental Disabilities
Community Services CARE system designed to support county services for DDCS clients.
c. "Additional Consumer Services"refers to indirect Client service types as follows:
(1) "Community Information and Education": Activities to inform and/or educate the general public
about developmental disabilities and related services. These may include information and
referral services: activities aimed at promoting public awareness and involvement: and
community consultation, capacity building and organization activities.
(2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or
interning students in the provision of services to people with developmental disabilities. Also to
enhance program related skills of board or advisory board members.
(3) "Other Activities"reserved for special projects and demonstrations categorized into the following
types:
(a) Infrastructure projects: Projects in support of Clients(services not easily tracked back to a
specific working age Client)or that directly benefit a Client(s)but the Client is not of working
age. Examples include planning services like generic job development e.g. "Project
Search".
(b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples
include equipment purchases and agency administrative support.
(c) Partnership Project: Collaborative partnerships with school districts, employment providers.
DVR, families, employers and other community collaborators needed to provide the
employment supports and services young adults with developmental disabilities require to
become employed during the school year they turn twenty-one(21).
d. "Budget and Accounting Reporting System (BARS)"means a master classification of balance
sheet, revenue and expenditure/expense accounts.
e. "Client"means a person with a developmental disability as defined in chapter 388-823 WAC who is
currently eligible and active with the Developmental Disabilities Community Services or is an
identified PASRR Client.
f. "Competitive Integrated Employment"means work performed by a Client on a part-time or full-time
basis. within an integrated setting within the community that meets HCBS settings requirements.
The Client must be compensated at minimum wage or higher, using the higher of the Federal.
State, or local rate, and at a rate comparable to the wage paid to non-disabled workers performing
the same tasks, including receiving the same benefits and opportunities for advancement.
g. "Consumer Support"refers to direct Client service types as follows:
(1) "Community Inclusion"or"CI": means individualized services provided in integrated community
settings with other individuals without disabilities. The activities are based on Client interests
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and provide opportunities typically experienced by the general public of similar age in their local
community, accessible by public transit or a reasonable commute from their home. The goal of
the service is to support clients to participate,contribute, and develop relationships with
community members who are not paid staff. These services may be authorized for individuals
age 62 and older. These services may be authorized in addition to or instead of employment
support(Individual Employment or Group Supported Employment)for working age individuals
who have received nine months of employment support.
(2) "Child Development Services"or"CDS": Birth to three services are designed to meet the
developmental needs of each eligible child and the needs of the family related to enhancing the
child's development. Service may include assistive technology, audiology, family training/home
visits, health services, medical services, nursing services, nutrition services, occupational
therapy, physical therapy, psychological services, sign language, social work, special
instruction, speech-language pathology, vision,and transportation. Services are provided in
natural environments to the maximum extent appropriate.
(3) "Individual Supported Employment"or"IE":services are a part of a Client's pathway to
employment and are tailored to individual needs, interests, and abilities, and promote career
development. These are individualized services necessary to help persons with developmental
disabilities obtain and continue integrated employment at or above the state's minimum wage in
the general workforce. These services may include intake, discovery, assessment,job
preparation,job marketing,job supports,record keeping and support to maintain a job.
(4) "Individualized Technical Assistance"or"ITA": services are a part of a Client's pathway to
individual employment or community inclusion. This service provides assessment and
consultation to the provider to identify and address existing barriers to employment or
community inclusion. This is in addition to supports received through supported employment or
community inclusion services for Clients who have not yet achieved their goal.
(5) "Group Supported Employment"or"GSE": services are a part of a Client's pathway to integrated
jobs in typical community employment. These services are intended to be short term and offer
ongoing supervised employment for groups of no more than eight(8)workers with disabilities in
the same setting. The service outcome is sustained paid employment leading to further career
development in integrated employment at or above minimum wage. Examples include
enclaves, mobile crews, and other business models employing small groups of workers with
disabilities in integrated employment in community settings.
h. "County"is the political subdivision of the state of Washington and the county or counties entering
into this Program Agreement.
i. "DDCS Case Resource Manager(CRM)"means a case manager for DDCS Clients.
j. "County Service Authorization (CSA)"means an authorization for county services.
k. "Developmental disabilities(DD)"means a disability attributable to intellectual disability, cerebral
palsy, epilepsy, autism,or another neurological or other condition of an individual found by the
secretary to be closely related to an intellectual disability or to require treatment similar to 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.
I. "Developmental Disabilities Community Services"DDCS"means a division within the Department of
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Social and Health Services.
m. "DDCS Regional office(DDCS Region)"means the regional DDCS office that supports DDCS
clients.
n. "Division of Vocational Rehabilitation (DVR)"means a division within the Department of Social and
Health Services
o. "Employment Outcome Payment"means a payment to providers for transition students born
between specific dates; have high acuity; are authorized for Individual employment and student
obtains a competitive integrated job within a specific timeframes. If the job is a minimum of ten
hours of work per week an additional amount will be include in the payment.
p. "General Terms and Conditions"means the contractual provisions contained within that agreement,
which govern the contractual relationship between DSHS and the county.
q. "High Acuity Client"means a DDCS Client who requires significant and intensive support in the
community, often due to complex needs, as determined through the DDCS assessment.
r. "Medicaid Home and Community Based Services(HCBS)"means services that occur in a Client's
home or community rather than institutions or other isolated settings. These programs serve a
variety of targeted populations groups, such as people with intellectual or developmental
disabilities, physical disabilities, and/or mental illnesses
s. "Job Foundation Report"is a document derived from employment readiness activities performed by
students who are between ages 19 through 20 that identifies actionable next step for employment.
The employment service providers developing the Job Foundation report will be supporting
students with employment activities on average of 35 hours.
t. "Preadmission Screening and Resident Review(PASRR)" means individuals with intellectual
disabilities or related conditions(ID/RC)who have been referred for nursing facility(NF)care.
u. "Person Centered Service Plan or PCSP"means a document that authorizes and identifies the
DDCS paid services to meet a Client's assessed needs. Formerly referred to as the Individual
Support Plan.
v. "Quality Assurance"means an adherence to all Program Agreement requirements, including DDCS
Policy 6.13, Provider Qualifications for Employment and Day Program Services, County Guidelines
and the Criteria for Evaluation, as well as a focus on reasonably expected levels of performance.
quality, and practice.
w. "Quality Improvement"means a focus on activities to improve performance above minimum
standards and reasonably expected levels of performance, quality and practice.
x. "Service Provider"is a qualified Client service vendor who is contracted to provide Employment and
Day Program services.
y. "Subcontractor"is the service provider contracted by the County to provide services.
2. Purpose: This Program Agreement is entered into between the Developmental Disabilities Community
Services and the County in accordance with chapter 71A.14 RCW. Its purpose is to advance the state
legislative policy to provide a coordinated and comprehensive state and local program of services for
persons with developmental disabilities.
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3. Client Eligibility: Client eligibility and service referral are the responsibility of DDCS under chapter
388-823 WAC(Eligibility)and chapter 388-825 WAC(Service Rules). Only persons referred by DDCS
shall be eligible for direct Client services under this Program Agreement. It is DDCS's responsibility to
determine and authorize the appropriate direct service(s)type. Direct Client services provided without
a current County Service Authorization are not reimbursable under this Program Agreement.
4. Credentials and Minimum Requirements:
a. Administration of the developmental disabilities County program cannot be subcontracted.
b. Qualified DD Program Coordinator A qualified DD program coordinator has a minimum of five
years training and experience in the administration and/or the delivery of developmental disabilities
services to a community. For a county where the coordinator administers more than one program
area(e.g. Chemical Dependency. Mental Health. Developmental Disabilities),training and
experience in administration and/or a related Human or Social service may be considered.
c. Administration Responsibility: The County must demonstrate the ability to administer the program
agreement including contract oversight and monitoring, community outreach and education
activities. and regular communication with the DDCS Regional Office(DDCS region) and contracted
providers.
d. Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including
maintaining books, records. documents and other materials relevant to the provision of goods and
services.
e. Sufficient Policies and Procedures for establishment and maintenance of adequate internal control
systems: The County will maintain written policy procedural manuals for information systems,
personnel, and accounting/finance in sufficient detail such that operations can continue should
staffing change or absences occur. Policies shall be dated and include dates when updated.
f. Background/Criminal History Check: A background/criminal history clearance is required every
three years for all employees(including DD program County staff), subcontractors. and/or
volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with
RCW 43.43.830-845, RCW 74.15.030, and chapter 388 WAC. If the entity reviewing the application
elects to hire or retain an individual after receiving notice that the applicant has a conviction for an
offense that would disqualify the applicant from having unsupervised access to vulnerable adults as
defined in chapter 74 34 RCW. then DDCS shall deny payment for any subsequent services
rendered by the disqualified individual provider. The DSHS Background Check Central Unit(BCCU)
must be utilized to obtain background clearance.
g. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include
members knowledgeable about developmental disabilities. No board member shall have a contract
with the County to provide Training, Community Information Activities. and Consumer Support as
defined in this Program Agreement, and shall not be a board member, officer, or employee of an
agency subcontracting with the County to provide such services_
h. Qualified Service Providers: The County assures that all service providers meet qualifications as
outlined in the DDCS Policy 6.13, Program Qualifications for Employment and Day Program
Providers.
i. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County
assures that each subcontractor has agreed to assign to DDCS its Medicaid billing rights for
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services to DDCS Clients eligible under Title XIX programs in this Program Agreement.Written
documentation shall be available to DSHS on request.
j. Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters
under RCW 74.34.020(13)must comply with reporting requirements described in RCW 74.34.035,
.040 and chapter 26.44 RCW. If the County is notified by DSHS that a subcontractor staff member
is cited or on the registry for a substantiated finding, then that associated staff will be prohibited
from providing services under this Program Agreement.
k. Counties who provide Child Development Services(birth to three early intervention services), must
provide those services under the regulations implementing the Individuals with Disabilities
Education Act(IDEA), Part C, and Washington State's Early Support for Infant and Toddler
Federally Approved Plan.
I. The County staff who perform evaluations of subcontractor work sites will promptly report to DSHS
per DDCS Policy 6-08, Incident Management and Reporting Requirements for County and County-
Contracted Providers, if:
(1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or
neglect(as defined in RCW 74.34.020)of a person who has a developmental disability(as
defined in RCW 71A.10.020)has occurred, and,
(2) If they have reason to suspect that sexual or physical assault of such a person has occurred,
they shall also immediately report to the appropriate law enforcement agency.
m. Counties are specifically authorized to have data storage on portable devices or media in
accordance with the Data Security Requirements.
n. Order of Precedence: In the event of any inconsistency in this Program Agreement and any
attached exhibits, unless otherwise provided herein,the inconsistency shall be resolved by giving
precedence, in the following order,to:
(1) County Program Agreement; and
(2) Attached Exhibits.
5. Duty to Disclose: Under 42 CFR§455.104,the Administration must obtain certain disclosures and
complete required screenings to ensure the State does not pay federal funds to excluded person or
entities. The County is required to provide disclosures from managing employees, specifically the
persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director,i.e.the
person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS
Form 27-094, should be submitted to the Administration to complete the required screenings.
Disclosures must be provided at contract renewal and within thirty-five(35)days whenever there is a
change in the staff holding these management positions[42 CFR 455.104(c)(1)].
6. Statement of Work: The County shall provide the services and staff, and otherwise do all things
necessary for or incidental to the performance of work, as set forth below.Working collaboratively and
sharing information as needed for service coordination, the parties shall administer DD services within
the county as set forth below:
a. The DDCS region shall:
(1) Review subcontractors and shall immediately notify the County of any concerns with the
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subcontractors identified by the County;
(2) Inform and include the County in the discharge planning of Client's leaving institutions and
returning to the community who will need program funding;
(3) Inform the County of Clients who have had their waiver status changed;
(4) Work with the County when referring Client's for services and will withdraw referrals when
authorization is not issued;
(5) Authorize new service within 5 working days and will extend existing service authorization
before expiration date;
(6) Inform Clients of service changes through Planned Action Notice(s);
(7) Work with the County to document planned services in the Client's Person Centered Service
Plan including notification of assessment dates;
(8) Work with the County when terminating services;
(9) Work with DDCS Head Quarters and the County on Spending Plan adjustments; and
(10)Work with the County in participating in evaluation of direct service providers.
b. The County shall:
(1) Work with the DDCS Region when Clients are referred for services, authorized services, and/or
for support modifications;
(2) Work with the DDCS Region to document planned services in the Client's Person Centered
Service Plan;
(3) Assist with informing the DDCS Region of any potential service level changes not documented
in the Client's DD Assessment prior to any changes;
(4) Work with the DDCS Region regarding service termination;
(5) Work with the DDCS Head Quarters on Spending Plan adjustments;
(6) Inform the DDCS Region of new providers to be included on the ALTSA Web Access(AWA)
system;
(7) Notify the DDCS Region of any intent to terminate a subcontractor who is serving a DDCS
referral;
(8) Provide a copy of each subcontractor's contract upon written request from DDCS; and
(9) Notify and work with the DDCS Regional Employment Specialist when performing evaluations of
direct service providers.
c. Compliance with Budget and Accounting Reporting System Policies: The County shall take any
necessary and reasonable steps to comply with BARS Policies.
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d. The County shall comply with the following referenced documents:
(1) DDCS Policy 4.11, County Services for Working Age Adults;
(2) Chapter WAC 388-850, chapter 388-828 WAC, WAC 388-845-0001, 0030, 0210, 0215, 0220,
0600-0610, 1030-1040, 2100, 2110;
(3) Criteria for Evaluation;
(4) DDA Guiding Values:
(5) County Guide to Achieve DDA's Guiding Values;
(6) DDA Guidelines for Community Assessments within Employment and Vocational Programs; and
(7) Disability Rights Washington (formerly Washington Protection and Advocacy System)Access
Agreement.
e. The County shall develop and submit a comprehensive plan for the County DD Services as
required by WAC 388-850-020.
f. Conveyance of The Estimated Number of People to be Served and Targeted Outcomes:The
County shall submit the Service Information Forms(SIF's)(provided by DDCS at Internet site
https://www.dshs.wa.gov/dda/county-best-practices)to indicate the estimated number of people to
be served, targeted outcomes, and identified goal(s)that focus on quality improvement within the
categories of Training, Community Information. Direct Client Services. and Other Activities within 30
days of execution of the Program Agreement. Once approved,the SIF outcomes may be modified
only by mutual agreement of the County and the DDCS Region.
g. Solicitation for Qualified Employment and Day Program Service Providers: Requests for
Applications(RFAs). Requests for Information (RFI's)and/or Requests for Proposals(RFPs).
Requests for Qualifications(RFQ's)for direct services, excluding Child Development, will be open
continuous enrollment.
h. Qualified Providers: A qualified provider must be a county or an individual or agency contracted
with a county or DDCS.
i. Technical Assistance: DDCS contracts with Technical Assistance providers that may be utilized by
Counties with prior written approval.
j. Subcontractors: The County will pass on all applicable contractual requirements that are between
DDCS and the County to the subcontractor. The County shall immediately notify the DDCS Region
of the County's intent to terminate a subcontractor who is serving a DDCS referral. Individuals or
agencies contracted with a county or DDCS may not subcontract for Employment or Community
Inclusion services.
k. The County shall provide or contract with qualified Employment and Day Program Service
Providers for consumer support services that include the following program outcomes:
(1) Monthly Community Inclusion (CI)service support hours will be based on the Clients CI service
level per WAC 388-828-9310 for all Clients who began receiving CI services July 1, 2011 and
forward.
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(a) To ensure health and safety, promote positive image and relationships in the community,
increase competence and individualized skill-building, and achieve other expected benefits
of CI, services will occur individually or in a group of no more than two(2)or three(3)
Client's with similar interests and needs.
(b) CI services will focus on activities that are typically experienced by the general public.
Support to participate in segregated activities and/or specialized activities will not be
reimbursed.
(2) Clients in an employment program will be supported to work towards a living wage. A living
wage is the amount needed to enable a Client to meet or exceed living expenses. Clients
should be supported to average twenty(20)hours of community work per week or eighty-six
(86)hours per month; however, each person's preferred hours of employment should be taken
into consideration. The amount of service a Client receives will be based on his/her
demonstrated need, acuity level and work history per WAC 388-828.
(3) The Client's DDCS PCSP is the driver for service. The AWA County Service Authorization
(CSA)and updated Planned Rates information will not exceed the Client's DDCS PCSP.
Service changes will not occur until the Client has received proper notification from DDCS.
(4) All Clients will have an Individualized Employment and/or Community Inclusion plan to identify
Client's preferences. Minimum plan elements are outlined in the reference document"Criteria
for an Evaluation." A copy of the Client's individualized plan will be provided to the Client,their
DDCS Case Resource Manager(CRM), guardian and others as appropriate.
(5) Six-month progress reports describing the progress made towards achieving Client's goal will
be provided by the service provider to the CRM, Client, and/or guardian, if any,within 30 days
following the six-month period. The report will summarize activities and outcomes made towards
the Client's individualized goal(s).AII Clients will be contacted by their service provider according
to Client need and at least once per month.
(6) All Clients will be contacted by their service provider according to Client need and at least once
per month.
(7) If Clients in Individual Employment or Group Supported Employment, have not obtained paid
employment at minimum wage or higher within six (6)months,the County will assure the
following steps are taken:
(a) Review the progress toward employment goals;
(b) Provide evidence of consultation with the Client/guardian; and
(c) Develop additional strategies with the Client/guardian, county staff, employment support
staff, case manager, and others identified by the Client. Strategies may include providing
technical assistance, changing to a new provider, and/or providing additional resources as
needed to support the Client's pursuit of employment. The additional strategies will be
documented for each Client and kept in the Client's file(s).
(8) If after twelve (12)months the Client remains unemployed, an additional review will be
conducted. The provider will address steps outlined in the previous six month progress report in
the next six month progress report. When requesting to participate in CI, the Client shall
communicate directly with his or her DDCS Case Manager. The DDCS Case Manager is
responsible for authorizing CI services.
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(9) For Individual Employment where the service provider is also the Client's employer, long term
funding will remain available to the service provider employer for six months after the employee
DDCS Client's date of hire. At the end of the six-month period, if the DDCS Client continues to
need support on the job, another service provider who is not the employer of record must
provide the support unless the County or DDCS issues prior written approval for the service
provider to continue to provide long-term supports if needed. If the County or DDCS approves
the continuation of long-term supports where the service provider is also the Client's employer.
the County or DDCS will regularly monitor these positions to assure fading efforts occur when
appropriate and any potential conflict of interest is addressed.
(10)Individual Employment staff hours must be attributed to the"Individual Employment and Billable
Activity Phase(s).
(11)For Group Supported Employment(GSE), Clients must have paid work. The total number of
direct service staff hours provided to the group should be equal to or greater than the group's
collective amount of individual support monthly base hours. If the direct service staff hours are
less than the collective amount,then the provider will be reimbursed only for the number of hours
staff actually provided.
(a) The collective group's individual hours should be the minimum staff hours delivered to
support the group.
(b) A GSE Client must be on-site/at work at least their base individual hours as a minimum per
month. If a Client is not on-site/at work for all of their base hours, the county should verify
that the provider delivered the collective groups individual hours to the group (what was the
number of staff hours provided to the group during the month?If it was less than the
collective group's total the provider can only bill for the staff hours that were provided).
(c) A GSE agency may not bill for a GSE Client who does not receive services during an entire
service month.
(d) A GSE agency must have a record of which staff is supporting which Clients on any given
day.
(e) A GSE agency must have supportive documentation that provides clear evidence of support
helping with specific activities as identified in the Client plan to move a Client on their
pathway towards their employment goal(s).
(f) Running a GSE service is a part of the business operation and not billable to Clients
(contract procurement, contract maintenance, or administration functions associated with
GSE).
(g) Individual time in the community working towards the individual employment goal. separate
from the group time, must include phase information (refer to Employment Phases and
Billable Activities-see Phases 1 —4 for element/activity description).
(12)Employment and day services must adhere to the Home and Community Based settings
(HCBS)requirements of 42 C.F.R. Section 441.301(c)(4), including that:
(a) The setting is integrated in the greater community and supports Clients to have full access
to the greater community:
(b) Ensures the Client receives services in the community to the same degree of access as
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individuals not receiving Medicaid HCBS:
(c) The setting provides opportunities to seek employment and work in competitive integrated
settings; and
(d) The setting facilitates individual choice regarding services and supports, and who provides
them.
I. Quality Assurance and Service Evaluation: The County shall develop and have available an
evaluation system to review services. The evaluation system must have both a Quality Assurance
and a Quality Improvement component, and both must include objective measures. The objective
measures at a minimum will include performance indicators, by acuity,that include the number of
new jobs:job loss and reasons for job loss:the percentage employed earning minimum wage or
better; and the average number of hours worked. The County's service evaluation system shall
serve as the method by which current providers demonstrate that they continue to be qualified
providers. A copy of description of such evaluation system shall be provided upon request to DDCS
for review.
m. Evaluation: The County shall evaluate and review services delivered to reasonably assure
compliance and quality. The County shall conduct at least one visit to each subcontractor every two
(2)years excluding Child Development Services subcontractors. The County shall conduct at least
one visit to Child Development Services providers every three(3)years. The County shall maintain
written documentation of all evaluations, recommendations and corrective action plans for each
subcontractor. Copies of such documentation will be provided to the DDCS upon request.
n. The County shall work with local developmental disability advisory groups to plan for and coordinate
services.
o. The County shall participate in regularly scheduled meetings between County DD staff and DDCS
staff to remain updated and current including ACHS and Regional Meetings.
p. AWA Data System: In compliance with the AWA Training Manual, the County shall use the AWA
data system for all:
(1) Billing requests;
(2) Service provider address and phone number maintenance;
(3) Evaluation dates:
(4) Employment outcome information; and
(5) Monthly provide all data described in the Billing Instructions and in the Employment Outcomes
Instructions,which is hereby incorporated by reference.
q. Assure the integrity of data submitted to the State.When data is submitted and rejected due to
errors or an error is later identified, the County will correct and resubmit the data within thirty(30)
days.
r. Review and respond the AWA"Work List' items within 5 working days including Referrals and
pending Authorization.
s. Review the AWA"Ticklers" Planned Rate tab and update the planned rate within 5 working days
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after the Planned Rate start date.
t. Partnership Project.
(1) A Job Foundation document will be completed per guidelines for eligible students. Eligible
students are DDCS clients who were born between:
(a) For fiscal year 2026 9/1/05 through 8/31/06
(b) For fiscal year 2027 9/1/06 through 8/31/07
These students currently attending school and have completed an application to participate in
this Value Based Payment(VPB) project. The VBP project application will include the following
minimum criteria identified in the sample application found at:
https://www.dshs.wa.gov/sites/default/fil es/DDA/dda/documents/Job%20Foundation%20Applica
tion 040720%20%28002%29.docx
(2) Qualified providers will collaborate with School District staff to complete the Job Foundation
document and then provide a copy to the County. To be a qualified provider for the Partnership
Project the Counties must require the provider to have a current contract with the Division of
Vocational Rehabilitation; a contract in good standing with the County and cannot be in
provisional status: a minimum of two years' experience providing Individual Employment with
demonstrated job placement skills. The Job Foundation recommendation will only have
actionable next steps towards integrated competitive employment.
(3) County participating in the Partnership Project must have the ability to work collaboratively with
School Districts to identify DDCS students in high school. collect and track information, be
proficient in electronic spreadsheets, and ability to evaluate if completed Job Foundation
document(s)meet quality standards.
u. Outcome Payment.
Providers. with transition students born between:
(a) For fiscal year 2026 9/1/03 through 8/31/04
(b) For fiscal year 2027 9/1/04 through 8/31/05
(2) High acuity transition students who are authorized for Individual employment, the provider may
receive one outcome payment if transition student obtains a competitive integrated job approved
by the County within timeframes described in the chart in the Billing Instructions. If the County
is also the service provider DDCS will provide the job approval. If the job is at a minimum of ten
hours of work per week an additional amount will be include in the payment.
(3) High acuity Clients who are authorized for Individual employment, provider may receive one
outcome payment if client obtains a new competitive integrated job at a minimum of ten hours of
work per week for a minimum of 4 out of each 6 months during the fiscal year_
(4) Client who are authorized for Community Inclusion who have an acuity of F which equals 18
support hours per month or G which equals 20 support hours per month as based on the
Support Intensity Scale(SIS). provider may receive on outcome payment per month if provider
delivers a minimum of 80%of the authorized hours.
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(5) A new Community Inclusion referral is defined as a Client who has a new County Service
Authorization (CSA). Incentive/outcome payments to accept and support overall increased
CSAs billed over the year may be requested from DDCS if funds are available.
(6) Community Inclusion case notes and 6-month progress report summary review that scores 16
points or more with the"Community Inclusion Case Note Review Tool"when used in
conjunction with a Community Inclusion plan that has scored 20+points with the Community
Inclusion plan Quality review tool, provider may receive an outcome payment.
(7) All outcome payments are described in the chart in the Billing Instructions.
7. Consideration:
a. Fees:
(1) Approval of fees is the responsibility of the DDCS. The DDCS HQ Employment and Day Unit
Manager reserves the right to approve fees/rates for the services being provided. The County
will submit a fee/rate schedule with the initial Program Agreement. The County will submit
updated fee/rate schedules to the HQ Employment and Day Unit Manager for approval as
changes occur. The rate schedule will include the following information:
(a) County(s)name;
(b) Time period for which the schedule is applicable: and
(c) Each contracted direct service(IE, GSE, CI, ITA, CDS)and its associated rate.
(2) Fee Limitations: The Billing Instructions found on the County Best Practices site provides
limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four.
b. Budget and Spending Plan, attached as Exhibit B:
(1) Budget amount listed in Exhibit B: The County may not exceed the state only revenue dollar
amount or the total revenue dollar amount indicated on the Program Budget Agreement
included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate
Clients moving from state-only employment and day services to waiver employment and day
services.
(2) Spending Plan: DDCS will provide the initial spending plan/Program Agreement Budget/
Exhibit B. Funding shall be distributed under State and Medicaid in the revenue section. The
planned expenditures for Consumer Support are based on authorized Clients, their acuity level
and work history for a given point in time. To determine the Additional Consumer Support
amount. the Consumer Support amount is multiplied by a percentage. The spending plan may
only be modified by mutual agreement of the parties in writing and shall not require a program
agreement amendment.
(a) Funds Designated for Additional Consumer Services: If a County provides Community
Information and Education services under additional consumer services, then activities must
include outreach efforts to federally recognized local tribes.
(b) Funds Designated for Adult Day Care Consumers: Funds designated for Adult Day Care
Consumers are available to Clients who were served between December 1996 and
December 2003 in Adult Day Health agencies and were subsequently determined ineligible
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for Level II or III services(Adult Day Health). Level II and III services are licensed
rehabilitation and skilled nursing services along with socialization. Level I services(Adult
Day Care)are supervised day programs where frail and disabled adults can participate in
social, educational, and recreational programs without the need for skilled nursing. These
Clients may be referred to services defined in the statement of work, or to an Adult Day Care
service other than Level II or III. If a aient no longer needs and wants services,the funds
are available for other Clients who are not part of the group of original Clients identified
between December 1996 and 2003. An Adult Day Care service shall only be provided by
Adult Day Care agencies certified by the local Area Agency on Aging.Adult Day Care
service is not a waiver approved service.
c. Program Agreement Amendments:A County can request an amendment at any time. An
amendment for additional Client(s)may be supported when clients exceed the number used to
develop the contract. An amendment for additional service hours authorized may be supported
when county provides evidence. An amendment request for expenditures exceeding contract total
due to hourly rates paid to service provider may not be supported as the county is responsible to
manage contract and rates paid to their providers.
d. Exemptions: The DDCS Assistant Secretary may approve in writing an exemption to a specific
program agreement requirement.
8. Billing and Payment:
a. Program Agreement Budget: DSHS shall pay the County all allowable costs,which are defined by
DDCS as cost incurred by the program for:
(1) Administration: Costs of the County Human Services Department or similar county office,
responsible for administration of the Developmental Disabilities Program. Allowable costs
include personnel and overhead costs directly related to the administration and coordination of
the program, including such activities as program planning, budgeting, contracting, monitoring,
and evaluation. Also induded are departmental and county indirect and/or direct administrative
costs, to the extent that such costs are appropriately allocated to the program using an
established methodology consistent with grants management guidelines. For a County whose
designated coordinator manages multiple programs, the County must be able to provide
evidence of the time the coordinator spent working on the Developmental Disabilities program.
(2) Additional Consumer Services:
(a) Training:
i. Staff Training: Costs incurred by the program for planned, structured activities for the
purpose of providing, or improving, or enhancing job-related knowledge and skills of
staff, providers,volunteers,or interning students in the provision of developmental
disabilities services.
ii. Board Training: Costs incurred by the program for planned, structured activities
designed to provide, improve, or enhance program-related skills of board and advisory
committee members.
(b) Community Information and Education: to inform and/or educate the general public about
developmental disabilities and related services. These may include information and referral
services; activities aimed at promoting public awareness and involvement;and community
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consultation, capacity building and organization activities.
(c) Other Activities.
i. Infrastructure projects: Projects in support of Clients(services not easily tracked back to
a specific working age Client)or that directly benefit a Client(s)but the Client is not of
working age. Examples include planning services like generic job development e.g.
"Project Search."
ii. Start-up projects: Projects that support an agency or directly benefit the agency.
Examples include equipment purchases and agency administrative support.
iii. Partnership project: Collaborative partnerships with school districts,employment
providers, Division of Vocational Rehabilitation(DVR),families, employers and other
community collaborators needed to provide the employment supports and services
young adults with developmental disabilities require to become employed during the
school year they turn twenty-one(21). Supports provided should complement and not
replace what the student(s)receive through the Individualized Education Program (IEP).
(3) Consumer Support.
(a) Adult Day Care services are available to Clients who were served between December 1996
and December 2003 in Adult Day Health agencies and were subsequently determined
ineligible for Level II or III services(Adult Day Health). Level II and III services are licensed
rehabilitation and skilled nursing services along with socialization. Level I services(Adult
Day Care)are supervised day programs where frail and disabled adults can participate in
social, educational, and recreational programs without the need for skilled nursing.
(b) Community Inclusion Services are individualized and provided in integrated community
settings with other individuals without disabilities. The activities are based on Client
interests and provide opportunities typically experienced by the general public of similar age
in their local community, accessible by public transit or a reasonable commute from their
home. The goal of the service is to support Clients to participate, contribute, and develop
relationships with community members who are not paid staff. These services may be
authorized for individuals age 62 and older. These services may be authorized in addition to
or instead of employment support(Individual Employment or Group Supported Employment)
for working age individuals who have received nine months of employment support.
(c) Child Development Services are designed to meet the developmental needs of each eligible
child and the needs of the family related to enhancing the child's development. Service may
include: assistive technology, audiology, family training/home visits, health services,
medical services, nursing services, nutrition services, occupational therapy, physical
therapy, psychological services, sign language, social work, special instruction, speech-
language pathology,vision, and transportation. Services are provided in natural
environments to the maximum extent appropriate.
(d) Individual Supported Employment services are a part of a Client's pathway to employment
and are tailored to individual needs, interests, and abilities to promote career development.
These are individualized services necessary to help persons with developmental disabilities
obtain and continue integrated employment at or above the state's minimum wage in the
general workforce. These services may include intake,discovery, assessment,job
preparation,job marketing,job supports, record keeping and support to maintain a job(per
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the Individual Employment Phases& Billable Activities)
(e) Individualized Technical Assistance services are a part of a Client's pathway to employment
or community inclusion. This service provides assessment and consultation to the provider
to identify and address existing barriers to employment or community inclusion. This is in
addition to supports received through supported employment or community inclusion
services for individuals who have not yet achieved their goal.
(f) Group Supported Employment services are a part of a Client's pathway to integrated jobs in
typical community employment. These services are intended to be short term and offer
ongoing supervised employment for groups of no more than eight(8)workers with
disabilities in the same setting. The service outcome is sustained paid employment leading
to further career development in integrated employment at or above minimum wage.
Examples include enclaves, mobile crews, and other business models employing small
groups of workers with disabilities in integrated employment community settings.
b. Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this
Program Agreement. However, with a Program Agreement amendment,the parties may increase
or decrease the Program Agreement amount. Counties will work with DDCS HQ on amendments to
the Program Agreement.
c. Monthly Invoice with Signed Documentation: All requests for reimbursement amounts must be
entered and posted into the AWA system. The County may post a combined claim of all
programs/services covered by this Program Agreement. DSHS shall make all payments due to the
County for all invoices submitted pursuant to this section within forty five(45)days following posting
of required information.
d. Clients will be assisted in accessing DVR services per the DDCS/DVR MOU. Client services shall
not be reimbursed under this Program Agreement when the same services are paid for under the
Rehabilitation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private
funding.
e. Reimbursement of Client Services: A claim for each Client is made on the AWA system by
indicating the number of service units delivered to each Client listed and the fee per unit. Units are
defined as:
(1) An "Hour"is at least fifty(50)minutes of direct service. Partial hour to the quarter may be
recorded.
(2) A"Day"is at least four(4)hours of direct service and will only be used in connection with Adult
Day Care reimbursement.
(3) A"Month" represents a minimum of at least fifty(50)minutes of direct service for CDS
reimbursement.
f. Program Administration: The County will provide program administration and coordination including
such activities as planning. budgeting, contracting. monitoring. and evaluation. Monthly claims for
administration can be 1/12 of the maximum amount identified in Exhibit B under Administration or
for the actual costs incurred in the given month but the total Administration billed will be the lesser
of the two.Administration cost reimbursement will not exceed 10% unless the Assistant Secretary
of DDCS approves a request for an exception under chapter 388-850 WAC.
g. The Individual Employment Phases& Billable Activities document defines the individual Client
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services that DDCS reimburses. That document is located on the DSHS DDCS County Best
Practices Web site at https://www.dshS Wa.gov/ddalcounty-best-practices.
h. The Community Inclusion Billable Activities document defines the individual Client services
DDCS reimburses. That document is located on the DSHS DDCS County Best Practices Web site
at https:/twww.dshs.w.a qov/dda/county-best-practices.
i. Timeliness of and Modification to Billings: All initial invoices with signed documentation must be
received by the DDCS Region within forty-five(45) calendar days following the last day of the
month in which the service is provided. Corrected invoices and documentation including re-posted
billing information will be accepted throughout the fiscal year as long as they are received within
sixty(60)calendar days of the associated fiscal year unless an extension is approved by the DDCS
Regional Administrator or designee. Payment will not be made on any invoice submitted past sixty
(60)calendar days after the Program Agreement fiscal year.
j. Recovery of Fees: If the County bills and is paid fees for services that DSHS later finds were(a)not
delivered or(b)not delivered in accordance with Program Agreement standards, DSHS shall
recover the fees for those services and the County shall fully cooperate during the recovery.
k. Preadmission Screening and Resident Review (PASRR)Administration: The County may bill for
administration costs as identified in Exhibit B. Monthly claims for administration cost will be based
on the actual PASRR expenditures multiplied by 10%.
I. Reimbursement for Partnership project: A claim of$3,000 per student for each completed Job
Foundation document that is at a satisfactory or above rating will be requested through the AWA
system as other monthly cost.
m. Job Foundation report line item 95 as identified in the ADSA VVeb Access(AWA)billing system.A
copy of the completed Job Foundation document will be sent electronically to the shared mailbox
located at: DDAJobFoundationReportsadshs.wa.00v
n. Job placement verification for transition students: The AWA Employment Output for Individual
Employment will be completed and submitted with payment request to verify employer,job start
date,job type, etc.
o. Job Foundation Administration: The County may bill for administration costs as identified in Exhibit
B. Monthly claims for administration cost will be based on the actual expenditures multiplied by
10%. Participating counties will use line item 13.
9. Intermediate Care Facilities for Intellectual Disabilities(ICF/ID)Agreement. If applicable per 42
CFR 483.410, the County shall assure that all county-operated or subcontracted programs serving
persons living in ICF/ID facilities develop a plan and coordinate their services with the facility on behalf
of the ICF/ID resident.
10. Single State Medicaid Agency—Health Care Authority(HCA): HCA, as the single state Medicaid
Agency. has administrative authority for Title XIX coverage per 42 CFR 431.10. DSHS is the operating
agency for the Home and Community Based Waivers for services for people with developmental
disabilities. The County only has responsibility for services covered in this agreement.
11. DSHS/DRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDCS is
incorporated by reference. The County assures that it and its subcontractors have reviewed the
Access Agreement. The agreement covers DRWs access to individuals with developmental
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disabilities, Clients, programs and records, outreach activities, authority to investigate allegations of
abuse and neglect, and other miscellaneous matters and is binding for all providers of DDCS
contracted services.
12. Confidential Information. All Counties and their subcontractors must:
a. Ensure the security of Confidential Information, and
b. Wien transporting client records containing Confidential Information outside a Secure Area, one or
more of the following as appropriate:
(1) Using a Trusted Network; or
(2) Encrypting the Confidential Information, including:
(a) Email and/or email attachments
(b) Confidential Information when it is stored on portable devices or media induding but not
limited to laptop computers and flash memory devices.
13. Data Security Requirements. Exhibit A shall only apply to the County if the County possesses 150 or
more DSHS records across all programs or services throughout their organization, or transmits more
than 5 records at one time.
14. Supersession of Prior Data Security Agreement. If the Parties hereto have previously entered into a
Standalone Data Security Requirements Agreement, both Parties hereby agree that upon mutual
execution said Agreement shall take precedence as the sole Data security Agreement between the
Parties.
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Exhibit A—Data Security Requirements
1. Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following
definitions:
a. "AES"means the Advanced Encryption Standard, a specification of Federal Information Processing
Standards Publications for the encryption of electronic data issued by the National Institute of
Standards and Technology(https://nvlpubs.nist.gov/nistpubs/FIPS/NIST.FIPS.197-upol.pdf).
b. "Authorized Users(s)"means an individual or individuals with a business need to access DSHS
Confidential Information, and who has or have been authorized to do so.
c. "Category 4 Data"is data that is confidential and requires special handling due to statutes or
regulations that require especially strict protection of the data and from which especially serious
consequences may arise in the event of any compromise of such data. For purposes of this
contract, data classified as Category 4 refers to data protected by: the Health Insurance Portability
and Accountability Act(HIPAA).
d. "Cloud"means data storage on servers hosted by an entity other than the Contractor and on a
network outside the control of the Contractor. Physical storage of data in the cloud typically spans
multiple servers and often multiple locations. Cloud storage can be divided between consumer
grade storage for personal files and enterprise grade for companies and governmental entities.
Examples of consumer grade storage would include iCloud, Dropbox, Box.com, and many other
entities. Enterprise cloud vendors include Microsoft Azure,Amazon Web Services, 0365, and
Rackspace.
e. "Encrypt"means to encode Confidential Information into a format that can only be read by those
possessing a "key";a password, digital certificate or other mechanism available only to authorized
users. Encryption must use a key length of at least 128 bits(256 preferred)for symmetric keys, or
2048 bits for asymmetric keys. When a symmetric key is used,the Advanced Encryption Standard
(AES)must be used if available.
f. "Hardened Password"means a string of at least eight characters containing at least three of the
following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special
characters such as an asterisk, ampersand, or exclamation point.
g. "Mobile Device"means a computing device, typically smaller than a notebook, which runs a mobile
operating system, such as i0S, Android, or Windows Phone. Mobile Devices include smart phones,
most tablets, and other form factors.
h. "Multi-factor Authentication"means controlling access to computers and other IT resources by
requiring two or more pieces of evidence that the user is who they claim to be. These pieces of
evidence consist of something the user knows, such as a password or PIN;something the user has
such as a key card, smart card,or physical token;and something the user is, a biometric identifier
such as a fingerprint, facial scan, or retinal scan. "PIN"means a personal identification number, a
series of numbers which act as a password for a device. Since PINs are typically only four to six
characters, PINs are usually used in conjunction with another factor of authentication, such as a
fingerprint.
i. "Portable Device"means any computing device with a small form factor, designed to be transported
from place to place. Portable devices are primarily battery powered devices with base computing
resources in the form of a processor, memory, storage, and network access. Examples include, but
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are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable
Device.
j. "Portable Media"means any machine readable media that may routinely be stored or moved
independently of computing devices. Examples include magnetic tapes, optical discs(CDs or
DVDs), flash memory(thumb drive)devices, external hard drives, and internal hard drives that have
been removed from a computing device.
k. Secure Area"means an area to which only authorized representatives of the entity possessing the
Confidential Information have access, and access is controlled through use of a key, card key,
combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or
locked storage containers(such as a filing cabinet or desk drawer)within a room, as long as access
to the Confidential Information is not available to unauthorized personnel. In otherwise Secure
Areas, such as an office with restricted access, the Data must be secured in such a way as to
prevent access by non-authorized staff such as janitorial or facility security staff, when authorized
Contractor staff are not present to ensure that non-authorized staff cannot access it.
I. "Trusted Network`means a network operated and maintained by the Contractor, which includes
security controls sufficient to protect DSHS Data on that network. Controls would include a firewall
between any other networks, access control lists on networking devices such as routers and
switches. and other such mechanisms which protect the confidentiality, integrity, and availability of
the Data.
m. "Unique User ID"means a string of characters that identifies a specific user and which, in
conjunction with a password. passphrase or other mechanism, authenticates a user to an
information system.
2. Authority. The security requirements described in this document reflect the applicable requirements of
policies and standards of the Washington Technology Services Agency
(https://watech.wa.gov/policies?combine=&field categories target id=80&field type target id=All),
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/ffaikeepinq-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.
3. 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.
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.
4. Authorization,Authentication, and Access. In order to ensure that access to the Data is limited to
authorized staff,the Contractor must:
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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
dasses: 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. Passwords that
increment by simply adding a number are not considered significantly different.
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 don't allow end-user modification.
(2) Not allowing the use of dial-up connections.
(3) Using industry standard protocols and solutions for remote access. Examples would include
RADIUS 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.
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(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.
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)
(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
abcdl2 would not be acceptable.
k. Render the device unusable after a maximum of 10 failed logon attempts.
5. 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 8 Data Disposition,may be
deferred until the disks are retired,replaced, or otherwise taken out of the Secure Area.
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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 Contractors
staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of
such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an
Authorized User's duties change such that the Authorized User no longer requires access to
perform work for this Contract.
g. Data storage on portable devices or media.
(1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on
portable devices or media unless specifically authorized within the terms and conditions of the
Contract. If so authorized,the Data shall be given the following protections::
(a) Encrypt the Data.
(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.
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(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 8 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 8
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 wiil 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 either the DSHS or 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.
Page 24
DSHS Central Contract Services
1769CS County Agreement(12-26-2025)
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 34 of 39
Special Terms and Conditions
(3) If the Data indudes 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.
6. 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.
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.
7. 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.
8. Data Disposition. When the contracted work has been completed or when the Data is no longer
needed, except as noted above in Section 5.b, 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 Data at
least three(3)times using either random or single
character data, or
Page 25
DSHS Central Contract Services
1769CS County Agreement(12-26-2025)
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 35 of 39
Special Terms and Conditions
Removable media(e.g.floppies, USB flash drives,
portable hard disks)excluding optical discs Degaussing sufficiently to ensure that the Data
cannot be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or Confidential Recycling through a contracted firm, provided the
Information contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential Information On-site shredding, pulping, or incineration
requiring special handling(e.g. protected health
information)
Optical discs(e.g. CDs or DVDs) Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Magnetic tape Degaussing, incinerating or crosscut shredding
9. Notification of Compromise or Potential Compromise. The compromise or potential compromise of
DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one(1)
business day of discovery. If no DSHS Contact is designated in the Contract,then the notification must
be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also
take actions to mitigate the risk of loss and comply with any notification or other requirements imposed
by law or DSHS.
10. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a
subcontractor,the Contract with the subcontractor must include all of the data security provisions within
this Contract and within any amendments, attachments, or exhibits within this Contract. If the
Contractor cannot protect the Data as articulated within this Contract,then the contract with the sub-
Contractor must be submitted to the DSHS Contact specified for this contract for review and approval.
Page 26
DSHS Central Contract Services
1769CS County Agreement(12-26-2025)
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 36 of 39
Exhibit B
Program Agreement Budget
Original Budget 0 Budget Revision
REVENUES
Fiscal Year Fund Source Original 1st Revision 2°d Revision 3rd Revision
2026 State only 551.096 509,369
Medicaid 512,970 476,670
Total Rev. $1,064,066 $986,066 $ $
Fiscal Year Fund Source Original 1st Revision 2'd Revision 3rd Revision
2027 State only 502,957
Medicaid 471,872
Total Rev. $974,829 $ S S
Job
Foundation PASRR Funds Medicaid
Funds State Funds Funds TOTAL
ADMINISTRATION(11,
12, 13) 0 0 48,742 39,879 88,621
OTHER CONSUMER
SUPPORTS
(31,32,41,92,93, 94,
97) 0 0 31.887 26 088 57 975
CONSUMER
SUPPORT
STATE-ONLY
(62,64,65,67,69) 0 0 0 0
Child Development(61) 16' 125 16.125
MEDICAID CLIENTS
3.000 0 404,554 404,554 812,108
ROADS to
COMMUNITY LIVING
(62,64,65,67,69) 0 0 0
TOTAL 3 000 0 501 303 470,521 974,829
Page 27
DSHS Central Contract Services
1769CS County Agreement(12-26-2025)
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 37 of 39
APPENDIX B—COMPLIANCE AND RISK MONITORING FORM
This Compliance and Risk Monitoring Form shall be submitted before the Agreement can be approved
and also shall be submitted along with every request for reimbursement.
CONTRACT NO: DD-26-058
DATE: —/ _31 - .c
NAME OF SUBAWARD CONCERNED CITIZENS
RECIPIENT:
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
Subaward Recipient is not presently debarred, suspended,
1 4'f, proposed for debarment, declared ineligible, or voluntarily i
excluded from transactions by any Federal, State, or local X(
department or agency
Subaward Recipient has not within a 3-year period
preceding the submission of this Compliance and Risk
Monitoring Form been convicted of or had a civil judgment
rendered against them for commission of fraud or a criminal
I '1 210 ; offense in connection with obtaining, attempting to obtain,
1 ; or performing a public(Federal, State, or local)transaction
)4
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
Subaward Recipient is not presently indicted for or
otherwise criminally or civilly charged by a governmental
entity (Federal, State, or local) with commission of fraud or
111 a criminal offense in connection with obtaining, attempting
31j7 ' , to obtain, or performing a public(Federal, State, or local)
transaction or contract under a public transaction; violation J�
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
Subaward Recipient has not within a 3-year period
1 31 1 7, ! preceding the submission of this Compliance and Risk �/
Monitoring Form one or more public transactions (Federal,
State, or local) terminated for cause or default
13 12 L Subaward Recipient has provided all written reports required
l by the Agency Contract and this Agreement as of
CDS Agreement with Concerned Citizens for DSI-1S Contract DD-26-039 Page 38 of 39
DATE CERTIFICATION ITEM YES NO
the submission of this Compliance and Risk Monitoring
Form
Subaward Recipient has provided any audit report received
by it from any government agency since the last
1/6�' certification for its performance related to the Agency
Contract
, Subaward Recipient certifies that all of the deliverables
1161 7(P and other work required since the last certification have x
been completed
11
All the work being billed for in the invoice being certified
N f oo by this Compliance and Risk Monitoring Form actually has
t 1 been •erformed, including_an_y timesheet or other backup
�t- Subaward Recipient agrees to submit to an audit within 30
No da s of a request from the County or the Agency
7�3t��b Subaward Recipient has corrected any deficiencies identified X
since the last certification
Signed at , G(./ t .
City State
-7-3 /-Z
U AWARD RECIPIENT SIGNATURE DATE
Eby&, $'t• �� Q.e,s
WRITTEN NAME OF PERSON SIGNING CERTIFICATION APPROVED BY THE COUNTY:
NT AP ROVALSIGNATURE DA E
WRITTEN NAME OF PERSON APPROVING CERTIFICATION
CDS Agreement with Concerned Citizens for DSHS Contract DD-26-039 Page 39 of 39
615 Sheridan Street
Port Townsend, WA 98368
c9e1[ehson www.JeffersonCountyPublicHealth.org
Consent Agenda
Public Healt
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Josh D. Peters, County Administrator
FROM: Apple Martine, Jefferson County Public Health Director
Bonnie Obremski, Intellectual and Developmental Disabilities (IDD) Coordinator
DATE: 34e(ftileAr ge:)-67
SUBJECT: Agenda item — County Subaward Agreement between Concerned Citizens and
the County of Jefferson for "Child Development Services," July 1, 2026 - June
30, 2027, fee-for-service up to $16,125.
STATEMENT OF ISSUE:
The County of Jefferson, the Intellectual and Developmental Disabilities program, requests Board approval of
the County Subaward Agreement between Concerned Citizens and the County of Jefferson for provision of
"Child Development Services,"which are defined in and reimbursed by the County's concurrent agreement
with the Washington State Department of Social and Health Services (DSHS), contract number: DD-26-039
DSHS-DDA County Svcs.
ANALYSIS/STRATEGIC GOALS/PROS and CONS:
This agreement will allow the County of Jefferson to reimburse Concerned Citizens for Child Development
Services for children ages 0-3 who experience developmental delays and are enrolled with DSHS. Concerned
Citizens is the sole Qualified Service Provider of these services in Jefferson County.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Funding for this Agreement is provided via the County's concurrent agreement with DSHS. Contract number:
DD-26-039 DSHS-DDA County Svcs.
RECOMMENDATION:
JCPH management requests approval of this agreement.
REVIEWED BY:
_)1144 .
62/62g/021,
f Josh D. 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-26-058
CONTRACT REVIEW FORM Clear Form
(INSTRUCTIONS ARE ON THE NEXT PAGE)
CONTRACT WITH: Concerned Citizens Contract No: DD-26-058
Contract For: Child Development Services Term: July 1, 2026-June 30, 2027
COUNTY DEPARTMENT: Public Health
Contact Person: Bonnie Obremski
Contact Phone: x 410
Contact email: Bonnie0@co.jefferson.wa.us
AMOUNT: $16,125 PROCESS: — Exempt from Bid Process
Revenue: Cooperative Purchase
Expenditure: $16,125 _ 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 DD#12768040 Other:
APPROVAL STEPS:
STEP 1: DEPARTMENT CERTIFIES COMA E W C 55.080 AND CHAPTER 42.23 RCW.
CERTIFIED: l i N/A:[ << - July 30, 2026
Glenn Gilbert Date
STEP 2: DEPARTMENT CERTIFIES THE PERSON PROPOSED FOR CONTRACTING WITH THE
COUNTY (CONTRACTOR) HAS NOT BEEN DEBA D BY ANY FEDERAL, STATE, OR LOCAL
AGENCY.
CERTIFIED: Ill N/A: f July 30, 2026
Glenn Gilbert Date
STEP 3: RISK MANAGEMENT REVIEW(will be added electronically through Laserfiche):
Electronically approved by Risk Management on 8/3/2026.
STEP 4: PROSECUTING ATTORNEY REVIEW(will be added electronically through Laserfiche):
Electronically approved as to form by PAO on 7/31/2026.
DPA Luther reviewed and approved on 7-31-2026.
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