HomeMy WebLinkAbout091916_ca02v\
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Port Townsend, WA 98368
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Consent Agenda
July 29, 2016
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, Development Disabilities
DATE: q / I q / Z0I (-c
SUBJECT: Agenda Item — Professional Services Agreement — Concerned Citizens
for Community Access A-1; July 1, 2016 — June 30, 2017; $13,041.00
for a total of $19,218.00
STATEMENT OF ISSUE:
Jefferson County Public Health, Developmental Disabilities Division is requesting Board approval of the
Amendment #1 to the July 1, 2015 — June 30, 2016 Concerned Citizens Contract, Community Access; July 1,
2016 — June 30, 2017; Additional $13,041 added to original amt. $6.177.00 for a total of $19,219.00
ANALYSIS/ STRATEGIC GOALS/PRO'S and CON'S:
JCPH Developmental Disabilities contracted with Concerned CitizensCommunity Access in July 2015 in the
amount of $6,177.00 dollars. This amendment #1 increases the original amount by $13,041.00 for a total
of $19,219.00. Amendment #1 also extends the term of the contract to July 1, 2016 to June 30, 2017. All
other terms and conditions of the agreement signed September 8, 2015 by the JC Board of County
Commissioners remains unchanged.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
This amendment increases the amount of the original agreement (Concerned Citizens Community Access
July 2015 — June 2016) by $13,041.00 dollars for a total expenditure of $19,219.00. The funds for this
contract amendment are generated by an amendment to the DSHS agreement from Developmental
Disabilities Administration Contract Amendment DSHS 1563-45217.
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Always working for a safer and healthier community
Environmental Health
Water Quality
360-385-9444
(f) 360-379-4487
RECOMMENDATION:
JCPH management request approval of Amendment #1, Concerned Citizens, Community Access which
extends the timeframe of the original contract, Concerned Citizens, Community Access July 2016 —
June2016, and adds funding as stated above; July 1, 2016 — June 30, 2017; Additional $13,041.00 for a
total of $19,219.00.
iFA.�r''
'' • • ' •
Date
Contract Amendment #1
Between
Concerned Citizens
And
Jefferson County Public Health
Developmental Disabilities Program
WHEREAS, Concerned Citizens (Subcontractor) and Jefferson County (County) entered into an
agreement on July 1, 2015 for Professional Services to be provided in connection with the provision of
Community Access Services to Persons with Developmental Disabilities in Jefferson County.
WHEREAS, the parties desire to amend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
1. The term of the above referenced agreement ends June 30, 2017.
2. The Subcontractor will continue to provide Community Access Services; opportunities to
build relationships, to contribute and to feel a sense of belonging to the community, to
access generic resources with peers without disabilities and volunteer opportunities in order
to enhance versatility, individualized education/self-advocacy skill development necessary
for new tasks in order to address growth and interaction needs of eligible persons.
3. Subcontractor shall receive $30.00 per unit for Community Access Services. One UNIT of
Community Access service is, defined as one (1) "HOUR" of direct service or assigned
service level to one eligible client. An "HOUR" is at least fifty (50) minutes of direct service;
(partial hour to the quarter may be recorded); ten (10) minutes of every "HOUR" of direct
service or assigned service level to one eligible client can be used for documentation.
4. Subcontractor's contract will be increased by $13,041.00 in funding for services rendered
during the term of July 1, 2015 through June 30, 2017. Total compensation under this
Agreement shall not exceed $19,218.00 without express written amendment signed by
both parties
5. All other terms and conditions of the agreement will remain the same.
Dated this___day of .4 2016
By:
, Chairman
Jefferson Board of County Commissioners
By: A M s
&Ibx4
"'�ijda Middleton
Executive Director, Concerned Citizens
Concerned Citizens Community Access Contract 2015-2016 1" +5�1 �ti
Page 1 of 15 C rill
SUBCONTRACT FOR PROFESSIONAL SERVICES
COMMUNITY ACCESS SERVICES
Agreement Between f!jJ
JEFFERSON COUNTY PUBLIC HEALTH
And
CONCERNED CITIZENS
This agreement is made and entered into between Jefferson COUNTY Public Health (COUNTY) and Con6eMed Citizens
(SUBCONTRACTOR) for provision of Community Access Services to persons with developmental disabilities in
Jefferson COUNTY. The term of this agreement is July 1, 2015 through June 30, 2016. Either party upon 60 days written
notice may terminate this Contract. Termination of this Contract shall not constitute a breach.
It is agreed Upon by Both Parties as Named Herein as Follows:
A. PROFESSIONAL SERVICES
Professional services to be provided by SUBCONTRACTOR shall include:
(1) Community Access Services - Opportunities to build relationships, to contribute and to feel a sense of belonging
to the community, to access generic resources with peers without disabilities and volunteer opportunities in
order to enhance versatility, individualized education/self-advocacy skill development necessary for new tasks
in order to address growth and interaction needs of eligible persons per Exhibit A - Statement of Work.
(2) Program management.
B. OBLIGATIONS
SUBCONTRACTOR shall fulfill the following obligations:
(1) SUBCONTRACTOR shall comply with all state and federal requirements regarding the confidentiality of
Client records. Client information is not disclosable to the public. Information acquired pursuant to RCW
71A.14.070 requires a signed Release of Information or a signed Oath of Confidentiality Form.
(2) SUBCONTRACTOR is required provide background checks, pursuant to RCW 43.43.830-845, RCW
74.15.030, and Chapter 388-06 WAC, which state that any prospective employee or volunteer who will or may
have unsupervised access to a vulnerable person with a developmental disability in the course of his or her
employment, or involvement with the business or organization, must have a background/criminal history
clearance before they have unsupervised access. The DSHS Background Check Central Unit (BCCU) must
be utilized to obtain background clearance.
(3) If SUBCONTRACTOR reviews the application and elects to hire or retain an individual after receiving
notice that the applicant has a conviction for an offense that would disqualify the applicant frorn 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.
(4) SUBCONTRACTOR is required pursuant to RCW 74.15.030, that if any prospective employee who has not
resided in Washington State during the last three years, and who will or may have unsupervised access to a
vulnerable person with a developmental disability in the course of his or her employment, or involvernent with
the business or organization, must have an F.B.I. Fingerprint Check before they have unsupervised access and
before prospective employer begins working. The DSHS Background Check Central Unit (BCCU) must be
utilized to obtain background clearance.
(5) SUBCONTRACTOR is required to repeat the background/criminal history clearance for all employees or
volunteers who will or may have unsupervised access to a vulnerable person with a developmental disability in
the course of his or her employment, or involvement with the business or organization, every three years. The
Concerned Citizens Community Access Contract 2015-2016
Page 2 of 15
DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance in
accordance with RCW 43.43.830-845, RCW 74.15.030 and Chapter 388-06 WAC.
(6) SUBCONTRACTOR shall comply, as mandated reporters under RCW 74.34.020 (11), with all state and federal
requirements under RCW 74.34.035, .040 Abuse and neglect of Vulnerable Adults; RCW 26.44, Abuse of
Children; the WACs: 275-26 Division of Developmental Disabilities Services Rules; 296-24 General Safety
& Health; 296-62 General Occupational Health Standards; WACs: 388-828 Developmental Disabilities
Administration, (DDA) Assessment; 388-845 Home and Community Based Waivers; Definitions 0001;
Criteria for HCBS Services 0030; Basic Waiver Services 0200; Basic Plus Waiver Services 0210; Core
Waiver Services 0215; Community Protection Waiver Services 0220; 0600-0610 Community Access
Service; Supported Employment Service 2100.
(7) SUBCONTRACTOR shall comply with the following Developmental Disabilities Administration, (DDA)
Policies: 3.01 Client Service Plans; 5.01 Criminal History Background Checks and Safeguarding Personal
Information; 5.02 Necessary Supplemental Accommodation (NSA); 5.03 Client Complaints; 5.05 Limited
English Proficiency (LEP) Clients; 5.06 Client Rights; 5.13 Protections From Abuse; 5.14 Positive Behavior
Support; 5.15 Use of Restrictive Procedures; 6.08 Mandatory Reporting Requirements for Employment and
Day Program Services Providers; 6.13 Employment/Day Program Provider Qualifications; 9.07 Human
Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS); 12.01 Incident
Management; 13.04 DRW Access Agreement, and the 1992 County Guidelines.
(8) SUBCONTRACTOR shall comply with the following referenced documents found at DDA Internet site
https;//www.dslis.wa.gov/dda/county-best-practices under "Counties":
(1) DDA Policy 4.1 1, County Services for Working Age Adults;
(2) WAC 388-850, WAC 388-828, WAC 388-845-0001, 0030, 0205,0210, 0215, 0220, 0600-0610,
1200-1210, 1400-1410, 2100, 2110;
(3) Criteria for Evaluation;
(9) The DRW Access Agreement with DDA, assures that the COUNTY and SUBCONTRACTORS have
reviewed the Access Agreement. The Access Agreement covers DRW's access to individuals with
developmental disabilities, to clients, to programs and records, to outreach activities, to authority to
investigate allegations of abuse, neglect, and other miscellaneous matters, and it is binding for all providers
of DDA contracted services.
(10) SUBCONTRACTOR shall have written policies regarding sexual harassment and non-discrimination (said
policies must guarantee human/civil rights); regarding a person's right to privacy, regarding safeguarding
personal information and abuse of participants; regarding agency medication procedure; regarding respectful
staff -to -participant interactions (i.e.: including a person's right to be treated with dignity and respect fi•ee of
abuse).
(11) SUBCONTRACTOR shall assure that participants, in accordance with Necessary Supplemental
Accommodation (NSA) Policy 5.02, have been informed of their rights; what services and benefits may be
expected from the program; the program's expectations of them; and, if necessary, shall assure that the
participant's family, guardian or advocate is also informed.
(12) SUBCONTRACTOR shall have a grievance policy that:
• negotiates conflicts and advises participants of grievance procedures
• is explained to participants and others in accordance with the NSA, DDA Policy 5.02
• prohibits retaliation for using the grievance process
• includes a non -retaliation statement
• assure that advocates are available and encourages participants to bring advocates to help negotiate
• includes a mediation process that promotes the use of someone who is unaffected by the outcome if
conflicts remain unresolved (a DDA Case Resource Manager may be included as an alternative option)
Concerned Citizens Community Access Contract 2015-2016
Page 3 of 15
• includes a process for tracking and reporting grievances
(13) SUBCONTRACTOR shall obtain and retain in the clients' files signed proof of client's and/or family's
review of all policies, provider expectation, and receipt of information about services and benefits to be
provided by the program. The signed proof required by this section shall be reviewed and renewed, with new
documentation, annually.
(14) SUBCONTRACTOR will encourage participant involvement in policy development.
(15) SUBCONTRACTOR shall update Client Intake Forms every 6 months during the Client Review meeting.
(16) SUBCONTRACTOR shall assure potential conflict of interest, real or apparent, will not arise. Such a conflict
will arise when: The employee, officer or agent, any member of immediate family, Guardian / decision
maker, or an organization that employs or is about to employ any of the above has financial or other interest
in the client(s).
(17) SUBCONTRACTOR shall have adequate staffing ratios and patterns to maintain quality and safety.
(18) All services for persons with developmental disabilities must be provided with attention to their health and
safety. SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health, and safety
regulations.
(19) SUBCONTRACTOR shall track and analyze incident reports for potential trends and patterns.
(20) Current emergency contact and medical information (medications, diet, allergies, etc.) needed during the
hours of service is readily available for each participant.
(21) The COUNTY and all SUBCONTRACTORS are mandated reporters under RCW 74.34.020(11). All
parties must comply with reporting requirements described in RCW 74.34.035, 040 and Chapter 26.44 and
must adhere to DDA Policy, 6.08 Mandatory Reporting Requirements for Employment and Day Program
Service Providers. All service provider employees, contractors, and volunteers are mandatory reporters and
must report every incident of observed, reported, or suspected abuse, improper use of restraint, neglect,
self-neglect, personal or financial exploitation, abandonment and/or mistreatment of clients.
(22) COUNTY, 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.
(23) SUBCONTRACTOR is required to maintain the following minimum organizational capacity in order to meet
the performance standards set forth in this agreement. Failure or inability of SUBCONTRACTOR to meet any
or all of these minimum capacity requirements, as determined solely by COUNTY, may be cause for termination
of this agreement as provided herein.
(a) Accreditation_ SUBCONTRACTOR must be able to demonstrate conformance to Commission on
Accreditation of Rehabilitation Facilities (CARF) standards for quality assurance and CARF accreditation.
(b) Confidentiality: SUBCONTRACTOR shall protect and maintain all Confidential Information gained by
reason of the Program Agreement against unauthorized use, access, disclosure, modification or loss. This
duty requires the COUNTY to employ reasonable security measures, which includes restricting access to
Confidential Infon-nation by:
Concerned Citizens Community Acc,css Contract 2015-2016
Page 4 of 15
(1) Allowing access to staff that have an authorized business requirement to view the Confidential
lnfonnation.
(2) Physically securing any computers, documents, or other media containing Confidential
Information.
(3) When transporting six (6) to one hundred forty nine (149) records containing Confidential
Information outside a Secure Area do one or more of the following as appropriate:
(a) Use a trusted System
(b) Encrypt the Confidential Information, including
(i) 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
(c) Send Paper documents containing Confidential Information via Trusted System.
(1) 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 Information upon written request by the other party.
(2) 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.
(3) 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 one hundred fifty (150) persons' protected data, and one
(1) business day of discovery of breaches of over one hundred fifty (150) 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.
(d) Equal Access: SUBCONTRACTOR will assures equal access to persons who do not speak or have a
limited ability to speak, read, or write English well enough to understand and communicate effectively
(reference: DDA Policy 5.05, Limited English Proficient (LEP) Clients).
(e) f inmicial and Program_ Management: SUBCONTRACTOR will maintain an
administrative/organizational structure that clearly defines responsibilities; systems and personnel to
maintain accounting records that accurately reflect all program revenues and expenditures; prepare
monthly statements of activity (ADSA Reports); maintain appropriate client service records and progress
reports; and track key program performance indicators.
(f)
Participants.- SUBCONTRACTOR has a commitment to support integration of individuals with
developmental disabilities with people who are not disabled and has involved participants with
developmental disabilities in policy development.
(g) Partnerships: SUBCONTRACTOR has a history of working cooperatively with community-based
organizations including Employers, other Agencies, the COUNTY DD Program, the Division of
Vocational Rehabilitation (DVR), and the Schools.
(h) Performance Plan_ SUBCONTRACTOR has a written performance plan that describes its mission,
program objectives, expected outcomes, and describes how and when objectives will be accomplished;
and will assure the plan is evaluated at least biennially with revisions based on actual performance.
(i) Internal Control Systems: SUBCONTRACTOR has sufficient policies and procedures for establishment
and maintenance of adequate internal control systems. SUBCONTRACTOR will maintain written policy
procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such
that operations can continue should staffing change or prolonged absences occur.
0) (Qualified Sial_. SUBCONTRACTOR will provide adequate, qualified staff with skills and experience
in evaluation, training, supervision, counseling and support of adults with developmental disabilities
who are earning wages, per the attached Statement of Work. SUBCONTRACTOR will assure that all
direct service staff are trained, and that training is documented. SUBCONTRACTOR will provide
COUNTY with information regarding staff qualifications upon request.
(k) Safety: SUBCONTRACTOR will provide evidence that it employs safety protection based on the
environment in which the participant is working or receiving services.
Concerned Citizens Community Access Contract 2015-2016
Page 5 of 15
(1) Employment and day services must adhere to the Home and Community Based settings (HOBS) requirements
of 42CFR 441 530(a)(1), including that:
(a) The setting is integrated in the greater community and supports individuals to have full access to
the greater community;
(b) Ensures the individual receives services in the community to the same degree of access as
individuals not receiving Medicaid HCBS;
(c) The setting provides opportunities to seek employment and work in competitive integrated settings;
and
(d) The setting facilitates individual choice regarding services and supports, and who provides them.
(25) SUBCONTRACTOR shall provide a Community Access Individual Program Plan and/or Person
Centered planning/profiles delineating individual skills and needs plans within 30 days of the beginning
of services on all program clients. The SUBCONTRACTOR shall use the Community Access Plan
Report Form for Individual Program Plans.
(1) The Community Access Report Plans will include:
1. Information that identifies and addresses the individualized goal and support needs for each
participant.
2. Plans must consider individualization, integration, and safety and should be developed by the
provider in collaboration with the Case Resource Manager, participant, and his or her family (the
team).
3. Initial plans will be completed within 60 days from date of service authorization and must be
signed by the participant and/or his or her guardian if any.
4. Copies of the initial and subsequent revised plans will be distributed as appropriate to all team
members.
5. Plans will be reviewed and signed annually.
(2) The Community Access Report Plans will also include the information listed below:
a) Current date: timeline for the Plan
b) Client's name: first and last
c) Client ADSA ID
d) The client's skills, gifts, interests, and preferred activities
e) The Community Access goal. The goal need to relate to one or more of the following (per
COUNTY'S Guidelines):
i. Identify integrated community places where the individual's interest, culture,
talent, and gifts can be contributed and shared with others with similar interests
ii. Identify clubs, associations, and organizations where the individual can be a
member and have decision-making capacities
iii. Identify opportunities where the individual can contribute to the community by
participating in new and interesting activities or activities the individual enjoys
iv. Building and strengthening relationships between family members and members
of the local community, who are not paid to be with the person
v. The Support Intensity Scale (SIS) subscale that most relates to the goal
(Community Living, Lifelong Learning, Employment, Health & Safety, Social,
and Protection & advocacy)
vi. Measurable strategies (action steps and supports) to meet the goal
vii. Identification of persons and/or entities available to assist the individual in
reaching his or her long-term goal
viii. Identification of other accommodations, adaptive equipment, and/or conditions
critical to achieve the goal
(26) Six month progress reports describing the progress made towards achieving client's goal will be provided
by the service provider to the Case Resource Manager, participant, and/or guardian, if any, within 30 days
following the six-month period.
(27) The SUBCONTRACTOR shall report any injury or accident that requires more than simple first aid, and
any extraordinary incident that requires intervention by the SUBCONTRACTOR to the DSHS/DDA Case
Concerned Citizens Community Access Contract 2015-2016
Page 6 of 15
Manager for the individual involved, and then report the injury, accident, or extraordinary incident to the
COUNTY Coordinator. This includes serious physical or emotional harm or potential harm.
The initial report to the COUNTY may be done via documented telephone calls to the
COUNTY Coordinator.
The SUBCONTRACTOR shall submit a written follow-up report within 10 days to the
COUNTY Coordinator. The report to the COUNTY Coordinator may be submitted by email,
facsimile (FAX) to 360-385-9401, or by mail to Jefferson COUNTY Public Health 615
Sheridan Port Townsend, WA 98368.
Serious and emergent incidents shall be handled in accordance with DSHS/DDA Policy 12.01,
Incident Management.
(28) All services for persons with developmental disabilities must be provided with attention to their health and
safety. SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health and safety
regulations.
(29) Within 30 days of the effective date of this agreement and at least semi-annually thereafter,
SUBCONTRACTOR will provide (a) company (b) program financial reports to COUNTY, including all
revenues and expenses generated by SUBCONTRACTOR, in sufficient detail to demonstrate the uses of funds
provided under this agreement.
(30) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all work
sites; all client records; records on productivity and client wages; and all documents, reports, and other data
applicable to this agreement. The COUNTY shall monitor services delivered, and conduct at least one on-site
visit with SUBCONTRACTOR during the period of this biennium to assure compliance with the DDA State
Work Order.
(31) AUDIT REQUIRIvM1 NTS. Independent Audit will be submitted annually to the Jefferson COUNTY DD
COUNTY Coordinator in the following manner:
SUBCONTRACTOR must be able to account for and manage public funds in compliance with
Generally Accepted Accounting Principles "GAAP". An agency, for-profit or non-profit, who
receives in excess of $100,000 in DDA funds during its fiscal year from the County, shall provide
Certified Public Accountant reviewed or audited financial statements within nine months
subsequent to the close of the subcontractor's fiscal year. Copies of the audit and management
letter shall be submitted to the Jefferson COUNTY Public Health Department within 9 months of
the end of the SUBCONTRACTOR'S fiscal year.
The SUBCONTRACTOR shall provide an independent audit of the entire organization which:
(a) is performed by an independent Certified Public Accountant, the Washington State
Auditor's Office, or another entity the COUNTY and the SUBCONTRACTOR mutually approve.
(b) Provide statements consistent with the guidelines of Reporting for Other Non -Profit Organizations
AICPA SOP 78-10, and is performed in accordance with generally accepted auditing standards
and with Federal Standards for Audit of Governmental Organizations, Programs, Activities, and
Functions, and meeting all requirements of OBM Circular A-133 or A-128, as applicable.
(c) The SUBCONTRACTOR shall submit one (2) copies of the audit and/or the summary and the
management letter directly to the COUNTY immediately upon completion. The audit must be
accomplished by documentation indicating the SUBCONTRACTOR'S Board of Directors has
reviewed the audit.
(32) If the Developmental Disabilities Program Coordinator finds indications of potential non-compliance during
the contract monitoring process or learns that the SUBCONTRACTOR is out of compliance with any of the
terms or conditions of this contract, the following process will be pursued:
Concerned Citizens Community Access Contract 2015-2016
Page 7of15
(a) Informal Notification: Informal process wherein the COUNTY Coordinator alerts the
SUBCONTRACTOR in writing of the potential non-compliance and an agreeable solution is
reached within ten (10) days.
(b) Official Notification: If the informal notification does not result in resolution, the official
notification of possible non-compliance to establish a date, within ten (10) working days of
notification, when representatives of the COUNTY and the SUBCONTRACTOR shall meet to
discuss areas of contention and attempt to resolve the issues.
(c) Written Summary: Within ten (10) working days of such official notification, the COUNTY will
provide the SUBCONTRACTOR a written summary of the areas of non-compliance by certified
mail. Notice shall be sent to the address identified in the Agreement.
(d) Discussion: Within twenty (20) days of the date of the written summary, a discussion between
COUNTY and SUBCONTRACTOR shall be conducted to resolve areas of non-compliance or
potential non-compliance.
(e) Should the above procedures fail to resolve the compliance issue, the parties will obtain the
services of the Peninsula Dispute Resolution Center, or another agreed upon resource, and shall
share equally in any retainer fees or other costs of services. If no agreement is reached, the
mediator's decision in the matter will be binding on all parties, except that in no event will the
COUNTY honor a financial determination that is greater than the funds allowed in the scope of
this Agreement.
(33) For six years following the end date of this agreement, SUBCONTRACTOR will maintain client records and
books, records, documents, reports and other evidence of accounting procedures and practices, which
sufficiently and properly reflect all direct and indirect expenditures of funds provided under this agreement.
Client records shall minimally include statement of client goals, documentation of training provided, training
hours, routine progress notes and semi-annual summary of progress toward meeting client goals.
(3) 4) SUBCONTRACTOR will provide COUNTY with Adult Community Access Plans (or Person Centered
Plan/Profile), client goals, and a summary of progress towards meeting those goals on a bi-annual basis.
(35) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all client
records; and all documents, reports, and other data applicable to this agreement.
(36) SUBCONTRACTOR shall provide COUNTY with a copy of a signed DSHS Provider Agreement within 30
days of the effective date of this agreement.
(37) SUBCONTRACTOR agrees to assign to COUNTY its Medicaid Billing Rights for services to clients eligible
under Title XIX programs. Written documentation shall be available to COUNTY on request. If
SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX, COUNTY
agrees that funding intended for those clients shall be excluded from this agreement. If SUBCONTRACTOR
contracts directly with Social Security to provide covered services under a PASS/IRWE, COUNTY agrees that
funding intended for those clients shall be excluded from this agreement.
C. REIMBURSEMENTS
(1) For said services rendered under this agreement, COUNTY shall reimburse SUBCONTRACTOR $30.00 per
unit of service, as defined in Exhibit A, Statement of Work.
Concerned Citizens Community Access Contract 2015-2016
Page 8 of 15
(2) SUBCONTRACTOR will bill COUNTY on a monthly basis, on or before the 5th day of the month, for units
of service provided under this agreement during the preceding month. SUBCONTRACTOR will submit a
Monthly DDA Services Report (ADSA) form for its billings. At no time shall the invoices for reimbursement
be submitted more than 60 calendar days following the last day of the month for which the services were
provided.
(3) COUNTY may, at its option, withhold reimbursement for any month for which required reports have not
been received or are inaccurate and/or complete.
(4) Total reimbursements for the fiscal year of 2015-2016 to SUBCONTRACTOR by COUNTY under this
contract shall not exceed $6,177.00 in completion of these services without express written amendment signed
by both parties to this Agreement. This total reimbursement includes any amendment within the fiscal year of
2015-2016.
D. MISCELLANEOUS
(1) DSHS Division of Developmental Disabilities (DDA) shall determine individual eligibility of persons for
services delivered under this agreement. DDA shall notify COUNTY of persons authorized for services
reimbursed under this agreement. Only persons referred to COUNTY by DDA through a County Service
Authorization, (CSA) shall be eligible for services reimbursed under this agreement.
(2) The SUBCONTRACTOR'S relation to the COUNTY shall at all times be that of independent
SUBCONTRACTOR. Any and all employees of the SUBCONTRACTOR, or other persons engaged in the
performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall be
considered employees of the SUBCONTRACTOR only, and any claims that may arise on behalf of or
against said employees shall be the sole obligation and responsibility of the SUBCONTRACTOR.
(3) The SUBCONTRACTOR shall not sublet or assign any of the services covered by this Agreement without
the express written consent of the COUNTY. Assignment does not include printing or other customary
reimbursable expenses that may be provided in an Agreement.
(4) The SUBCONTRACTOR, by signature to this Agreement, certifies that the SUBCONTRACTOR is not
presently debarred, suspended, proposed for debannent, declared ineligible, or voluntarily excluded from
participating in this Agreement, or any Agreement by any Federal department or agency. The
SUBCONTRACTOR also agrees to include the above requirement to all subcontracts into which it enters.
(5) The SUBCONTRACTOR shall obtain and keep in force during the terns of the Agreement, or as
otherwise required, the following insurance with companies or through sources approved by the State
Insurance Commissioner pursuant to RCW 48:05:
(a) Worker's compensation and employer's liability insurance as required by the State of Washington.
(b) Commercial Automobile Liability or Business Use Insurance providing bodily injury and property
damage liability coverage for all owned and non -owned vehicles assigned to or used in the
performance of the work for a combined single limit of not less than $1,000,000 each occurrence
with the COUNTY named as an additional insured in connection with the SUBCONTRACTOR'S
performance of the contract.
(c) General Commercial Liability Insurance in an amount not less than a single limit of one million
dollars ($ 1,000,000.00) per occurrence and a aggregate of not less than two (2) times the
occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and property
damage, unless a greater amount is specified in the contract specifications. The insurance
coverage shall contain no limitations on the scope of the protection provided and include the
following minimum coverage:
(1) Broad Form Property Damage, with no employee exclusion
(2) Personal Injury Liability, including extended bodily injury
(3) Broad Form Contractual/Commercial Liability - including completed operations
Concerned Citizens Community Access Contract 2015-2016
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(4) Premises - Operations Liability (M&C)
(5) Independent Contractors and Subcontractors
(6) Blanket Contractual Liability
(6) All employees or subcontractors of SUBCONTRACTOR who are required to be professionally certified by
the State in the performance of services under this agreement shall maintain professional liability insurance
in the amount of not less than one million dollars ($1,000,000). In no case shall such professional liability
to third parties be limited in any way.
(7) It shall be the responsibility of the SUBCONTRACTOR to insure that any and all persons engaged in the
performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall comply
with the same insurance requirements that SUBCONTRACTOR is required to meet.
(8) Failure on the part of the SUBCONTRACTOR to maintain the insurance as required shall constitute a
material breach of contract upon which the COUNTY may, after giving five working days' notice to the
SUBCONTRACTOR to correct the breach, immediately terminate the contract or, at its discretion, procure
or renew such insurance and pay any and all premiums 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
the SUBCONTRACTOR from the COUNTY.
(9) All insurance costs shall be considered incidental to and included in the unit contract prices and no additional
payment will be made. Upon failure of the SUBCONTRACTOR to maintain the insurance as required the
COUNTY may withhold compensation otherwise due and owing to the SUBCONTRACTOR.
(10) Excepting the Workers Compensation insurance and any professional liability insurance secured by the
SUBCONTRACTOR, the COUNTY will be named on all certificates of insurance as an additional insured.
The SUBCONTRACTOR shall furnish the COUNTY with verification of insurance and endorsements
required by this Agreement. The COUNTY reserves the right to require complete, certified copies of all
required insurance policies at any time.
(11) All insurance shall be obtained from an insurance company authorized to do business in the State of
Washington. The SUBCONTRACTOR shall submit a verification of insurance as outlined herein within 14
days of the execution of this Agreement to the COUNTY. All insurance policies obtained by the
SUBCONTRACTOR shall be primary to any equivalent or applicable policies held by the COUNTY. All
insurance policies obtained by the SUBCONTRACTOR shall include a waiver of subrogation rights. Any
third -party liability coverage provided to the COUNTY by its membership and participation in a Ch. 48.62
Risk Pool Shall be in excess and shall be non-contributory to the insurance policies provided by the
SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract. All policies
provided by the SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract
must be endorsed to show this primary coverage.
(12) The COUNTY will pay no progress payments under Section C until the SUBCONTRACTOR has fully
complied with this section. This remedy is not exclusive; and the COUNTY may take such other action as
is available to them under other provisions of this Agreement, or otherwise in law.
(13) Nothing in the foregoing insurance requirements shall prevent the COUNTY, at its option, from additionally
requesting that the SUBCONTRACTOR deliver to the COUNTY an executed bond as security for the faithful
performance of this contract and for payment of all obligations of the SUBCONTRACTOR.
(14) The SUBCONTRACTOR shall comply with all Federal, State, and local laws and ordinances applicable to
the work to be done under this Agreement. This Agreement shall be interpreted and construed in accord
with the laws of the State of Washington and venue shall be in Jefferson COUNTY, WA.
(15) The SUBCONTRACTOR shall comply with the WA State Department of Labor and Industries Minimum Wage
Act, RCW 49.46, acknowledging persons with disabilities participating in job assessments are not considered
employees.
(16) The SUBCONTRACTOR shall indemnify and hold the COUNTY, and their officers employees, and agents
harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses
Concerned Citizens Community Access Contract 2015-2016
Page 10 of 15
relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly,
from the SUBCONTRACTOR'S negligence or breach of any of its obligations under this Agreement;
provided that nothing herein shall require a SUBCONTRACTOR to indemnify the COUNTY against and
hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY,
their officers, employees and agents, and provided further that if the claims or suits are caused by or result
from the concurrent negligence of:
(a) the SUBCONTRACTOR'S agents or employees; and, (b) the COUNTY, its officers, employees
and agents, this indemnity provision with respect to (1) claims or suits based upon such negligence,
and/or (2) the costs to the COUNTY of defending such claims and suits, etc., shall be valid and
enforceable only to the extent of the SUBCONTRACTOR'S negligence or the negligence of the
SUBCONTRACTOR'S agents or employees.
(17) Claims against the COUNTY shall include, but not be limited to assertions that the use and transfer of any
software, book, document, report, film, tape, or sound reproduction of material of any kind, delivered there
under, constitutes an infringement of any copyright, patent, trademark, trade name, or otherwise results in an
unfair trade practice or an unlawful restraint of competition.
(18) The SUBCONTRACTOR specifically assumes potential liability for actions brought against the COUNTY by
SUBCONTRACTOR'S employees, including all other persons engaged in the performance of any work or
service required of the SUBCONTRACTOR under this Agreement and, solely for the purpose of this
indemnification and defense, the SUBCONTRACTOR specifically waives any immunity under the state
industrial insurance law, Title 51 RCW. The SUBCONTRACTOR recognizes that this waiver was
specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation.
(19) SUBCONTRACTOR shall not discriminate against any person presenting themselves for services based on
race, religion, color, sex, age, or national origin.
(20) COUNTY reserves the right to terminate this contract in whole or in part, without prior written notice, in the
event that contractual terns are not fulfilled, or if expected or actual funding from the Department of Social
and Health Services Division of Developmental Disabilities is withdrawn, reduced, or limited in any way after
the effective date of this agreement. In the event of termination under this clause, COUNTY shall be liable
only for payment for services rendered prior to the effective date of termination.
(21) No portion of this contract may be assigned or subcontracted to any other individual, firm, or entity without
the express and prior written approval of COUNTY. If the COUNTY agrees in writing that all or a portion of
this Contract may be subcontracted to a third -party, then any contract or agreement between the
SUBCONTRACTOR and a third -party subcontractor must contain all provisions of this Agreement and the
third -party subcontractor must agree to be bound by all terms and obligations found in this agreement.
ADOPTED THISay of ljt�l7% , 2015
By: -
David Sulli , Chai an
Jefferson County Board of Commissioners
By: /�? /uu-?-�
Deput lerk of the Board
10
B[[..kiveDirector
Li
FEEConcerned Citizens
APPRO ED AS TO FOR ONLY;
By:
Jefferson COUNTY Prosecuting Att ney
Concerned Citizens Community Access Contract 2015-2016
Page 1 1 of 15
EXHIBIT A
STATEMENT OF WORK
COMMUNITY ACCESS
I. WORK STATEMENT
SUBCONTRACTOR shall provide Community Access services for program clients as described hereinafter.
SUBCONTRACTOR shall be reimbursed for such services on a unit of service basis, pursuant to Section E.,
Reimbursements, of this contract.
II. PROGRAM DESCRIPTION
A. Program Goals
Transfer or reduction of specialized supports as a result of increased personal independence and/or
community support systems.
2 Frequent opportunities to participate in community social, recreational, commercial, and/or
volunteer/contribution activities also utilized by peers/community members without disabilities.
3. Assisting individuals to participate in activities that promote individualized skill development,
independent living, and community integration.
4. Activities that provide individuals with opportunities to develop personal relationships with others
in their local communities and to learn to practice and apply life skills that promotes greater
independence and community inclusion.
5. Development of social contacts, friendships, and support systems with people without disabilities.
6. Frequent outings on an individual basis away from their home setting.
7. An opportunity to acquire supplemental training in a volunteer/job situation to enhance versatility and
individualized education/self-advocacy skill development necessary for new tasks in order to address
growth and interaction needs.
B. Definitions
Community Access. is:
• an opportunity to experience choice, power, and status in the community
• an opportunity to build relationships, to contribute and, to feel a sense of belonging to the
community
• opportunities to learn, to practice and apply life skills that promotes greater independence and
community inclusion
• an opportunity to access generic resources with peers without disabilities
• an opportunity to access volunteer opportunities in order to enhance versatility
• an opportunity for self advocacy and skill development for new tasks, and to contribute to the
community
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Concerned Citizens Community Access Contract 2015-2016
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C. Program Requirements
1. SUBCONTRACTOR shall provide Community Access Services. These services, as defined in Section
11.13 above & are in the Community Access Billable Activities Form.
2. SUCONTRACTOR shall provide Monthly Community Access service support hours that are based on
the Client's community access service level per WAC 388-828-9310.
SUBCONTRACTOR shall provide an Individual Program Plan and/or Person Centered
planning/profiles delineating individual skills and needs within 30 days of the beginning of services
with all program clients. The SUBCONTRACTOR will use the Community Access Plan Report
Foran, which will serve as an aid in matching program clients to appropriate services in the
community; and will serve as a transition tool towards the advancement of the individual's increased
personal independence in the community; an opportunity to build relationships; to contribute and to
feel a sense of belonging to the community, while accessing volunteer opportunities in order to
enhance versatility and develops skills necessary for new tasks.
4. SUBCONTRACTOR shall schedule a six-month review of meetings for all program participants. The
review shall include an assessment of the need for continued community access services and an
evaluation of the Individual Program plan goals and objectives in the form of a Semi -Annual Progress
Report. The SUBCONTRACTOR shall use the Community Access Plan Report Form, to report on the
semi-annual progress of the client.
5. The Semi -Annual Community Access Plan Report shall demonstrate the implementation strategy,
client goals, and how the individual is advancing towards meeting the outcomes of his or her goals;
training provided and a written synopsis showing progress toward meeting objectives or a description
of the reasons for any shortfall concerning the outcomes and proposed actions for correction.
6. COUNTY shall receive the dates for the 6 -month reviews for program clients one month before the
required meetings.
7. SUBCONTRACTOR will submit 6 -month progress reports that describe the outcomes of activities of
each Client, to the COUNTY, DDA Case Management, Residential Provider, Parent/Guardian and
others as appropriate. The report will summarize the progress made towards the Client's individualized
goals.
8. The SUBCONTRACTOR will use the Community Access Report Form, to report on the 6 -month
progress of the client.
9. SUBCONTRACTOR will contact every Client according to Client need and at least once per month.
10. The frequency of the Semi -Annual Progress Reports for this contractual period will be one every six (6)
months after the initial plan, July through December 2015 with the report due on January 4th of 2016,
the second due date will be January thru June 2016, due July 1" 2016.
11. Services shall promote the use of natural supports, which means personal associations and
relationships typically developed in the community that enhance the quality and security of life for
people, including but not limited to friendships reflecting the diversity of the neighborhood and the
community, associations with fellow students in community classes, and associations developed
through participation in clubs, organizations, and civic activities.
12. 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. Services will occur individually or in a group of no more than 2 individuals with similar
interest and needs.
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Concerned Citizens Community Access Contract 2015-2016
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13. Services shall provide support to those individuals wishing to seek volunteer activities; such as using
public transportation, assisting with referrals to the appropriate agencies, and other agreed upon
vocationally related goals in preparation for volunteering.
14. The SUBCONTRACTOR shall provide coordination of activities to develop a diverse schedule of
activities based on the client's needs and interests as connected to their Individual Program plan.
15. The SUBCONTRACTOR shall provide Community Access services in the community that promote
and achieve:
a. health and safety,
b. a positive image,
c. relationships,
d. increased competence,
e. individualized skill -building
f. and other expected benefits of Community Access.
16. The SUBCONTRACTOR shall assess and document in the Community Access Plan Report Form each
participant's transportation needs. The Provider shall assist each participant to access public or
specialized transportation for some activities sponsored as a part of Community Access services. It is
expected that public or specialized transportation will be utilized, except as detailed in the
transportation plan. The cost of transportation is included in the fee for service that a Provider receives.
17. Program participants must be authorized for service by the Developmental Disabilities Administration
(DDA) and referred to the COUNTY. Only persons referred to COUNTY by DDA through a County
Service Authorization, (CSA) shall be eligible for services reimbursed under this agreement.
18. A client receiving Community Access services will not receive Employment services simultaneously.
19. A client receiving Community Access services may at anytime choose to leave Community Access to
pursue work and to receive Individual Employment services.
20. If a client is not satisfied with employment services after nine (9) months in an employment program,
(an unsuccessful job search), the client may choose Community Access services.
21. SUBCONTRACTOR must ensure there is a legal requirement and a clear delineation for staff
qualifications and proof of background criminal history clearance in accordance with RCW 43.43.830-
845 and RCW 74.15.030 and Chapter 388-06 WAC on all staff.
22. SUBCONTRACTOR shall submit a written Program Staff Training Plan to COUNTY for approval or
disapproval within 30 days of the effective date of this agreement, semi-annually thereafter or when
reorganization occurs, which minimally includes:
i. SUBCONTRACTOR's procedure to train new direct service staff, training must include,
• DDA Policies & Competencies (see Section C -Number 23-26)
• RCW's & WAC's referenced on page 1 & 2 of the County Contract under Section B.
Obligations
• agency policies & procedures
• skills on how to instruct/teach clients
• skills on how to document data collection, daily/weekly notes, & 6 -month reports in
client files
ii. skills on how to write Community Access Client Plans and/or Person Centered Plans (creating
client goals/objectives)
iii. SUBCONTRACTOR's plan to provide staff who are skilled in applying training techniques to
enhance the work related skills of program clients
iv. FTE levels, job descriptions, and organization chart pertaining to program staff
V. SUBCONTRACTOR is required to send one direct service staff to a minimum of 16 hours of
workshops, trainings, and/or conferences about developmental disabilities. Should
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Concerned Citizens Community Access Contract 2015••2016
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SUBCONTRACTOR fail to access trainings for direct service staff, the SUBCONTRACTOR
will reimburse the COUNTY at the rate of 30.00 an hour for every hour of training not
accessed for staff (for not more than a total of $480).
23. SUBCONTRACTOR will provide COUNTY with information regarding staff qualifications and
documented training's upon request.
24. SUBCONTRACTOR must assure new staff are informed specifically of all agency policies/procedures
and have documentation that assures all direct service staff 18 years of age or older are trained in the
following DDA Policies Prior to WbrkinjZ with Clients: ADA training, APS Reporting Requirements,
client confidentiality, current individual instruction and Action Steps/Vocational Plans for each client
with whom the employee works; DDA Policy 4.11 Working Age Adult (adult services only); DDA
Policy 5.06 Client Rights; DDA Policy 5.13 Protection from Abuse, Mandatory Reporting; DDA
Policy 12.0 Incident Management.
25. SUBCONTRACTOR must ensure that new direct service staff demonstrate the following
competencies:
1) Values that support the abilities of individuals
2) Effective Communication — The ability to effectively listen and to make oneself
understood
3) Planning methods
4) Crisis Prevention and Intervention
26. Withiv one month of employment: zent: SUBCONTRACTOR must ensure that direct service staff received
training and are knowledgeable in the following areas: Overview of DDA Policies including: DDA
Policy 3.01 Service Plans; DDA Policy 5.03 Client Complaints; DDA Policy 5.17 Physical
Intervention Techniques; DDA Policy 6.13 Employment/Day Program Provider Qualifications; DDA
Policy 13.04 DRW Access Agreement; DDA Policy 15.03 Community Protection Standards for
Employment/Day Programs; and all reporting requirements related to these DDA Policies.
27. Within six months o era to went: SUBCONTRACTOR must ensure that direct service staff received
training and are knowledgeable in the following areas: Program skill development, DDA Policy 5.02
Necessary Supplemental Accommodation; DDA Policy 5.14 Positive Behavior Support; DDA Policy
5.15 Use of Restrictive Procedures; DDA Policy 9.07 HIV and AIDS and Program Skill Development.
28. SUBCONTRACTOR will have signed documentation that staff training took place within the timelines
listed above in Section C -Number 23-26.
29. Within 30 days of the effective date of this agreement, and annually thereafter, SUBCONTRACTOR
will develop and submit to COUNTY a Community Access program -operating budget detailing the
projected allocation of contract funds, other sources and amounts of funding, program staffing
expenses and other cost allocations. Within 30 days of the effective date of this agreement and at least
semi-annually thereafter, SUBCONTRACTOR will provide company and program operating financial
reports to COUNTY, including all revenues and expenses generated by SUBCONTRACTOR, in
sufficient detail to demonstrate the uses of funds provided under this agreement.
30. Every 6 months, SUBCONTRACTOR will develop and submit to COUNTY, Community Access
financial reports reflecting the actual revenues received and expenses incurred compared to the
projected program budget submitted, along with the overall operating budget.
D. Performance Standards
SUBCONTRACTOR shall provide Community Access services for up to one program client who is
authorized for service by DSHS/DDA and have been referred by COUNTY.
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Concerned Citizens Community Access Contract 2015-2016
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E. Service Level Guidelines
I. Client Acuity is determined through the DDA assessment. Acuity reflects conditions typically
related to individual disabilities that are not likely to change, and are generally not impacted by
outside factors. Client acuity is determined as "High", "Medium", or "Low" as defined within WAC
388-828.
2. Prior to beginning service or prior to an expected change in service, the provider will clearly
communicate to the Client and the County the maximum service hours per month the Client can
expect to receive. Service changes will not occur until the Client has received proper notification
from DDA.
(a) The Client's DDA ISP 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 CMIS County Service
Authorization and updated Planned Rates information
(c) 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.
Service Level Guidelines reflect Client Acuity and other considerations, (see Table below); the
assigned support levels typically reflect direct service staff time provided to or on behalf of the client
on an individual basis, to participate in age appropriate community activities similar to those without
disabilities. Allowable activities are defined in the Community Access Billable Activities
document.
The expectation is that all hours reported are documented specific to the client, authorized and relate
to the goals and supports outlined within the client's Community Access Plan.
COMMUNITY ACCESS- ASSIGNED SERVICE LEVEL -Monthly Support HOURS
ACUITY LEVEL
Monthly Support Hours
Level A
Up to 3 hours
Level B
Up to 6 hours
Level C
Up to 9 hours
Level D
Up to 12 hours
Level E
Up to 15 hours
Level F
Up to 18 hours
Level G
Up to 20 hours
F. Community Access Unit of Service
I. One UNIT of Community Access service is defined as one (1) or more "HOUR" of direct service or
ASSIGNED SERVICE LEVEL to one eligible client. A UNIT is defined as a "HOUR" which is at
least fifty (50) minutes of direct service; (partial hour to the quarter may be recorded), ten (10) minutes
of every "HOUR" can be used for documentation and/or meeting times.
2. Community Access service support hours per month will be based on the client's Community Access
Acuity Level per WAC.
3, SUBCONTRACTOR will provide a maximum of 216 units of service per fiscal year at $30.00 a unit
for up to one client.
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