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HomeMy WebLinkAbout111620_ca03615 Sheridan Street Port Townsend, WA 98368 �e�thson www.JeffersonCountyPublicHealth.org Consent Agenda Public Health JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Vicki Kirkpatrick, Director Anna McEnery, Developmental Disabilities/Behavioral Health DATE: SUBJECT: Agenda Item — Professional Services Agreement — DSHS-DDA; September 9, 2019 — June 30, 2021; Fee for Service STATEMENT OF ISSUE: Jefferson County Public Health, Developmental Disabilities Program is requesting Board approval of the Professional Services Agreement with DSHS, the Developmental Disabilities Administration (DDA), to provide emergency preparedness planning and assessments for individuals with developmental disabilities and their families; September 9, 2020 — June 30, 2021; Fee for Service at $70.00 an hour. ANALYSIS/STRATEGIC GOALS/PRO'S and COWS: The Professional Services Agreement is with the Developmental Disabilities Program for JCPH to provide consultation with clients, families, staff or caregivers to provide the following, (as requested): 1. Perform an assessment of need for emergency preparedness or response; 2. Develop an emergency plan or recommendations with input from the family, staff, client and recommendations from the WA Department of Health; 3. Provider individual training services; 4. Provide group training services; and/or Provide consultation. FISCAL IMPACT/COST BENEFIT ANALYSIS: Funding for the agreement comes from DSHS, the Developmental Disabilities Administration. RECOMMENDATION: JCPH management requests approval of the Professional Services Agreement with DSHS, the Developmental Disabilities Administration; September 9, 2020 — June 30, 2021; Fee for Service at $70.00 an hour. REVI BY: ��- . ;.. Community Health Developmental Disabilities 360-385-9400 360-385-9401 (f) Always working for a safer and healthier community Environmental Public Health 360-385-9444 (f) 360-379-4487 DSHS Agreement Number Washington State Department of Social COUNTY PROGRAM AGREEMENT 2063-91477 7 & Health Services Staff/Family Consultation Transforming lives This Program Agreement is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified Agreement Number below, and is issued in conjunction with a County and DSHS Agreement On General Terms and Conditions, which is incorporated by reference. County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Developmental Disabilities Division of Developmental 1223 1786CP-63 Admin Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Lucia Barbu 6860 Capitol Blvd SE Contracts Specialist Tumwater, WA 98501 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL 360 725-0132 Click here to enter text. barbulc@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County 615 SHERIDAN STREET Jefferson County DDA CountyServices Port Townsend, WA 98368 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Anna McEnery COUNTY CONTACT TELEPHONE COUNTY CONTACT FAX COUNTY CONTACT E-MAIL 360 385-9410 360 385-9401 amcenery@co.jefferson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? No PROGRAM AGREEMENT START DATE PROGRAM AGREEMENT END DATE MAXIMUM PROGRAM AGREEMENT AMOUNT 09/09/2020 06/30/2021 Fee For Service EXHIBITS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this County Program Agreement by reference: ❑ Exhibits (specify): ❑ No Exhibits. The terms and conditions of this Contract are an integration and representation of the final, entire and exclusive understanding between the parties superseding and merging all previous agreements, writings, and communications, oral or otherwise, regarding the subject matter of this Contract. The parties signing below represent that they have read and understand this Contract, and have the authority to execute this Contract. This Contract shall be binding on DSHS only upon signature by DSHS. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED Greg Brotherton, County Commissioner DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED Luise Frank, CS 3 Ap oved as rm ly: 7• C. Date: Philip C. H nsu cer, Chief Civil beputy Prosed6ti;6 Attorney Jefferson County Prosecuting Attorney's Office DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 1 Special Terms and Conditions 1. Definitions Specific to Special Terms. The words and phrases listed below, as used in this Contract, shall each have the following definitions: a. "Assistance" means help provide to a client for the purpose of aiding him/her in the performance of tasks. b. "Authorized" means approved by a DDA Case Resource Manager as evidenced by ProviderOne authorizations or approved by a DDA PASRR assessor. c. "Case Resource Manager or CRM" means the DSHS or DDA Case Manager, social worker or DDA PASRR Assessor assigned to a Client. d. "Client" means an individual whom DSHS has determined financially and programmatically eligible to receive services and for whom specific services have been authorized or has been determined to be PASRR eligible by DDA to receive PASRR services. e. "DDA" means the Developmental Disabilities Administration within the Department of Social and Health Services. f. "Determined to be PASRR-eligible by DDA" means having been assessed by a DDA PASRR Assessor as having a condition meeting the federal specifications for intellectual disability or related. g. "Direct Service Provider" means an individual or agency who meets the provider qualifications and is contracted with DSHS to provide direct services to the Client. h. "Family" means relatives who live in the same home with the eligible Client. Relatives include spouse or registered domestic partner; natural, adoptive or step parent; grandparent; child; stepchild; sibling; stepsibling; uncle; aunt; first cousin; niece; or nephew. i. "PASRR" means Pre -Admission Screening and Resident Review, a process required by federal rule for individuals who are referred to a Medicaid -certified nursing facility (NF). j. "PASRR Assessor" means a designated DDA Case Resource Manager who is trained to complete PASRR assessments. k. "PASRR Level II" means a type of assessment performed by DDA for PASRR Clients. I. "Physical Assistance" means the provision of hands-on assistance in the performance of daily tasks or activities. m. "Plan of Care" means a written plan for service delivery which identifies ways to meet the Client's needs with the most appropriate services or supports. n. "Primary Caregiver(s)" means the parents, legal guardians or other persons who have or assume primary responsibility for the necessary care of the Client. o. "ProviderOne" means the Washington State Medicaid management and information system, which is the payment system used for all Medicaid services. p. "Person Centered Service Plan or PCSP" is a component of the DDA CARE assessment which identifies formal and informal supports to meet the Client's needs as described in chapter 388-828 WAC and or a PASRR Level II or Follow-up report. DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 2 Special Terms and Conditions q. "Stabilization Services -Staff/ Family Consultation" means short-term, intermittent, or episodic supports to assist a Client who is experiencing a crisis related to challenging behaviors and is at immediate risk of hospitalization or institutionalization as defined in chapter 388-845 WAC. r. "Staff/Family Consultation" means professional assistance to families or direct service providers to help them better meet the needs of a participant as outlined in the service plan. s. "Waiver' means home and community based services (HCBS) approved by the Centers for Medicare and Medicaid Services (CMS) under section 1915(c) of the Social Security Act as an alternative to intermediate care facility for the individuals with intellectual disabilities (ICF/IID). 2. Purpose. The purpose of this Contract is to provide Staff/Family Consultation services and/or Staff/Family Consultation -Stabilization Services in accordance with chapter 388-845 WAC. Staff/Family Consultation Services are individualized and intended to provide professional assistance to families or direct service providers to help them better meet the needs of a Client as outlined in the person - centered service plan. 3. Licenses, Registrations, and Certifications. a. The Contractor is required to follow all laws, rules, and policies and meet training requirements applicable to their license, registration, and/or certification. b. Maintain all necessary licenses, registrations, and certifications as required by law. Licenses, registrations and certifications must remain in good standing without any substantiated complaints or sanctions during the period of performance of this Contract. c. When licensing or certification requirements and Contract requirements differ, the Contractor shall meet the higher standard of the two. d. In the event that any required license of the Contractor is revoked or expired, this Contract shall be suspended, without the necessity of written notice by DSHS, as of the effective date of revocation or the actual date of expiration. In the case of license revocation, this Contract shall then be terminated in accordance with the terms of this Contract, and such termination shall be effective on the effective date of the license revocation. 4. Contractor Qualifications. a. Staff/Family Consultation providers shall be licensed, registered or certified in Washington State according to the standards of their profession as listed below: (1) Audiologist licensed in accordance with RCW 18.35; (2) Licensed practical nurse licensed in accordance with RCW 18.79; (3) Marriage and family therapist licensed in accordance with RCW 18.225; (4) Mental health counselor licensed in accordance with RCW 18.225; (5) Occupational therapist licensed in accordance with RCW 18.59; (6) Physical therapist licensed in accordance with RCW 18.74; (7) Registered nurse licensed in accordance with RCW 18.79; DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 3 Special Terms and Conditions (8) Sex offender treatment provider licensed in accordance with RCW 18.155; (9) Speech/language pathologist licensed in accordance with RCW 18.35; (10) Social worker licensed in accordance with RCW 18.225; (11) Psychologist licensed in accordance with RCW 18.83; (12) Certified American Sign Language instructor; (13) Nutritionist licensed in accordance with RCW 18.138; (14) Counselors certified in accordance with chapter RCW 18.19; (15) Certified dietician licensed in accordance with RCW 18.138; (16) Professional advocacy organization; (17) Recreation therapist registered certified in Washington accordance with RCW 18.230 and certified by the national council for therapeutic recreation; (18) Educator or teacher certified in accordance with RCW 181-79A; (19) Providers listed in WAC 388-845-0506 and with a current Contract with DDA to provide CUBS Intensive Services; or (20) Or other provider identified in WAC chapter 388-845 for Staff/Family Consultation. 5. Statement of Work. The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as identified in the PCSP and as set forth below: a. Consultation for families, and direct support providers to meet the specific needs of the waiver or PASRR participant including: (1) Positioning and transfer; (2) Health and medication monitoring to report to the healthcare provider; (3) Basic and advanced instructional techniques; (4) Residential Habilitation Positive Behavior Support Implementation training; (5) Augmentative communication systems; (6) Consultation with potential referral resources (Mental Health Crisis Line, End -harm line, etc); (7) Diet and nutritional guidance; (8) Disability information and education; (9) Consultation to existing plan of care; (10) Strategies for effectively and therapeutically interacting with the participant; DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 4 Special Terms and Conditions (11) Environmental consultation; (12) Assistive Technology; or (13) Individual and family counseling only for the Basic Plus, Individual and Family Services and Children's Intensive In -home Supports waivers. b. The Contractor shall coordinate with the DDA Case Manager, Client, family, or direct service provider to: (1) Develop a relevant plan of care with goals or objectives that are specific, measureable, observable, and time -limited; (2) Provide individual consultation services; (3) Provide group consultation services; and, (4) Provide a quarterly update to the plan of care every 90 days. c. Staff and Family Consultation Services authorized as a Stabilization Service may be authorized for up to 90 days and must be added to the PCSP within 30 days of the start date of the authorization. Stabilization services are intermittent and temporary. The duration and amount of service needed to stabilize the Client in crisis is determined by DDA. Stabilization services are provided to Clients who are experiencing a behavioral health crisis and are at risk of hospitalization. Once the crisis situation is resolved and the Client is stabilized, stabilization services will be terminated. d. Ongoing need for Staff and Family Consultation services will be met under the stand-alone Staff/Family Consultation services category as identified in the PCSP. Ongoing need for staff and family consultation must be identified in the PCSP prior to the start of services. e. Staff/Family Consultation is not intended to replace direct therapeutic interventions for the Client that is otherwise available through private insurance, Medicare, the Medicaid state plan, state agencies, or another liable third party payer. 6. Reports. The Contractor shall: a. Submit the initial plan of care to the DDA CRM within thirty (30) days of initiating services. The plan of care shall include the following information, at a minimum: (1) Basic Client Information; (2) Client Presentation; (3) Summary of issues or concerns; (4) Account of Client's views of his/her present situation; (5) Medical history and current medical status; (6) Referrals provided; (7) Recommendations for ongoing supports; DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 5 Special Terms and Conditions (8) Specific measurable, observable, time -limited goals and objectives; (9) Consultation or training strategies to achieve the goal; (10) Goal completion criteria stated in objective, measurable terms; and (11) Other information as requested by the DDA case manager. b. Submit a progress report to the DDA Case manager every 90 days or as requested including the following, at minimum: (1) Specific dates of service and hours of service provided each day; (2) The names of persons present; (3) Summary of the progress towards achieving the goals and objectives in measurable terms; (4) The types of services provided; (5) Recommended changes to the plan, if any, in the progress report; (6) Barriers to meeting goals; (7) Changes in Client presentation; and (8) Referrals provided since the last report. c. Progress reports are not required for Stabilization Services that are not authorized or extended beyond 90 days. d. Maintain an ongoing, updated professional record of the Client's progress that is consistent with the provider's credential. 7. Consideration. Total consideration payable to Contractor for satisfactory performance of the work under this Contract shall be based on the following: a. This Contract is a Fee for Service Contract and the Contractor shall not be paid more than per service. Current rates are published at: hops://www.dshs.wa.gov/altsa/management-services division/office-rates-management. b. DSHS will only reimburse the Contractor for the number of units of service authorized and provided per Client. c. Administrative functions, such as record keeping, travel to work site, billing, and report development are not billable as separate services but are included in the established rate schedule. d. Transportation services. If needed, mileage shall be paid at current state of Washington rates, as published by the office of financial management, for miles driven while transporting Clients from one location to another. e. The rate established in this Contract is subject to change and does not require a Contract amendment. The rates will be adjusted accordingly and incorporated into this Contract on the date DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 6 Special Terms and Conditions the rate(s) become effective. f. Contractor must only deliver Staff/Family Consultation services identified in the PCSP. Stabilization Services-Staff/Family Consultation services may be authorized immediately as a short-term, intermittent or episodic prevention and intervention and will be added to the PCSP within 30 days of the start date of the service authorization. g. Contractor must not bill DDA for services which are available to a waiver recipient through the Medicaid state plan, managed care organization, or other legally obligated third party payer. 8. Billing and Payment a. The Contractor shall bill for authorized benefits using the ProviderOne Payment system which is the state of Washington's Medicaid management system. b. Billing instructions are located at: https://www.hca.wa.gov/billers- providers/providerone/providerone-social-services. c. DSHS shall not pay the Contractor for cancelled or missed appointments, nor for scheduled hours of service when clients are not seen or served by the Contractor. d. The Contractor agrees to accept this payment as total and complete remuneration for services provided under this Contract to DSHS clients. e. If DSHS pays the Contractor for services authorized but not provided by the Contractor the amount paid shall be considered to be an overpayment. f. If this Contract is terminated for any reason, DSHS shall pay for only those services authorized and provided through the date of termination. g. Payment shall be considered timely if made by DSHS within 30 days after receipt of properly completed invoices. Payment shall be sent to the address designated by Contractor. DSHS may, at its sole discretion, terminate the Contract or withhold payments claimed by Contractor for services rendered if Contractor fails to satisfactorily comply with any term or condition of this Contract. 9. Additional Client Rights: a. In compliance with Title VI of the Civil Rights Act of 1964, and under RCW 2.42.010, RCW 2.43.010, and RCW 49.60.010, the Contractor shall ensure that Limited English Proficient (LEP) Clients have access to a certified, or, if non -certifiable language, to an otherwise qualified language interpreter, who has successfully passed the DSHS language test. The Contractor shall also ensure that DSHS Clients have access to documents translated into the Client's primary language. To request a qualified interpreter, you must register at https://hcauniversal.com/new-reg1.a.uester- registration/ or email schedulingCa-ulsonline.net. For additional information, visit their Provider FAQs page. b. In compliance with the Americans with Disabilities Act (ADA) of 1990, under RCW 2.42.010 and RCW 49.60.010, the Contractor shall ensure that deaf, deaf -blind, or hard of hearing Clients have access to the services of an interpreter certified by the National Association of the Deaf (NAD) as a Sign Language Interpreter, or a qualified interpreter having a Registry of Interpreters for the Deaf (RID). DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 7 Special Terms and Conditions 10. Duty to Report Suspected Abuse, Abandonment, Neglect or Financial Exploitation. The Contractor and its employees must immediately report all instances of suspected abandonment, abuse, financial exploitation or neglect of a vulnerable adult under RCW 74.34.035 or a child under RCW 26.44.030.The report shall be made to the Department's current state abuse hotline, 1-866-363-4276 (END -HARM). The Contractor must also report all suspected instances to the Client's case manager. If the notice to the Client's case manager was verbal then it must be followed up by written notification within one business day. Further, when required by RCW 74.34.035, the Contractor and the Contractor's employees must immediately make a report to the appropriate law enforcement agency. 11. Significant Change in Client's Condition. The Contractor agrees to report any significant change in the Client's condition within twenty-four (24) hours to the Client's Case Manager. 12. Death of Clients. The Contractor shall report all deaths of DSHS Clients receiving services under this Contract to the Client's case manager within one hour upon notification of the death. The Contractor shall follow up with written notification of the Client's death to the Client's case manager within one business day. 13. Provider Screenings. a. The State must ensure the Department does not pay federal funds to excluded persons or entities. States are also required to check for the death of an individual provider, agency owner or authorized official prior to contracting. The required ownership and control information for individuals with ownership interest of five percent (5%) or more, officers and managing employees will be obtained from the Medicaid Provider Disclosure Statement and checked against all required federal exclusion lists, and the Social Security Death Master List, prior to finalizing a contract. b. The Contractor will report any change in ownership, managing employees, and/or those with a controlling interest to the Department within thirty-five (35) days of such a change so that these individuals can be screened against the required federal exclusion lists as well as the Social Security Death Master List. For detailed instructions, please refer to the Medicaid Provider Disclosure Statement. 14. Duty to Disclose Business Transactions. a. Under 42 CFR 455.104, the Contractor is required to provide disclosures from individuals with ownership interest, managing employees, and those with a controlling interest. The State must obtain certain disclosures from providers and complete screenings to ensure the State does not pay federal funds to excluded person or entities. Contractor must complete and submit a Medicaid Provider Disclosure Statement, DSHS Form 27-094. According to 42 CFR 455.104(c) (1), disclosures must be provided: (1) When the prospective Contractor submits their initial application; (2) When the prospective Contractor signs the contract; (3) Upon request of the Department at contract revalidation/renewal; (4) Within thirty-five (35) days after any change in ownership of the Contractor entity. b. Failure to submit the requested information may cause the Department to refuse to enter into an agreement or contract with the Contractor or to terminate existing agreements. The State will recover any payments made to a disclosing entity that fails to disclose ownership or control information, as required by 42 CFR 455.104. DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 8 Special Terms and Conditions c. Under 42 CFR 455.105(b), within thirty-five (35) days of the date of a request by the Secretary of the U.S. Department of Health and Human Services or DSHS, the Contractor must submit full and complete information related to Contractor's business transactions that include: (1) The ownership of any subcontractor with whom the Contractor has had business transactions totaling more than $25,000 during the twelve (12) month period ending on the date of the request; and (2) Any significant business transactions between the Contractor and any wholly owned supplier, or between the Contractor and any subcontractor, during the five (5) year period ending on the date of the request. d. Failure to comply with requests made under this term may result in denial of payments until the requested information is disclosed. See 42 CFR 455.105(c). 15. Background Check. The signatory for this contract agrees to undergo and successfully complete a DSHS criminal history background check conducted by DSHS every three years or more often as required by program rule or as otherwise stated in the contract, and as required under RCW 43.20A.710, RCW 43.43.830 through 43.43.842. If the Contractor has owners, administrators, subcontractors, employees or volunteers who may have unsupervised access to Clients in the course of performing the work under this Contract, the Contractor shall require those owners, administrators, subcontractors, employees or volunteers to successfully complete a criminal history background check prior to any unsupervised access and at least every three years thereafter or more often if required by program rule or as otherwise stated in the contract. The Contractor must maintain documentation of successful completion of required background checks. 16. False Claims Act Education Compliance. Federal law requires any entity receiving annual Medicaid payments of five (5) million or more to provide education regarding federal and state false claims laws for all of its employees, contractors and/or agents. If Contractor receives at least five (5) million or more in annual Medicaid payments under one or more provider identification number(s), the Contractor is required to establish and adopt written policies for all employees, including management, and any contractor or agent of the entity, including detailed information about both the federal and state False Claims Acts and other applicable provisions of Section 1902(a)(68) of the Social Security Act. The law requires the following: Contractor must establish written policies to include detailed information about the False Claims Act, including references to the Washington State False Claims Act; a. Policies regarding the handling and protection of whistleblowers; b. Policies and procedures for detecting and preventing fraud, waste, and abuse; c. Policies and procedures must be included in an existing employee handbook or policy manual, but there is no requirement to create an employee handbook if none already exists. 17. Bribes and Kickbacks. Federal law stipulates that Medicaid participants be offered free choice among qualified providers, therefore any exclusive relationship between the Contractor and any other Medicaid service is prohibited. 18. State or Federal Audit Requests. The Contractor is required to respond to State or Federal audit requests for records or documentation, within the timeframe provided by the requestor. The Contractor must provide all records requested to either State or Federal agency staff or their designees. DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/2512020) Page 9 Special Terms and Conditions 19. Drug -Free Workplace. The Contractor agrees he or she and all employees or volunteers shall not use or be under the influence of alcohol, marijuana, illegal drugs, and/or any substances that impact the Contractor's ability to perform duties under this Contract. 20. Execution and Waiver. This Contract shall be binding on DSHS only upon signature by DSHS with an Authorized Countersignature. Only the Contracting Officer or the Contracting Officer's designee has authority to waive any provision of this Contract on behalf of DSHS. 21. Additional Client Rights. a. In compliance with Title VI of the Civil Rights Act of 1964, and under RCW 2.42.010, RCW 2.43.010, and RCW 49.60.010, the Contractor shall ensure that Limited English Proficient (LEP) Clients have access to a certified, or, if non -certifiable language, to an otherwise qualified language interpreter, who has successfully passed the DSHS language test. The Contractor shall also ensure that DSHS Clients have access to documents translated into the Client's primary language. To request a qualified interpreter, you must register at https://hcauniversal.com/new-requester- registration/ or email scheduling Aulsonline.net. For additional information, visit their Provider FAQs page. b. In compliance with the Americans with Disabilities Act (ADA) of 1990, under RCW 2.42.010 and RCW 49.60.010, the Contractor shall ensure that deaf, deaf -blind, or hard of hearing Clients have access to the services of an interpreter certified by the National Association of the Deaf (NAD) as a Sign Language Interpreter, or qualified interpreter having a Registry of Interpreters for the Deaf (RID). 22. Duty to Report Suspected Abuse, Abandonment, Neglect or Financial Exploitation. The Contractor and its employees must immediately report all instances of suspected abandonment, abuse, financial exploitation or neglect of a vulnerable adult under RCW 74.34.035 or a child under RCW 26.44.030. The report shall be made to the Department's current state abuse hotline, 1-866-363-4276 (END -HARM). The Contractor must also report all suspected instances to the Client's case manager. If the notice to the Client's case manager was verbal then it must be followed by written notification within 48 hours. Further, when required by RCW 74.34.035, the Contractor and the Contractor's employees must immediately make a report to the appropriate law enforcement agency. 23. Significant Change in Client's Condition. The Contractor agrees to report any significant change in the Client's condition within twenty-four (24) hours to the Case Manager identified in the Client's current service plan. 24. Death of Clients. The Contractor shall report all deaths of DSHS Clients receiving services under this Contract to the Client's Case Manager within twenty-four (24) hours of finding out about the death. In addition, the Contractor shall provide written notification of the Client's death to the Client's Case Manager within seven (7) days. 25. Provider Screenings. a. The State must ensure the Department does not pay federal funds to excluded persons or entities. States are also required to check for the death of an individual provider, agency owner or authorized official prior to contracting. The required ownership and control information for individuals with ownership interest of five percent (5%) or more, officers and managing employees will be obtained from the Medicaid Provider Disclosure Statement and checked against all required federal exclusion lists, and the Social Security Death Master List, prior to finalizing a contract. b. The Contractor will report any change in ownership, managing employees, and/or those with a DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 10 Special Terms and Conditions controlling interest to the Department within thirty-five (35) days of such a change so that these individuals can be screened against the required federal exclusion lists as well as the Social Security Death Master List. For detailed instructions, please refer to the Medicaid Provider Disclosure Statement. 26. Duty to Disclose Business Transactions. a. Under 42 CFR §455.104, the Contractor is required to provide disclosures from individuals with ownership interest, managing employees, and those with a controlling interest. The State must obtain certain disclosures from providers and complete screenings to ensure the State does not pay federal funds to excluded person or entities. Contractor must complete and submit a Medicaid Provider Disclosure Statement, DSHS Form 27-094. According to 42 CFR 455.104(c) (1), disclosures must be provided: (1) When the prospective Contractor submits their initial application; (2) When the prospective Contractor signs the contract; (3) Upon request of the Department at contract revalidation/renewal; (4) Within thirty-five (35) days after any change in ownership of the Contractor entity. b. Failure to submit the requested information may cause the Department to refuse to enter into an agreement or contract with the Contractor or to terminate existing agreements. The State will recover any payments made to a disclosing entity that fails to disclose ownership or control information, as required by 42 CFR 455.104. c. Under 42 CFR §455.105(b), within thirty-five (35) days of the date of a request by the Secretary of the U.S. Department of Health and Human Services or DSHS, Contractor must submit full and complete information related to Contractor's business transactions that include: (1) The ownership of any subcontractor with whom the Contractor has had business transactions totaling more than $25,000 during the twelve (12) month period ending on the date of the request; and (2) Any significant business transactions between the Contractor and any wholly owned supplier, or between the Contractor and any subcontractor, during the five (5) year period ending on the date of the request. d. Failure to comply with requests made under this term may result in denial of payments until the requested information is disclosed. See 42 CFR §455.105(c). 27. Background Check. The signatory for this Contract agrees to undergo and successfully complete a DSHS criminal history background check conducted by DSHS or the AAA every two years, and as required under RCW 43.20A.710, and RCW 43.43.830 through 43.43.842. If the Contractor has owners, employees or volunteers who may have unsupervised access to Clients in the course of performing the work under this Contract, the Contractor shall require those owners, employees or volunteers to successfully complete a criminal history background check prior to any unsupervised access and at least every two years thereafter. The Contractor must maintain documentation of successful completion of required background checks. 28. False Claims Act Education Compliance. Federal law requires any entity receiving annual Medicaid payments of five (5) million or more to provide education regarding federal and state false claims laws DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 11 Special Terms and Conditions for all of its employees, contractors and/or agents. If Contractor receives at least five (5) million or more in annual Medicaid payments under one or more provider identification number(s), the Contractor is required to establish and adopt written policies for all employees, including management, and any contractor or agent of the entity, including detailed information about both the federal and state False Claims Acts and other applicable provisions of Section 1902(a)(68) of the Social Security Act. The law requires the following: Contractor must establish written policies to include detailed information about the False Claims Act, including references to the Washington State False Claims Act; a. Policies regarding the handling and protection of whistleblowers; b. Policies and procedures for detecting and preventing fraud, waste, and abuse; c. Policies and procedures must be included in an existing employee handbook or policy manual, but there is no requirement to create an employee handbook if none already exists. 29. Bribes and Kickbacks. Federal law stipulates that Medicaid participants be offered free choice among qualified providers, therefore any exclusive relationship between the Contractor and any other Medicaid Service is prohibited. 30. State or Federal Audit Requests. The Contractor is required to respond to State or Federal audit requests for records or documentation, within the timeframe provided by the requestor. The Contractor must provide all records requested to either State or Federal agency staff or their designees. 31. Drug -Free Workplace. The Contractor agrees he or she and all employees or volunteers shall not use or be under the influence of alcohol, marijuana, illegal drugs, and/or any substances that impact the Contractor's ability to perform duties under this Contract. 32. Execution and Waiver. This Contract shall be binding on DSHS only upon signature by DSHS with an Authorized Countersignature. Only the Contracting Officer or the Contracting Officer's designee has authority to waive any provision of this Contract on behalf of DSHS. DSHS Central Contract Services 1786CP- Staff/Family Consultation (08/25/2020) Page 12