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HomeMy WebLinkAbout072114_ca14Consent Agenda JEFFERSON COUNTY PUBLIC REALTH 615 Sheridan Street o Port Townsend o Washington o 98368 www,jeffersoncountypublichealth.org June 27, 2014 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERI AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Jean Baldwin, Director DATE: SUBJECT: Agenda Item — Agency Agreement with Department of Social and Health Services for Developmental Disabilities Administration,(DDA) #1463-16414; July 1, 2014 — June 30, 2015; $281,175.00 STATEMENT OF ISSUE: Jefferson County �Public Health, Developmental Disabilities Division, is requesting Board approval) of the Agency Agreement with Department of Social and Health Services for Developmental Disabilities Administration, (DDA) #1463-16414; July 1, 2014 — June 3,0, 2015; $281,175.00 AN GOALSIPRO'S and CAIN " S: S: _ This contract is a continuation of services with DSHS for services to clients with developmental disabilities in Jefferson County. The contract covers a variety of services. The services include administration, training expenses (volunteers, board members, and staff), community information activities, consumer support (Early intervention services for Child development services for Birth to 3), Group Supported Employment, Pre Vocational Services, Individual Supported Employment, Individual Technical Assistance, Community Access, and other activities (special projects). The statement of work requires a qualified coordinator, advisory board, Intermediate Care Facilities agreement (where applicable), working knowledge of [)SHS/DRW Access Agreement, Feb. 27, 2001, and assignment of Medicaid billing rights under Title XIX. Jefferson County has professional service subcontracts with agencies or organizations representing each group. The developmental disabilities program services provide educational opportunities for life-long learning and training to a specific workforce that allows interactions, equal opportunity, and integrated participation with non-disabled community members. These program services also support strategic efforts toward a sustainable economic base by recognizing the need for integrated employment opportunities for persons with disabilities. DDA program services undergird the economic reach of the disabled community by supporting programs that emphasize and address prevention, early intervention, and recovery; and provide opportunities to overcome community complexity by providing community outreach and activities that recognize the significant health issues the disabled community confronts. COMMUNITY HEALTH PUBLIC HEALTH ENVIRONMENTAL HEALTH DEVELOPMENTAL DISABILITIES ALWAYS WORKIM6 FOR A SAFER AND WATER QUALITY MAIN: (360) 385-9400 MAIN: (360) 385-9444 FAX: (360) 385-9401 HEALTHIER COMMUNITY FAX: (360) 379-4487 Consent Agenda FISCAL IMPACT COST BENEFIT ANALYSIS: This is a contract with the Department of Social and Health Services and includes both State and Waiver revenue. This revenue will be used to support programs in the Developmental Disabilities Programs. RECOMMENDATION; JCPH management request approval of the Agency Agreement with Department of Social and Health Services for Developmental Disabilities Administration, (DDA) #1463-16414; July 1, 2014 — June 30, 2015; $281,175.00 'z Philip lvl&l, CouOty t dministrator ) Date ,(Routed to all Public Health Managers) Jefferson county 615 Sheridan St Port Townsend, WA 98368- COUNTY FEDERAL COUNTY CONTACT NAME 5 : NUMBER. Anna McEnery ---F�-OUNTY CONTACT E-MAIL (360) 385-9410 0 COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX (360) 385-9401 1 aimcenery@co.jefferson.wa.us IS THE COUNTY A SUMECIPIE7 FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? I No ROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT PROGR)�ki��.,';'tGi���EEllilEl'I 063/3012015 $2A1,175.00 07/01/2014 EXHII S. The following Exhibits are attached: Exhibit A — Data Security Requirements and Exhibit B - Program Ag regiment _Burl get 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 si ni this Program ,Agreement. COUNTY SIGNATURE(S) I PRINTED NAME(S) AND TITLE(S) DATES) SIGNED I SiG DSHS Central Contract Services 1769CS County Agreement 5-7-2014 AND TITLE proved as, form onj I ff erson 0. P 0 efterson 0. Prosecutoes ice it I P David Alvarez, Chief Civil A DATE SIGNED Page I DSHS Agreement Number COUNTY �FsDc 1463-16414 V*s;h,'7 tern state EPART16ENT OF >CIAL &HEALTH 7 ` SERVICPS PROGRAM AGREEMENT DDD County Services This Program Agreement is by and between the State of Washington, Department of Administration or Division Number Social and Health Services (DSHS) and the County identified beiow, and is issued in Agreement conjunction with a,County and DSHS Agreement On General Terms and Conditions, County Agreement Number which is incorporated by reference. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Developmental Disabilities Division of Developmental 1223 1769CS-63 Disabilities Admin DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Wendi Winchel PO BOX 45315 Re lonal Business Mana er Olympia, WA 98504-5315 ii;; CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL DSHS C N 360 586-6502 winchwa(d' (360) 725-4264 COUNTY ADDRESS Jefferson county 615 Sheridan St Port Townsend, WA 98368- COUNTY FEDERAL COUNTY CONTACT NAME 5 : NUMBER. Anna McEnery ---F�-OUNTY CONTACT E-MAIL (360) 385-9410 0 COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX (360) 385-9401 1 aimcenery@co.jefferson.wa.us IS THE COUNTY A SUMECIPIE7 FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? I No ROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT PROGR)�ki��.,';'tGi���EEllilEl'I 063/3012015 $2A1,175.00 07/01/2014 EXHII S. The following Exhibits are attached: Exhibit A — Data Security Requirements and Exhibit B - Program Ag regiment _Burl get 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 si ni this Program ,Agreement. COUNTY SIGNATURE(S) I PRINTED NAME(S) AND TITLE(S) DATES) SIGNED I SiG DSHS Central Contract Services 1769CS County Agreement 5-7-2014 AND TITLE proved as, form onj I ff erson 0. P 0 efterson 0. Prosecutoes ice it I P David Alvarez, Chief Civil A DATE SIGNED Page I 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 an individual's abilities and needs as determined through the DDA assessment. b, "AWK means ADSA Web Access also referred to as the CMS. c. "Additional Consumer Services" refers to indirect client service types as follows: (1) "Community Information and Education": Activities to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. (3) "Other Activities" reserved for special projects and demonstrations categorized into the following types: (a) Infrastructure projects: Projects in support of clients (services not easily tracked back to a specific working age client) or that directly benefit a client(s) but the client is not of working age. Examples include planning services like benefits planning and generic job development eg. "Project Search." (b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support, d. 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 21. e. "ADSK means Aging & Disability Services Administration. f, "Authorized User(s)" means an individual or individuals with an authorized business requirement to access DSHS Confidential Information. 9. "BARS" means DDA Budget and Accounting Reporting System. h. "CSK means County Service Authorization. i, 11CMIS" means the Case Management Information System also referred to as AWA. j, "'Client" means a person with a developmental disability as defined in Chapter 18-8-823 WAC who is currently eligible and active with the Developmental Disabilities Administration. k, "County" means the county or counties entering into this Program Agreement. "Confidential Information" means information that is exempt from disclosure to the public or other unauthorized persons under RCW 42.56 or other federal or state laws, Confidential :information includes, but not limited to, Personal information. 0 DSHS Central Contract Services age 1769CS County Agreement 5-7-2014 Special Terms and Conditions m. "Consumer Support" refers to direct client service types as follows: (1) ""Community Access" or "CA": services are individualized services provided in typical integrated community settings for individuals in retirement. Services will promote individualized skill development, independent living and community integration for persons' to learn how to actively and independently engage in their local community. Activities will provide opportunities to develop relationships and to learn, practice and apply skills that result in greater independence and community inclusion. These services may be authorized instead of employment support (individual Employment, Group Supported Employment or Pre-Vocational services) for working age individuals who have received nine months of employment support, have not found a job and decide not to continue looking for work. (2) "Child Development Services" or "CDS": Birth to three services are designed to meet the developmental needs of each eligible child eligiible and the needs of the family related to enhancing the child's development. Services may include specialized instruction, speech- language pathology, occupational therapy, physical therapy, assistive technology, and vision services. Services are provided in natural environments to the maximum extent appropriate. (3) "Individual Supported Employment" or "IF: services are a part of an individual's pathway to employment and are tailored to individual needs, interests, and abilities to, 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 "ITX: services are a part of an individual's pathway to individual employment. This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment. This is in addition to supports received through supported employment services or pre-vocational services for individuals who have not yet achieved their employment goal. (5) "Group Supported Employment" or "GSE": services are a part of an individual's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment in community settings. (6) "Pre-Vocational Services" or "PVS": services are a part of an individual's pathway to integrated jobs in typical community employment. These services and supports are intended to be short term and should be designed to further habilitation goals that will lead to greater opportunities for competitive and integrated employment and career advancement at or above minimum wage. Services are provided by agencies established to provide services to people with disabilities and offer training and skill development for groups of workers with disabilities in the same setting as well as individual! support. Participants are provided at least monthly opportunities to experience typical community settings in support of their pursuit to integrated employment. n. "CRM" means the DDA Case Resource Manager. o. "DD" means developmental disabilities. DSHS Central Contract Services Page 3 1769CS County Agreement 5-7-2014 Special Terms and Conditions p, "DDA" means the Developmental Disabilities Administration within DSHS. q, "DDA Region" means the DDA Regional office. r. "DVR" means the Division of Vocational Rehabilitation. s. "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. t. "Hardened Password" means a string of at least eight characters containing at least one alphabetic character, at least one number and at least one special character such as an asterisk, ampersand or exclamation point. u. "ISP"' means the Individual Support Plan, a document that authorizes and identifies the DDA paid services to meet a client's assessed needs. v. "Personal Information" means information identifiable to any person including, but not limited to, information that relates to a person's name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, Social Security Numbers, drivers license numbers, other identifying numbers, and any financial identifiers. w. "Physically Secure" means that access is restricted through physical means to authorized individuals only. x. "Quality Assurance" means an adherence to all Program Agreement requirements, including DDA Policy 6. 13, EmploymentlDay Program Provider Qualifications, County Guidelines and the Criteria for Evaluation, as well as a focus on reasonably expected levels of performance, quality, and practice. y. "Quality improvement" means a focus on activities to improve performance above minimum standards and reasonably expected levels of performance, quality and practice. z. "Secured Area" means an area to which only authorized representatives of the entity possessing the Confidential Information have access. Secured Areas may include buildings, rooms or locked storage containers (such as a filing cabinet) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. aa, "Service Provider" is a qualified client service vendor who is contracted to provide Employment and Day Program services. bb, "Subcontractor" is the service provider contracted by the County to provide consumer services, cc, "Tracking" means a record keeping system that identifies when the sender begins delivery of Confidential Information to the authorized and intended recipient, and when the sender receives confirmation of delivery from the authorized and intended recipient of Confidential Information, dd. "Trusted Systems" include only the following methods of physical delivery: (1) hand-delivery by a person authorized to have access to the Confidential Information with written acknowledgement of receipt; (2) United States Postal Service ("USPS") first class mail, or LISPS delivery services that include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery services (e.g. FedEx, UPS, DHL) which offer tracking and receipt confirmation; and (4) the Washington State Campus mail system. For electronic transmission, the Washington State Governmental Network (SGN) is a Trusted System for communications within that Network. Page 4 DSHS Central Contract Services 176905 county Agreement 5-7-2014 Special Terms and Conditions ee. "Unique User ID" means a string of characters that identifies a specific user and tiNhich, in conjunction with a password, passphrase or other mechanism, authenticates a user to an information system, 2. Purpose: This Program Agreement is entered into between DDA and the County in accordance with Chapter 71 A. 14 RCW. its purpose is to advance the state legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities. 3. Confidentiality: a. The County shall not use, publish, transfer, sell or otherwise disclose any Confidential Information gained by reason of this Program Agreement for any purpose that is not directly connected with the performance of the services contemplated hereunder, except: (1) As provided by law; or, (2) In the case of Personal Information, as provided by law or with the prior written consent of the person or personal representative of the person who is the subject of the Personal Information. b. The County shall protect and maintain all Confidential Information gained by reason of this Program Agreement against unauthorized use, access, disclosure, modification or loss. This duty requires the County to employ reasonable security measures, which include restricting access to the Confidential Information by: (1) Allowing access only to staff that have an authorized business requirement to view the Confidential Information; (2) Physically Securing any computers, documents, or other media containing the Confidential Information-, (3) Ensuring the security of Confidential Information transmitted via fax (facsimile) by verifying the recipient phone number to prevent accidental transmittal of Confidential Information to unauthorized persons; (4) When transporting six (6) to one hundred forty nine (149) records containing Confidential Information outside a Secure Area, one or more of the following as appropriate: (a) Using a Trusted System, or (b) Encrypting the Confidential Information, including: Email and/or email attachments. ii, Confidential Information when it is stored on portable devices or media, including but not limited to laptop computers and flash memory devices, (5) When transporting one hundred fifty (150) records or more containing Confidential Information outside a Secure Area, referring to the requirements in Exhibit A — Data Security Requirements; and (6) Sending paper documents containing Confidential Information via a Trusted System. c, To the extent allowed by law, at the end of the Program Agreement term or when no longer needed, the parties shall return Confidential Information or certify in writing the destruction of Confidential DSHS Central Contract Services Page 5 1769CS County Agreement 5-7-2014 Special Terms and Conditions Information upon written request by the other party. d. Paper documents with Confidential Information may be recycled through a contracted firm, provided the contract with the recycler specifies that the confidentiality of information will be protected and the information destroyed through the recycling process. Paper documents containing Confidential Information requiring special handling (e.g. protected health information) must be destroyed through shredding, pulping, or incineration. e. The compromise or potential compromise of Confidential Information must be reported to the DSHS Contact designated on this Program Agreement within five (5) business days of discovery for breaches of less than 500 persons' protected data, and three (3) business, days of discovery of breaches of over 500 persons' protected data. The parties must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law. 4. Client Eligibility: Client eligibility and service referral are the responsibility of the DDA pursuant to Chapter 388-823 WAC (Eligibility) and Chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct client services under this Program Agreement. It is DDA's responsibility to determine and authorize the appropriate direct service(s) type. Direct client services provided without authorization are not reimbursable under this Program Agreement. 5. 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 acommunity, 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. Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services. d. Sufficient Policies and Procedures for Establishment and Maintenance of adequate internal control systems: The County will maintain written policy procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such that operations can continue should staffing change or absences occur. e. Background/Criminal History Check: A backgrouind/criminal history clearance is required every three years for all employees, subcontractors, and/or volunteers who may have unsupervised access to vulnerable DSHS clients, in accordance with RCW 43,43.830-845, RCW 7415.030, and Chapter 388-106 WAC. If the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in Chapter 74.34 RCW, then DDA shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance. f. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include members knowledgeable about developmental disabilities. No board member shall have a contract with the County to provide Training, Community Information Activities, Consumer Support as defined in this agreement, and shall not be a board member, officer, or employee of an agency Page 6 DSHS Central Contract Services 1769CS County Agreement 5-7-2014 Special Terms and Conditions subcontracting with the County to provide such services, g, Qualified Service Providers: The Couinty assures that all service providers meet qualifications as outlined in the DDA Policy 6.13, Program Provider Qualifications. h, Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to assign to DDA its Medicaid billing rights for services to DDA clients eligible under Title XIX programs in this agreement. Written documentation shall be available to DSHS on request. i, Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters under RCW 74.34.020(11') 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 willl be prohibited from providing services under this Program Agreement. j. Counties who provide Child Development Services (birth i to three early intervention services), must provide those services under the regulations implementing the Individuals with Disabilities Education Act (IDEA), Part C, and Washington State's Early Support for Infant and Toddler Federally Approved Plan. k, The County staff who perform on-site evaluations of subcontractor work sites will promptly report to DSHS per DDA Policy 5.13, Protection from Abuse: Mandatory Reporting, if: (1) They have reasonable cause to believe that abandonment, abuse, financial exploitation or neglect (as defined in RCW 74.34.020) of a person who has a developmental disability (as defined in RCW 71A.10,020) has occurred, and, (2) If they have reason to suspect that sexual or physical assault of such a person has occurred, they shall also immediately report to the appropriate law enforcement agency. 6. Statement of Work: The County shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below, Working collaboratively, the parties shall administer DD services within the county as set forth below: a. The DDA region shall: (1) Review subcontractors and shall immediately notify the County of any disapproval of the subcontractors identified by the County; (2) Inform and include the County in the discharge planning of individuals leaving institutions and returning to the community who will need program funding; (3) Inform the County of individuals who have had their waiver status changed; (4) Work with the County when referring individuals for services; (5) Inform clients of service changes through Planned Action Notice(s); (6) Work with the County to document planned services in the Individual's Support Plan including notification of assessment dates; (7) Work with the County when terminating services; DSHS Central Contract Services Page 7 1769CS County Agreement 5-7-2014 Special Terms and Conditions (8) Work with the County on Spending Plan adjustments; and (9) Work with the County in participating in on-site evaluation of direct service providers. b. The County shall: (1) Work with the DDA Region when individuals are referred for services; (2) Work with the DDA Region to document planned services in the Individual's Support Plan; (3) Assist with informing the DDA Region of any potential service level changes not documented in the individual's DD Assessment prior to any changes; (4) Work with the DDA Region regarding service termination; (5) Work with the DDA Region on Spending Plan adjustments; (6) Inform the DDA Region of new providers to be included on the CMIS system; (7) Notify the DDA Region of any intent to terminate a subcontractor who is serving a DDA referral; (8) Provide a copy of each subcontractor's contract upon written request from the DDA Region; and (9) Notify and work with the DDA Region when performing on-site evaluations of direct service providers. C, Compliance with BARS Policies: The County shall take any necessary and reasonable steps to comply with BARS. d, Comply with the following referenced documents found at DDA Internet site under "Counties": (1) DDA Policy 4.11, County Services for Working Age Adults; (2) WAC 388-850, WAC 388-828, WAC 388-8,45-0001, 0030, 0205,0210, 01215, 0220, 0600-0610, 1200-1210, 1400-1410, 2100, 2110; (3) Criteria for Evaluation; (4) County Guidelines; and (5) Disability Rights Washington (formerly Washington Protection and Advocacy System) Access Agreement. e. Develop and submit a comprehensive plan for the County DD Services as required by WAC 388- 850 -020. f. Conveyance of The Estimated Number of People to be Served and Targeted outcomes: The County shall submit the Service Information Forms (SIF's) (provided by DDA at Internet site http://MLW1.ds-hs.wa.gov/ddd/countiies.shtml) to indicate the estimated number of people to be served, targeted outcomes, and identified goal(s) that focus on quality improvement within the categories of Training, Community Information, Direct Client Services, and! Other Activities within 30 days of execution of the Program Agreement. Once approved, the SIF outcomes may be modified only by mutual agreement of the County and the DDA Region. Page 8 DSHS Central Contract Ser0ces 1769CS County Agreement 5-7-2014 Special Terms and Conditions g. Solicitation for Qualified Employment and Day Program Service Providers: Requests for Proposals (RFPs), Requests for Qualifications (RFQ's) or Requests for Information (BFI's) for direct services will be issued at a minimum of once every four years. The County will establish a clear process for soliciting new providers. If a client's needs cannot be met by the current qualified providers, then the County may issue an RFQ prior to the four year cycle, Qualified Providers: A qualified provider must be a county or an individual or agency contracted with a county or DDA, Regional Approval of Subcontractors: The DDA Region shall review new subcontractors and shall immediately notify the County of any disapproval of the subcontractors identified by the County. j. Subcontractors: The County will pass on all applicable contractual requirements that are between DDA and the County to the subcontractor. The County shall immediately notify the DDA Region of the County's intent to terminate a subcontractor who is serving a DDA referral. k. Initiate a contract with qualified Employment and Day Program Service Providers for consumer support services that include the following program outcomes: (1) Monthly Community Access service support hours willl be based on the client's Community Access Acuity per 'AC 388-828, (a) To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill-building, and achieve other expected benefits of Community Access, services will occur individually or in a group of no more than 2 or 3 individuals with similar interests and needs. (b) Community Access services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/or specialized activities will not be reimbursed. (c) A client receiving Community Access services will not receive employment support simultaneously. (dl) A client receiving Community Access services may at any time choose to leave Community Access to pursue work and receive employment support. (2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable an individual to meet or exceed his/her living expenses. Clients should average twenty (20) hours of community work per week or eighty-six (86) hours per month. The amount of service a client receives will be based on his/her demonstrated need, acuity level and work history, (3) Prior to beginning service or prior to an expected change in service, the provider will clearly communicate to the client and the County the maximum service hours per month the client can expect to receive. Service changes will not occur until the client has received proper notification from DDA. (a) The client's DDA I SP is the driver for service. The CMIS County Service Authorization and updated Planned Rates information will not exceed the client's DDA ISP. (b) The amount of service the client receives should match with the CM,IS County Service Authorization and updated Planned Rates information DSHS Central Contract Services Page 9 1769CS County Agreement 5-7-2014 Special Terms and Conditions (4) All clients will have an individualized plan to identify client's preferences, Minimum plan elements are outlined in the reference document "Criteria for an Evaluation." A copy of the client's individualized plan will be provided to their CRM, guardian and others as appropriate, (5) Semi-annual progress reports that describe the outcomes of activities will be provided by the provider or the County to the CRM, guardian and others as appropriate. The report will summarize the progress made towards the client's individualized goals. (6) All clients will be contacted by their service provider according to client need and at least once per month. (7) if clients in Individual Employment, Group Supported Employment, or Prevocational services have not obtained paid employment at minimum wage or better within six (6) months, the County will assure the following steps are taken: (a) Review the progress toward employment goals; (b) Provide evidence of consultation with the family/client; and (c) Develop additional strategies with the family/client, county staff, employment support staff and the case manager. Strategies may include providing technical assistance, changing to a new provider, and/or providing additional resources as needed to support the individual's pursuit of employment. The additional strategies will be documented for each client and kept in the client's file(s). (8) If after twelve (12) months the client remains unemployed, an additional review will be conducted. The provider will address steps outlined in the previous six month progress report in the next six month progress report. The client may request to participate in Community Access activities or the client may choose to remain in an employment program. When requesting to participate in Community Access services, the client shall communicate directly with his or her DIDA Case Manager. The DIDA Case Manager is responsible for authorizing Community Access services. (9) For Group Supported Employment, it is expected that clients have paid work or paid training. The total number of direct service staff hours provided to the group should be equal to or greater than the group's collective amount of individual support monthly base hours. If the direct service staff hours are less than the collective amount, then the provider will be reimbursed only for the number of hours staff actually provided. (10) For Prevocational services, it is expected that clients receive training and skill development in groups as well as individual support in the community. The total number of direct service staff hours provided to the group should be equal to or greater than the group's collective amount of individual support monthly base hours. If the direct service staff hours are less than the collective amount, then the provider will be reimbursed only for the number of hours staff actually provided, I. Limitation to the Waiver services: The County will monitor the client's yearly waiver limits for consumer support services in accordance with WAC 388-845. m. Quality Assurance and Service Evaluation: The County shall develop and have available an evaluation system to review services. The evaluation system will incorporate Quality Assurance items and Quality Improvement measures. A copy of such evaluation system shall be provided upon request to DDA for review and approval. Page 10 DSHS Central Contract Services 1769CS County Agreement 5-7-2014 Special Terms and Conditions n. On-Site Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one on-site visit to each subcontractor during the biennium. The County shall maintain written documentation of all evaluations, recommendations and corrective action plans for each subcontractor. Copies of such documentation will be provided to the DDA upon request, o. Work with local DD advisory groups to plan for and coordinate services. p. Participate in the Association of County Human Service "ACHS" meetings. q. CMIS Data System: The County shall use the CMIS data system for all billing requests, service provider address and phone number maintenance, evaluation dates and to provide employment outcome information. (1) Monthly provide all data described in the Billing Instructions and in the Employment Outcomes Instructions incorporated by reference. (2) Assure the integrity of data submitted to the State. When data is submitted and rejected due to errors or an error is later identified, the County will correct and resubmit the data within thirty days. 7. Consideration: a. Fees: (1) Approval of fees is the rresponsibility of the DDA. The DDA Region reserves the right to approve fees/rates for the services being provided. The County will submit a fee/rate schedule with the initial Program Agreement. The County will submit updated fee/rate schedules to the DDA Region for approval as changes occur. The rate schedule will include the following information: (a) County(s) name; (b) Time period for which the schedule is applicable; and (c) Each contracted direct service (IE, GSE, PVS, CA, ITA, CDS) and its associated rate. (2) Fee Limitations: The DDA will set limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four. The current Rates are as follows: (a) Employment services will not exceed an hourly rate of $90.00, Individual Employment services should not exceed $75,00/hour. ii. Group Supported Employment services should not exceed $65.001/hour. iii. Prevocational services should not exceed $55,00/hour, (b) Community Access services will not exceed an hourly rate of $30.00, (c) Child Development services will not exceed a monthly rate of $500,010. b. Budget and Spending Plan, attached as Exhibit B: DSHS Central Contract Services Page 11 1769CS County Agreement 5-7-2014 B. Special Terms and Conditions (1) Budget amount listed in Exhibit B: The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate clients moving from state-only employment and day services to waiver employment and day services. (2) Spending Plan: DDA will provide the initial Spending Plan. Funding shall be distributed under planned expenditures as well as allocated under State and Medicaid shall function as a line item budget for expenditures under this agreement. The planned expenditures for Consumer Support is based on client numbers as well as planned additional consumer services expenditures. The spending plan may only be modified by mutual agreement of the parties in writing and shall not require a contract amendment. c. Client Funding: Funds will follow clients if they move and/or choose a qualified provider in a different county. The client funding amount will be based on that client's historical employment, acuity level and the County classification plus administration. Negotiation for client funding between the receiving and sending counties, including the DDA Regional office, is permissible. d, If a County provides Community Information and Education services under additional consumer services, then activities must include outreach efforts to federally recognized local tribes, e. Funds Designated for Adult Day Care Consumers: Funds designated, for Adult Day Care Consumers are available to clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level 11 or III services (Adult Day Health), Level 11 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 aduilts 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 11 or Ill. If a client no longer needs and wants services, the funds are available for other clients who are not part of the group of original clients identified between December 1996 and 2003. An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the local Area Agency on Aging, Adult Day Care service is not a waiver approved service. f. Exemptions: The DDA Assistant Secretary may approve in writing an exemption to a specific program agreement requirement. Billing and Payment: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDA as: (1) Administration: Costs of the County Human, Services Department or similar county office, responsible for administration of the Developmental Disabilities Program. Allowable costs include personnel and overhead costs directly related to the administration of the program, including such activities as program planning, budgeting, contracting, monitoring, evaluation, and coordination. Also included are departmental and county indirect and/or direct administrative costs, to the extent that such costs are appropriately allocated to the program using an established methodology consistent with grants management guidelines. (2) Additional Consumer Services: (a) Training: DSHS central Contract Services Page 12 1769CS County Agreement 5-7-2014 Special Terms and Conditions i:, Staff Training: Costs incurred by the program for planned, structured activities for the purpose of providing, or improving, or enhancing job-related knowledge and skills of staff, providers, volunteers, or interning students in the provision of developmental disabilities services. ii. Board Training: Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program-related skills of board and advisory committee members. (b) Community Information and Education: to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (c) Other Activities i. Infrastructure projects- Projects in support of clients (services not easily tracked back to a specific working age client) or that directly benefit a client(s) but the client is not of working age. Examples include planning services like benefits planning and generic job development e.g. "Project Search," J, Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support. iii. Partnership project: Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn 21. (3) Consumer Support (a) Adult Day Care services are available to clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level 11 or III services (Adult Day Health). Level It and III services are licensed rehabilitation and skilled nursing services along with socialization, Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. (b) Community Access services are individualized services provided in typical integrated community settings for individuals in retirement. Services will promote individualized skill development, independent Iliviing and community integration for persons to learn how to actively and independently engage in their local community. Activities will provide opportunities to develop relationships and to learn, practice and apply skills that result in greater independence and community inclusion. These services may be authorized instead of employment support (individual Employment, Group Supported Employment or Pre- Vocational services) for working age individuals who have received nine months of employment support, have not found a job and decide not to continue looking for work. (c) Child Development Services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. Services may include specialized instruction, speech-language pathology, occupational therapy, physical therapy, assistive technology, and vision services. Services are provided in natural environments to the maximum extent appropriate, DSHS Central Contract Services Page 13 1 769CS County Agreement 5-7-2014 Special, Terms and Conditions (d) Individual Supported Employment services are a part of an individual's pathway to employment and are tailored to individual needs, interests, and abilities to promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state's minimum wage in the general workforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job. (e) Individualized Technical Assistance services are a part of an individual's pathway to employment. This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment. This is in addition to supports received through supported employment services or pre-vocational services for individuals who have not yet achieved their employment goal. (f) Group Supported Employment services are a part of an individual's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated: employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment community settings,. (g) Pre-Vocational Services are a part of an individual's pathway to integrated jobs in typical community employment. These services and supports are intended to be short term and should be designed to further habilitation goals that will lead to greater opportunities for competitive and integrated employment and career advancement at or above minimum wage. Services are provided by agencies established to provide services to people with disabilities and offer training and skill development for groups of workers with disabilities in the same setting as well as individual support. Participants are provided at least monthly opportunities to experience typical community settings in support of their pursuit to integrated employment. b. Reimbursement for the Fiscal Year shall not exceed the total amount listed in Exhibit B to this Program Agreement, However, with a Program Agreement amendment, the parties may increase or decrease the Program Agreement amount. c. Monthly Invoice with Documentation: All requests for reimbursement amounts must be entered and posted into the CMIS system. The Contractor may post a combined claim of all programs/services covered by this agreement. DSHS shall make all payments due to the Contractor for all invoices submitted pursuant to this section within sixty (60) days following posting of required information. d. it is an expectation that all clients access DVR"funding as a resource. Client services shall not be reimbursed under this Program Agreement when the same services are paid for under the Rehabilitation Act of 1973 by DVR, P.L. 94-142 by Public Education, or any other source of public or private funding. e. Reimbursement of Client Services: A claim for each individual is made on the CMIS system by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined as: (1) An "Hour" is at least fifty (50) minutes of direct service. Partial hour to the quarter may be recorded. Page 14 DSHS Central Contract Services 1769CS County Agreement 5-7-2,014 Special Terms and Conditions (2) A "Day" is at least four hours of direct service and will only be used in connection with Adult Day Care (ADC) reimbursement. (3) A "Month" represents a minimum of one service visit which is at least fifty (50) minutes of direct service for Child Development Services (CDS) reimbursement. f. Program Administration : The County will provide program administration and may bill for administrative costs as identified in Exhibit B. Administrative costs will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer Support services unless the director of DDA approves a request for an exception under Chapter 388­850 WAC. Monthly claims for administrative costs will be 1/12 of the maximum Administration amount identified in Exhibit B. g. The Employment Phases, & Billable Activities document defines the individual client services that DDA reimburses. That document is located on the DSHS DDA County Best Practices Web site at http://www.dshs.wa.gov/ddd/counties.shtml h. The Community Access Billable Activities document defines the individual client services DDA reimburses. That document is located on the DSHS DDA County Best Practices Web site at http-://www,dshs.wa.gov/ddd/counties.shtm, Timeliness of and Modification to Billings: All initial invoices with documentation must be received by the DDA Region within sixty (60) calendar days following the last day of the month in which the service is provided. Corrected invoices and documentation including re-posted billing information will be accepted throughout the fiscal year as long as they are received within sixty (60) calendar days of the associated fiscal year unless an extension; is approved by the DDA Regional Administrator or designee. Payment will not be made on any invoice submitted past 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. 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 lCF/ID facilities develop a plan and coordinate their services with the facility on behalf of the ICI= /ID resident. DDA will supply to the County a list of ICF/ID residents who attend a day program. 10. Single State Medicaid Agency—Health Care Authority (HCA): HCA, as the single state Medicaid Agency, has administrative authority for Title XIX coverage per 42 CFR 431.10. DSHS is the operating agency for the Home and Community Based Waivers for services for people with developmental disabilities. The County only has responsibility for services covered in this agreement. 11. DSHS/DRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDA is incorporated by reference, The County assures that it and its subcontractors have reviewed the Access Agreement. The agreement covers DRW's access to individuals with developmental disabilities, clients, programs and records, outreach activities, authority to investigate allegations of abuse and neglect, and other miscellaneous matters and is binding for all providers of DDA contracted services, DSHS Central Contract Services Page 15 1769CS County Agreement 5-7-2014 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. "Authorized User(s)" means an 'individual or individuals with an authorized business requirement to access DSHS Confidential Information. b. "Hardened Password" means a string of at least eight characters containing at least one alphabetic character, at least one number and at least one special character such as an asterisk, ampersand or exclamation point. c, "Unique User ID" means a string of characters that identifies a specific user and which, in conjunction with a password, passphrase or other mechanism, authenticates a user to an information system. 2. Data Transport. When transporting DSHS Confidential Information electronically, includingi via email, the Data will be protected by: a. Transporting the Data within the (State Governmental Network) SGN or Contractor's internal network, or; b. Encrypting any Data that will be in transit outside the SGN or Contractor's, internal network. This includes transit over the public Internet. 3. Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect the Data as described: a. Hard disk drives. Data stored on local workstation hard disks. Access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. b, Network server disks. Data stored on hard disks mounted on network servers and made available through shared folders, Access to the Data will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics, or smart cards. Data on disks mounted to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism, For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as long as the disks remain in a Secured Area and otherwise meet the requirements listed in the above paragraph. Destruction of the Data as outlined in Section 5. Data Disposition may be deferred until the disks are retired, replaced, or otherwise taken out of the Secured Area. C. optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS on optical discs which will be used in local workstation optical disc drives and which will not be transported out of a Secured Area. When not in use for the contracted purpose, such discs must be locked in a drawer, cabinet or other container to which only Authorized Users have the key, combination or mechanism required to access the contents of the container. Workstations which access DSHS Data on optical discs must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. Page 16 DSHS Central Contract Services 1769CS County Agreement 5-7-2014 d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by DSHS, on optical discs which will be attached to network servers and which will not be transported out of a Secured Area. Access to Data on these discs will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on discs attached to such servers must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. e. Paper documents. Any paper records must be protected by storing the records in a Secured Area which is only accessible to authorized personnel. When not in use, such records must be stored in a locked container, such as a file cabinet, locking drawer, or safe, to which only authorized persons have access. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an Authorized User's duties change such that the Authorized User no longer requires access to perform work for this Contract. g. Data storage on portable devices or media. (1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on portable devices or media unless specifically authorized within the terms and conditions of the Contract. If so authorized, the Data shall be given the following protections: (a) Encrypt the Data with a key length of at least 128 bits (b) Control access to devices with a Unique User ID and Hardened Password or stronger authentication method such as a physical token or biometrics. (c) Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available. Maximum period of inactivity is 20 minutes. Physically Secure the portable device(s) and/or media by (d) Keeping them in locked storage when not in use (e) Using check-in/check-out procedures when they are shared, and (f) Taking frequent inventories (2) When being transported outside of a Secured Area, portable devices and media with DSHS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data. (3) Portable devices include, but are not limited to; smart phones, tablets, flash memory devices (e.g. USIB flash drives, personal media players), portable hard disks, and lap,top/notebook/netbook computers if those computers may be transported outside of a Secured Area. I[DSHS Geni:4 Contract Services Page 17 1769CS County Agreement 5-7-2014 4. (4) Portable media includes, but is not limited to optical media (e,g. CDs, DVDs), magnetic media (e.g. floppy disks, tape), or flash media (e.g, CompactFlash, SD, MMC). h. Data stored for backup purposes,. (1) DSHS data may be stored on portable media as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. Such storage is authorized until such time as that media would be reused during the course of normal backup operations. If backup media is retired while DSHS Confidential Information still exists upon it, such media will be destroyed at that time in accordance with the disposition requirements in Section 5. Data Disposition (2) DSHS Data may be stored on non-portable media (e.g. Storage Area Network drives, virtual media, etc.) as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. if so, such media will be protected as otherwise described in this exhibit. If this media is retired while DSHS Confidential Information still exists upon it, the data will be destroyed at that time in accordance with the disposition requirements in Section 5, Data Disposition. Data Segregation. a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS data. This is to ensure that when no longer neededi by the Contractor, all DSHS Data can be identified for return or destruction. It also aids in determining whether DSHS Data has or may have been compromised in the event of a security breach. As such, one or more of the following methods will be used for data segregation. b. DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc,) which will contain no non-DSHS data. And/or, c. DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. And/or, d, DSHS Data will be stored in a database which will contain no non-DSHS data. And/or, e. DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records. f. When stored as physical paper documents, DSHS Data will be physically segregated from non - DSHS data in a drawer, folder, or other container. g. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the 'DSHS Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit. 6. Data Disposition, When the contracted work has been completed or when no longer needed, except as noted in Section 3. Protection of Data b. Network Server Disks above, Data shall be returned to DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of destruction are as follows: Data stored on: _Server ­or_wo_rk`station —hard disks, or Removable mediae floppies, U§_B flash d DSHS Central Contract Services 1769CS County Agreement 5-7-2014 Will be destroyed by: using a _"wipe" utility which, will overwrite the Data at least three (3) times using either random or single character data, or Page 18 portable hard disks) excluding optical discs Degaussing sufficiently to ensure that the Data cannot be reconstructed, or Ph sically qcle eying the disk taper documents with sensitive or Confidential Information Recycling through a contracted firm provided the contract with the recycler assures that the confident i4!itt of Data will be protected. Paper documents containing Confidential Information requiring special handling (e.g. protected health information) -- 6n-site shredding, pulping, or incineration 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 shreddin 6. Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1) business day of discovery, If no DSHS Contact is designated in the Contract, then the notification must be reported to the DSHS Privacy Officer at dshsprlvacyofficer@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. T. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub- Contractor must be submitted to the DSHS Contact specified for this contract for review and approval. DSHS Central Contract Servuces Page 19 1769CS County Agreement 5-7-2014 EXHIBIT B Program Agreement Budget x Original Budget Budget Revision REVENUES Fiscal Year Cori inal 151 Revision 2"' Revision 2014 $ $ $ Fiscal Year Fund Source �1ri final 151 Revision 2 "� Revision 2015 State $151,428 Waiver $129, 747 Total Rev. $281,175 $ $ COUNTY 1=Y 15 SPENDING PLAN 3 "d Revision $ 3rd Revision Page 20 DSHS Central Contract Services 1769CS County Agreement 5 -7 -2014