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Home My WebLink About022221_ca08Al615 Sheridan Street dj Port Townsend, WA 98368 e Mon www.JeffersonCountyPublicHealth.org Public HeConsent Agenda 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 Coordinator DATE: SUBJECT: Agenda Item — Amendment No. 2 for the Developmental Disabilities Program Agreement with Department of Social and Health Services, the Developmental Disabilities Administration, (DDA) #1963-57619; July 1, 2019 — June 30, 2021; Additional $11,348 for a total of $784,232. STATEMENT OF ISSUE: Jefferson County Public Health, Developmental Disabilities Division, is requesting Board approval of Amendment No. 2 for the Developmental Disabilities Program Agreement with Department of Social and Health Services, the Developmental Disabilities Administration, (DDA) #1963-57619; July 1, 2019 — June 30, 2021; Additional $11,348 for a total of $784,232. ANALYSIS/STRATEGIC GOALS/PRO'S and CONS: This amendment is a continuation of services with DSHS:DDA for services to clients with developmental disabilities in Jefferson County. The contract covers a variety of services. The services include administration, training expenses (volunteers, board members, and staff), community information activities, consumer support (Early intervention services for Child development services for Birth to 3), Group Supported Employment, Individual Supported Employment, Individual Technical Assistance, Community Inclusion, and other activities (special projects). The statement of work requires a qualified Developmental Disabilities Coordinator, DD Advisory Board, working knowledge of DSHS/DRW Access Agreement and assignment of Medicaid billing rights under Title XIX. Jefferson County has professional service subcontracts with agencies or organizations representing each group. The Developmental Disabilities Program services provide educational opportunities for life-long learning and training to a specific workforce that allows interactions, equal opportunity, and integrated participation with community members without disabilities. These program services also support strategic efforts toward a sustainable economic base by recognizing the need for integrated employment opportunities for persons with disabilities. DD County program services undergird the economic reach of people with developmental disabilities by supporting programs that emphasize and address early intervention, community inclusion, integrated employment; while providing opportunities for community information and education for citizens with and without disabilities. Community Health Environmental Public Health Developmental Disabilities 360-385-9444 360-385-9400 (f) 360-379-4487 360-385-9401 (f) Always working for a safer and healthier community FISCAL IMPACT/COST BENEFIT ANALYSIS: This is a contract with the Department of Social and Health Services and includes both State and Waiver revenue. This revenue will be used to support programs in the Developmental Disabilities Programs. RECOMMENDATION: JCPH management request approval of Amendment No. 2 for the Developmental Disabilities Program Agreement with Department of Social and Health Services, the Developmental Disabilities Administration, (DDA) #1963-57619; July 1, 2019 — June 30, 2021; Additional $11,348 for a total of $784,232. REVIEWED BY: lily''=� • �C•ty ' • •.�� Community Health Developmental Disabilities 360-385-9400 360-385-9401 (f) Date Always working for a safer and healthier community Environmental Public Health 360-385-9444 (f) 360-379-4487 DSHS Agreement Number MAICL COUNTY PROGRAM AGREEMENT 1963-57619 AMU Department of Social BtHealthServices AMENDMENT Amendment No. Transforming fives DDA County Services 02 This Program Agreement Amendment is by and between the State of Washington Administration or Division Department of Social and Health Services (DSHS) and the County identified below. Agreement Number Click here to enter text. County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER CCS CONTRACT CODE Developmental Disabilities Division of Developmental 1223 1223 Admin Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Wendi Winchel PO BOX 45315 Olympia, WA 98504-5315 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL 360 725-4264 360 586-6502 winchwa@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County 615 SHERIDAN STREET Jefferson County DDA County Services Port Townsend, WA 98368 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER 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 AMENDMENT START DATE PROGRAM AGREEMENT END DATE 07/01 /2020 06/30/2021 PRIOR MAXIMUM PROGRAM AGREEMENT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM PROGRAM AGREEMENT AMOUNT AMOUNT $772, 884.00 $11, 348.00 $784,232.00 REASON FOR AMENDMENT; CHANGE OR CORRECT CHOOSE ONE: EXHIBITS. When the box below is marked with a check (4) or an X, the following Exhibits are attached and are incorporated into this Program Agreement Amendment by reference: ❑ Exhibits (specify): This Program Agreement Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Program Agreement. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Program Agreement remain in full force and effect. The parties signing below warrant that they have read and understand this Program Agreement Amendment, and have authority to enter into this Pro ram Agreement Amendment. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS Central Contract Services 1769CS County Program Agreement Amendment (11-9-20) Approved as to form only: Date: Philip C. Hunsucker, Chief Civil Deputy Prosecuting Attorney Jefferson County Prosecuting Attorney's Office Page 1 This Program Agreement between the County and the State of Washington Department of Social and Health Services (DSHS) is hereby amended as follows: 1. The Total Maximum Contract Amount is hereby increased in the amount of $11,348.00 for a new Contract Amount of $784,232.00. This amount is for services provided during the added fiscal year. 2. Section 1. Definition Specific to Program Agreement, Items c, (3) (c), v, w, x will be replaced with the following language: c. (3) (c) Partnership Project: Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). Supports provided should complement and not replace what the student(s) receive through the Individualized Education Program (IEP). v. "Competitive Integrated Employment" work performed by an individual on a part-time or full-time basis, within an integrated setting within the community that meets HCBS settings requirements. The individual must be compensated at minimum wage or higher, using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non -disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement. w. "Employment Outcome Payment' a payment to Providers for transition students born between specific dates; have high acuity; are authorized for Individual employment; and student obtains a competitive integrated job within a specific timeframes. If the job is a minimum of ten hours of work per week an additional amount will be include in the payment. x. "Job Foundation report" is a document derived from employment readiness activities performed by transition students that identifies actionable next step for employment. 3. Section 6. Statement of Work, item p. AWA Data System will include the following: p. (3) Review and respond within 5 working days to the "Work List' items including Referrals and pending Authorization. The "Ticklers" Planned Rate tab are attended to within 5 working days after the Planned Rate effective start date. 4. Section 6. Statement of Work, will replace the following: a. (4) Work with the County when referring individuals for services. Authorize new service within 5 working days. Extend existing service authorization before expiration date. b. (1) Work with the DDA Region when individuals are referred for services, authorized for services, and/or for support modifications. 6. Section 8. Billing and Payment will include the following: o. Job Foundation Administration: The County may bill for administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual expenditures multiplied by 7%. King, Snohomish and Pierce Counties will use line item 13, all other participating Counties will use line item 14 (OSPI). 6. Section 8. Billing and Payment items I, m, n will be replaced with the following language: Reimbursement for the Job Foundation report: a claim of $2,400 per student for each completed Job Foundation document that is at a satisfactory or above rating will be requested through the AWA system as other monthly cost. DSHS Central Contract Services 1769CS County Program Agreement Amendment (11-9-20) Page 2 m. Job Foundation report line item 95 and 96 as identified in the ADSA Web Access (AWA) billing system. King, Snohomish and Pierce Counties will use line item 95, all other participating Counties will use line item 96 (OSPI.) A copy of the completed Job Foundation document will be sent electronically to the shared mailbox located at: DDAJobFoundationReports(a-)-dshs.wa.gov n. Job placement verification for transition students: The AWA data transfer Employment Output for Individual Employment will be completed and submitted with payment request to verify employer, job start date, job type, etc. 7. Exhibit B. Program Agreement Budget is hereby replaced with the following Budget Revision. All other terms and conditions of this Program Agreement remain in full force and effect. DSH 1769 Exhibit B Program Agreement Budget ❑ Original Budget ❑X Budget Revision REVENUES Fiscal Year Fund Source Original 1at Revision 2nd Revision 3rd Revision 2020 State Funds 182,203 188,000 188,000 Medicaid match Funds 161,722 163,434 163,434 Total $343,925 $351,434 $351,434 2021 State Funds 222,805 225,815 Medicaid match Funds 198,645 206,983 Total $421,450 $432,798 COUNTY FY 2021 SPENDING PLAN Planned Expenditures OSPI or PASRR Job Funds Foundation Medicaid Funds State Funds Funds TOTAL' ADMINISTRATION CMIS/AWA BARS 11) 3361 0 15,474 12,661 28,471 OTHER CONSUMER SUPPORTS (CMIS/AWA Code 31, 32, 41, 92, 93, 94) 0 0 1 14462 11,832 26,294 CONSUMER SUPPORT STATE -ONLY 0 0 0 0 Child Development 16,125 16,125 MEDICAID CLIENTS 2,400 0 179,754 179,754 361,908 ROADS to COMMUNITY LIVING 0 0 0 0 0 TOTAL 2,736 0 225,815 204,247 432,798 DSHS Central Contract Services 1769CS County Program Agreement Amendment (11-9-20) Page 4 DSHS CONTRACT NUMBER: w, artm o n soda. Department of social CONTRACT AMENDMENT 1963-57619 Health Stances Amendment No. 01 Transforming /Ives This Contract Amendment is between the State of Washington Department of Program contract Number Social and Health Services (DSHS) and the Contractor identified below. Click here to enter text. Contractor Contract Number CONTRACTOR NAME CONTRACTOR doing business as (DBA) Jefferson County Jefferson County DDA County Services CONTRACTOR ADDRESS WASHINGTON UNIFORM BUSINESS DSHS INDEX NUMBER 615 SHERIDAN STREET IDENTIFIER (UBI) 1223 161-001-169 Port Townsend, WA 98368 CONTRACTOR CONTACT CONTRACTOR TELEPHONE CONTRACTOR FAX CONTRACTOR E-MAIL ADDRESS Anna McEne (360) 385-9410 360 385-9401 1 amcene co.'efferson.wa.us DSHS ADMINISTRATION DSHS DIVISION DSHS CONTRACT CODE Developmental Disabilities Admin Division of Developmental 1769CS-63 Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Wendi Winchel PO BOX 45315 Regional Business Manager I Olympia, WA 98504-5315 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL ADDRESS 360 7254264 360 586-6502 winchwa dshs.wa. ov IS THE CONTRACTOR A SUBRECIPIENT FOR PURPOSES OF THIS CONTRACT? CFDA NUMBERS No AMENDMENT START DATE CONTRACT END DATE 07/01/2019 06/30/2021 PRIOR MAXIMUM CONTRACT AMOUNT AMOUNT OF INCREASE OR DECREASE TOTAL MAXIMUM CONTRACT AMOUNT $343,925.00 $428,959.00 $772,884.00 REASON FOR AMENDMENT: CHANGE OR CORRECT CHOOSE ONE: ATTACHMENTS. When the box below is marked with an X, the following Exhibits are attached and are incorporated into this Contract Amendment by reference: ❑ Additional Exhibits s ci : This Contract Amendment, including all Exhibits and other documents incorporated by reference, contains all of the terms and conditions agreed upon by the parties as changes to the original Contract. No other understandings or representations, oral or otherwise, regarding the subject matter of this Contract Amendment shall be deemed to exist or bind the parties. All other terms and conditions of the original Contract remain in full force and effect. The parties signing below warrant that they have read and understand this Contract Amendment, and have authority to enter into this Contract Amendment. C PRINTED NAME AND TITLE DATE SIGNED VTF*C�IGNATURE 6 reo +4ertVl Chimer 8`l o j-6 � DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED 7kz'��" D � Melissa Diebert, Contract Specialist 08/17/20 Applooved a$ fo m only: '�J C`• rj D. ?roZri Philip C. Hunsudc�Chief Civil Deputy Prosec;tino Attomey Jefferson County Prosecuting Attorney's Office DSHS Central Contract Services Page 1 6024PF Contract Amendment (1-26-2018) This Contract between the State of Washington Department of Social and Health Services (DSHS) and the Contractor is hereby amended as follows: The Total Maximum Contract Amount is hereby increased in the amount of $428,959 for a new Contract Amount of $772,884. This amount is for services provided during the added fiscal year. 2. The Program Agreement end date is extended to June 30, 2021. 3. Section 1. Definition Specific to Program Agreement Item c.(3) (c) will be replaced with the following language: a. (3) (c) "Partnership Project". Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). Supports provided should complement and not replace what the student(s) receive through the Individualized Education Program (IEP). 4. Section 1. Definition specific to Program Agreement will include the following definitions: v. Competitive Integrated Employment - work performed by an individual on a part-time or full-time basis, within an integrated setting within the community that meets HCBS settings requirements. The individual must be compensated at minimum wage or higher, using the higher of the Federal, State, or local rate, and at a rate comparable to the wage paid to non -disabled workers performing the same tasks, including receiving the same benefits and opportunities for advancement. w. Employment Outcome Payment — A document derived from employment readiness activities performed by transition students who are between ages 19 through 20 that identifies actionable next step for employment. The employment service providers developing the Job Foundation report will be supporting transition students with employment activities for an average of 35 hours until student moves to Job Development phase of employment activities. x. Job Foundation document —A document derived from employment readiness activities performed by transition students that identifies actionable next step for employment. 5. Section 6. Statement of Work is revised to include the following: q. Partnership Project. (1) A Job Foundation document will be completed per guidelines for eligible students. Eligible students are DDA clients who were born between 9/1/00 through 8/31/01, currently attending school and have completed an application to participate in this Value Based Payment project. The VBP project application will include the following minimum criteria identified in the sample application found at: https://www dshs wa oov/sites/defauittfiles/DDA/dda/documents/Job%o20Foundation%2OADplica tion 040720%20%28002%29.docx (2) Qualified providers will collaborate with School District staff to complete the Job Foundation document and then provide a copy to the County. To be a qualified provider for the Partnership Project the Counties must require the provider to have a current contract with the Division of Vocational Rehabilitation; a contract in good standing with the County and cannot be in provisional status; a minimum of two years' experience providing Individual Employment with DSHS Central Contract Services Page 2 6024PF Contract Amendment (1-26-2018) demonstrated job placement skills. If the Job Foundation recommendation is for subminimum wage work / group work, service provider may not continue support. (3) County participating in the Partnership Project must have the ability to work collaboratively with School Districts to identify DDA students in high school, collect and track information, be proficient in electronic spreadsheets, and ability to evaluate if completed Job Foundation document(s) meet quality standards. r. Employment Outcome Payment. — Providers, with transition students born between 9/1/00 through 8/31/01, high acuity and authorized for Individual employment, may receive one outcome payment if student obtains a competitive integrated job approved by the County within timeframes described in the chart below. If the County is also the service provider DDA will provide the job approval. If the job is at a minimum of ten hours of work per week an additional amount will be include in the payment. 6. Section 8. Billing and Payment, will include the following: I. Reimbursement for Partnership project: a claim of $2,400 per student for each completed Job Foundation document that is at a satisfactory or above rating will be requested through the AWA system as other monthly cost m. 94 Partnership line item. A copy of the completed Job Foundation document will be sent electronically to DDA Employment and Day HQ staff. m. Job placement verification for transition students: The AWA Employment Output for Individual Employment will be completed and submitted with payment request to verify employer, job start date, job type, etc. 7. Adding two new section as follows effective 7/1/2019: Section 12. Confidential Information. All Counties and their subcontractors must: A. Ensure the security of Confidential Information; B. Use a Trusted Network when available; C. When transporting outside of a Secure Area, Portable Devices and Portable Media with DSHS Confidential Information must be under the physical control of staff with authorization to access the Data, even if the Data is encrypted. D. When transporting data containing DSHS Confidential Information outside a Secure Area must encrypt the data. Section 13. Data Security Requirements. Exhibit A shall only apply to the County if the County serves 150 or more DSHS clients. The Exhibit A will apply to the County subcontractor if the subcontractor serves 150 or more DSHS clients. 8. Exhibit A — Data Security Requirements the following replaces existing language effective 711/2020: Section 1 Definitions, item e, "Encrypt means to encode Confidential Information into a format that can only be read by those possessing a "key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 128 bits (256 preferred and required to be implemented by 6/30/2021 for symmetric keys, or 2048 bits for asymmetric keys. When a symmetric key is used, the advance Encryption Standard (AES) must be used if available. DSHS Central Contract Services Page 3 6024PF Contract Amendment (1-26-2018) Section 4 Authorization, Authentication, and Access, item h, (6) Ensuring use of Multi -factor Authentication to connect from the external end point to the internal end point. All contractors must be in compliance by 6/30/2021. 9. Exhibit B. Program Agreement Budget is hereby replaced with the following Budget Revision: DSHS Central Contract Services Page 4 6024PF Contract Amendment (1-26-2018) ❑ Original Budget Program Agreement Budget REVENUES ® Budget Revision EXHIBIT B Fiscal Year Fund Source Original 1't Revision 2"d Revision 3rd Revision 2020 State Funds 182,203 188,000 Medical Funds 161,722 163,434 Total $3443 925 $351,434 2021 State Funds 222,805 Federal Funds 198,645 Total $421,450 COUNTY FY 2021 SPENDING PLAN DSHS Central Contract Services Page 5 6024PF Contract Amendment (1-26-2018) COUNTY FY 2020 SPENDING PLAN All other terms and conditions of this Contract remain in full force and effect. DSHS Central Contract Services Page 6 6024PF Contract Amendment (1-26-2018) DSHS Agreement Number COUNTY Nasb1#01e0 SUfs 1963-57619 V"Iiiwd of Antoil osafcel Transfanring Yves PROGRAM AGREEMENT DDA County Services This Program Agreement is by and between the State of Washington Department of Administration or Division Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number conjunction with a County and DSHS Agreement On General Terms and Conditions, County Agreement Number which is incorporated by reference. DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Developmental Disabilities Division of Developmental 1223 1769CS-63 Admin Disabilities DSHS CON I"ACT NAME AND TITLE DSHS CONTACT ADM SS Wendi Winchel PO BOX 45315 Regional Business Manaqer Olyrn2ia, WA 98504-5315 DSHS CONTACTTEI EPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL 360 725-4264 360 586-6502 winchwa dshs.m v COUNTY NAME COUNTY ADDRESS Jefferson County 815 SHERIDAN STREET Jefferson County DDA County Services Port Townsend, WA 98368 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER Anna McEnery COUNTY CONTACT TELEPHONE COU M CONTACT FAX COUNTY CONTACT E-MAIL (360) 385-9410 360 385-9401 amcene co. rson.wa.us IS THE COUNTY A SUBRECIPIENT FOR PURPOSES OF THIS PROGRAM CFDA NUMBERS AGREEMENT? No PROGRAM AGREEMENT START GATE PROGRAM AGREEMENT END [SATE MAXIMUM PROGRAM AGREEMENT AMOUNT 07/01/2019 06/30/2020 $343,925.00 � EXHIBITS. The fallowing Exhibits are attached: Exhibit A — Data Security Requirements, Exhibit B — Budget and Sp2nding Plan By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all documents Incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify that they are authorized to sign this Program A regiment. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED Kate Dean, Chair Jefferson Co. Board of Commissioners DSHS-9I TURE PRINTED NAME AIt{RII�� Ewa Dfebert DATE SIGNED Contract Manager DSHS Central Contract Services 17e9CS County Agreement 5-1-2019 APPROVED AS TO FORM ONLY: C._4 a ;uling AttyPhilip Hunsucker, Chiet`Cvl Dae Page 1 333 DSHS Agreement Number COUNTY 1963-57619 Department of Social & Health Serkices PROGRAM AGREEMENT Transforming lives _.4 DDA County Services This Program Agreement is by and between the State of Washington Department of Administration or Division Social and Health Services (DSHS) and the County identified below, and is issued in Agreement Number conjunction with a County and DSHS Agreement On General Terms and Conditions, which is incorporated by reference. County Agreement Number DSHS ADMINISTRATION DSHS DIVISION DSHS INDEX NUMBER DSHS CONTRACT CODE Developmental Disabilities Division of Developmental 1223 1769CS-63 Admin Disabilities DSHS CONTACT NAME AND TITLE DSHS CONTACT ADDRESS Wendi Winchel PO BOX 45315 Regional Business Manager Olympia, WA 98504-5315 DSHS CONTACT TELEPHONE DSHS CONTACT FAX DSHS CONTACT E-MAIL 360 725-4264 360 586-6502 winchwa@dshs.wa.gov COUNTY NAME COUNTY ADDRESS Jefferson County 615 SHERIDAN STREET Jefferson County DDA County Services Port Townsend, WA 98368 COUNTY FEDERAL EMPLOYER IDENTIFICATION COUNTY CONTACT NAME NUMBER 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 07/01/2019 06/30/2020 $343,925.00 EXHIBITS. The following Exhibits are attached: Exhibit A — Data Security Requirements; Exhibit B — Budget and Spending Plan By their signatures below, the parties agree to the terms and conditions of this County Program Agreement and all documents incorporated by reference. No other understandings or representations, oral or otherwise, regarding the subject matter of this Program Agreement shall be deemed to exist or bind the parties. The parties signing below certify that they are authorized to sign this Program Agree ent. COUNTY SIGNATURE(S) PRINTED NAME(S) AND TITLE(S) DATE(S) SIGNED Kate Dean, Chair Jefferson Co. Board of Commissioners DSHS SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS Central Contract Services 1769CS Count' Agreement 5-1-2019 APPROVED AS IFORRIVI ONLY: By: V ' e, Philip Hunsucker, Chief Civil Depu Pr se ting Atty Page 1 1. Definitions Specific to Program Agreement: The words and phrases listed below, as used in this Program Agreement, shall each have the following definitions: a. "Acuity Level" means the level of an individual's abilities and needs as determined through the DDA assessment. b. "AWK means ALTSA Web Access also referred to as the CMIS. c. "Additional Consumer Services" refers to indirect Client service types as follows: (1) "Community Information and Education": Activities to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (2) "Training": To increase the job related skills and knowledge of staff, providers, volunteers, or interning students in the provision of services to people with developmental disabilities. Also to enhance program related skills of board or advisory board members. (3) "Other Activities" reserved for special projects and demonstrations categorized into the following types: (a) infrastructure projects: Projects in support of Clients (services not easily tracked back to a specific working age Client) or that directly benefit a Client(s) but the Client is not of working age. Examples include planning services like benefits planning and generic job development e.g. "Project Search". (b) Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support. (c) "Partnership Project": Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). d. "BARS" means DDA Budget and Accounting Reporting System. e. "Client" means a person with a developmental disability as defined in chapter 388-823 WAC who is currently eligible and active with the Developmental Disabilities Administration or is an identified PASRR Client. f. "County" is the political subdivision of the state of Washington and the county or counties entering into this Program Agreement. g. "Consumer Support" refers to direct Client service types as follows: (1) "Community Inclusion" or "Cl": services are individualized services provided in typical integrated community settings. Services will promote individualized skill development, independent living and community integration for persons to learn how to actively and independently engage in their local community. Activities will provide opportunities to develop relationships and to learn, practice and apply skills that result in greater independence and community inclusion. These services may be authorized for individuals age 62 and older. These services may be authorized instead of employment support (Individual Employment or Group Supported Employment) for working age individuals who have received nine months of employment support. Page 2 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 i (2) "Child Development Services" or "CDS": Birth to three services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. Services may include specialized instruction, speech -language pathology, occupational therapy, physical therapy, assistive technology, and vision services. Services are provided in natural environments to the maximum extent appropriate. (3) "Individual Supported Employment" or "IE": services are a part of an individual's pathway to employment and are tailored to individual needs, interests, and abilities, and promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state's minimum wage in the general workforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job. (4) "Individualized Technical Assistance" or "ITA": services are a part of an individual's pathway to individual employment. This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment. This is in addition to supports received through supported employment services for individuals who have not yet achieved their employment goal. (5) "Group Supported Employment" or "GSE": services are a part of an individual's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment in community settings. h. "CRM" means the DDA Case Resource Manager. i. "CSK means County Service Authorization. j. "DD" means developmental disabilities. k. "DDA" means the Developmental Disabilities Administration within DSHS. I. "DDA Region" means the DDA Regional office. m. "DVR" means the Division of Vocational Rehabilitation. n. "General Terms and Conditions" means the contractual provisions contained within that agreement, which govern the contractual relationship between DSHS and the county. o. "HCBS" means the Medicaid Home and Community Based Services. p. "PASRR" means Preadmission Screening and Resident Review. q. "PCSP means Person Centered Service Plan, a document that authorizes and identifies the DDA paid services to meet a Client's assessed needs. Formerly referred to as the Individual Support Plan. r. "Quality Assurance" means an adherence to all Program Agreement requirements, including DDA Policy 6.13, Employment/Day Program Provider Qualifications, County Guidelines and the Criteria for Evaluation, as well as a focus on reasonably expected levels of performance, quality, and practice. Page 3 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 s. "Quality Improvement" means a focus on activities to improve performance above minimum standards and reasonably expected levels of performance, quality and practice. t. "Service Provider" is a qualified Client service vendor who is contracted to provide Employment and Day Program services. u. "Subcontractor" is the service provider contracted by the County to provide services. 2. Purpose: This Program Agreement is entered into between DDA and the County in accordance with chapter 71A.14 RCW. Its purpose is to advance the state legislative policy to provide a coordinated and comprehensive state and local program of services for persons with developmental disabilities. 3. Client Eligibility: Client eligibility and service referral are the responsibility of DDA under chapter 388- 823 WAC (Eligibility) and chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under this Program Agreement. It is DDA's responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services provided without authorization are not reimbursable under this Program Agreement. 4. Credentials and Minimum Requirements: a. Administration of the developmental disabilities County program cannot be subcontracted. b. Qualified DD Program Coordinator: A qualified DD program coordinator has a minimum of five years training and experience in the administration and/or the delivery of developmental disabilities services to a community. For a county where the coordinator administers more than one program area (e.g. Chemical Dependency, Mental Health, Developmental Disabilities), training and experience in administration and/or a related Human or Social service may be considered. c. Administration Responsibility: The County must demonstrate the ability to administer the program agreement including contract oversight and monitoring, community outreach and education activities, and regular communication with the DDA region and contracted providers. d. Fiscal Responsibility: The County must demonstrate the ability to safeguard public funds including maintaining books, records, documents and other materials relevant to the provision of goods and services. e. Sufficient Policies and Procedures for Establishment and Maintenance of adequate internal control systems: The County will maintain written policy procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such that operations can continue should staffing change or absences occur. f. Background/Criminal History Check: A background/criminal history clearance is required every three years for all employees (including DD program County staff), subcontractors, and/or volunteers who may have unsupervised access to vulnerable DSHS Clients, in accordance with RCW 43.43.830-845, RCW 74.15.030, and chapter 388 WAC. If the entity reviewing the application elects to hire or retain an individual after receiving notice that the applicant has a conviction for an offense that would disqualify the applicant from having unsupervised access to vulnerable adults as defined in chapter 74.34 RCW, then DDA shall deny payment for any subsequent services rendered by the disqualified individual provider. The DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance. g. Qualified Advisory Board Members: A Developmental Disabilities advisory board shall include members knowledgeable about developmental disabilities. No board member shall have a contract with the County to provide Training, Community Information Activities, and Consumer Support as Page 4 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 defined in this Program Agreement, and shall not be a board member, officer, or employee of an agency subcontracting with the County to provide such services. h. Qualified Service Providers: The County assures that all service providers meet qualifications as outlined in the DDA Policy 6.13, Program Provider Qualifications. i. Home and Community Based Waiver Services Assignment of Medicaid Billing Rights: The County assures that each subcontractor has agreed to assign to DDA its Medicaid billing rights for services to DDA Clients eligible under Title XIX programs in this Program Agreement. Written documentation shall be available to DSHS on request. j. Reporting Abuse and Neglect: The County staff and its subcontractors who are mandated reporters under RCW 74.34.020(13) must comply with reporting requirements described in RCW 74.34.035, .040 and chapter 26.44 RCW. If the County is notified by DSHS that a subcontractor staff member is cited or on the registry for a substantiated finding, then that associated staff will be prohibited from providing services under this Program Agreement. k. Counties who provide Child Development Services (birth to three early intervention services), must provide those services under the regulations implementing the Individuals with Disabilities Education Act (IDEA), Part C, and Washington State's Early Support for Infant and Toddler Federally Approved Plan. I. The County staff who perform 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. m. Contractors are specifically authorized to have data storage on portable devices or media in accordance with the Data Security Requirements. n. Order of Precedence: in the event of any inconsistency in this Program Agreement and any attached exhibits, unless otherwise provided herein, the inconsistency shall be resolved by giving precedence, in the following order, to: (1) County Program Agreement; (2) Attached Exhibits. 5. Duty to Disclose: Under 42 CFR §455.104, the Administration must obtain certain disclosures and complete required screenings to ensure the State does not pay federal funds to excluded person or entities. The County is required to provide disclosures from managing employees, specifically the persons in the positions of Developmental Disabilities Director and Fiscal/Budget Director, i.e. the person who authorizes expenditures. A completed Medicaid Provider Disclosure Statement, DSHS Form 27-094, should be submitted to the Administration to complete the required screenings. Disclosures must be provided at contract renewal and within thirty-five (35) days whenever there is a change in the staff holding these management positions [42 CFR 455.104 (c)(1)]. 6. Statement of Work: The County shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below. Working collaboratively and Page 5 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 sharing information as needed for service coordination, the parties shall administer DID services within the county as set forth below: a. The DDA region shall: (1) Review subcontractors and shall immediately notify the County of any concerns with the subcontractors identified by the County; (2) Inform and include the County in the discharge planning of individuals leaving institutions and returning to the community who will need program funding; (3) Inform the County of individuals who have had their waiver status changed; (4) Work with the County when referring individuals for services; (5) Inform Clients of service changes through Planned Action Notice(s); (6) Work with the Contractor to document planned services in the Individual's Support Plan including notification of assessment dates; (7) Work with the Contractor when terminating services; (8) Work with the Contractor on Spending Plan adjustments; and (9) Work with the Contractor in participating in on -site evaluation of direct service providers. b. The County shall: (1) Work with the DDA Region when individuals are referred for services; (2) Work with the DDA Region to document planned services in the Individual's Support Plan; (3) Assist with informing the DDA Region of any potential service level changes not documented in the individual's DID Assessment prior to any changes; (4) Work with the DDA Region regarding service termination; (5) Work with the DDA Region on Spending Plan adjustments; (6) Inform the DDA Region of new providers to be included on the CMIS system; (7) Notify the DDA Region of any intent to terminate a subcontractor who is serving a DDA referral; (8) Provide a copy of each subcontractor's contract upon written request from the DDA Region; and (9) Notify and work with the DDA Region when performing on -site evaluations of direct service providers. c. Compliance with BARS Policies: The County shall take any necessary and reasonable steps to comply with BARS Policies. d. The County shall comply with the following referenced documents found at DDA Internet site httos://www.dshs,wa.gov/dda/county-best--practices under "County Best Practices": Page 6 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (1) DDA Policy 4.11, County Services for Working Age Adults; (2) Chapter WAC 388-850, chapter 388-828 WAC, WAC 388-845-0001, 0030, 0210, 0215, 0220, 0600-0610, 1030-1040, 1400-1410, 2100, 2110; (3) Criteria for Evaluation; (4) DDA Guiding Values: (5) County Guide to Achieve DDA's Guiding Values; (6) DDA Guidelines for Community Assessments within Employment and Vocational Programs: and (7) Disability Rights Washington (formerly Washington, Protection and Advocacy System) Access Agreement. e. The County shall develop and submit a comprehensive plan for the County DD Services as required by WAC 388-850-020. Conveyance of The Estimated Number of People to be Served and Targeted Outcomes: The County shall submit the Service Information Forms (SIF's) (provided by DDA at Internet site https://www.dshs.wa.gov/dda/county-best-j2ractices) to indicate the estimated number of people to be served, targeted outcomes, and identified goal(s) that focus on quality improvement within the categories of Training, Community Information, Direct Client Services, and Other Activities within 30 days of execution of the Program Agreement. Once approved, the SIF outcomes may be modified only by mutual agreement of the County and the DDA Region. g. Solicitation for Qualified Employment and Day Program Service Providers: Requests for Applications (RFAs), Requests for Information (RFI's) and/or Requests for Proposals (RFPs), Requests for Qualifications (RFQ's) for direct services, excluding Child Development, will be open continuous enrollment. h. Qualified Providers:: A qualified provider must be a county or an individual or agency contracted with a county or DDA. i. Technical Assistance: DDA contracts with Technical Assistance providers that may be utilized by Counties with prior written approval. j. Subcontractors: The County will pass on all applicable contractual requirements that are between DDA and the County to the subcontractor. The County shall immediately notify the DDA Region of the County's intent to terminate a subcontractor who is serving a DDA referral. Individuals or agencies contracted with a county or DDA may not subcontract for Employment or Community Inclusion services. k. The County shall provide or contract with qualified Employment and Day Program Service Providers for consumer support services that include the following program outcomes: (1) Monthly Community Inclusion service support hours will be based on the Client's Cl service level per WAC 388-828-9310 for all Clients who began receiving Cl services July 1, 2011 and forward. (a) To ensure health and safety, promote positive image and relationships in the community, increase competence and individualized skill -building, and achieve other expected benefits of Cl, services will occur individually or in a group of no more than two (2) or three (3) Page 7 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 individuals with similar interests and needs. (b) Cl services will focus on activities that are typically experienced by the general public. Support to participate in segregated activities and/or specialized activities will not be reimbursed. (c) A Client receiving CI services will not receive employment support simultaneously. (d) A Client receiving Cl services may at any time choose to leave Community Inclusion to pursue work and receive employment support. (2) Clients in an employment program will be supported to work towards a living wage. A living wage is the amount needed to enable an individual to meet or exceed his/her living expenses. Clients should be supported to average twenty (20) hours of community work per week or eighty-six (86) hours per month; however, each person's preferred hours of employment should be taken into consideration. The amount of service a Client receives will be based on his/her demonstrated need, acuity level and work history per WAC 388-828. (3) The Client's DDA PCSP is the driver for service. The AWA CSA and updated Planned Rates information will not exceed the Client's DDA PCSP. Service changes will not occur until the Client has received proper notification from DDA. (4) All Clients will have an Individualized Employment or Community Inclusion plan to identify Client's preferences. Minimum plan elements are outlined in the reference document "Criteria for an Evaluation." A copy of the Client's individualized plan will be provided to the Client, their CRM, guardian and others as appropriate. (5) Semi-annual progress reports that describe the outcomes of activities will be provided by the provider or the County to the client, their CRM, guardian and others as appropriate. The report will summarize the progress made towards the Client's individualized goals. (6) All Clients will be contacted by their service provider according to Client need and at least once per month. (7) If Clients in Individual Employment or Group Supported Employment, have not obtained paid employment at minimum wage or better within six (6) months, the County will assure the following steps are taken: (a) Review the progress toward employment goals; (b) Provide evidence of consultation with the Client/guardian; and (c) Develop additional strategies with the Client/guardian, county staff, employment support staff, case manager, and others identified by the Client. Strategies may include providing technical assistance, changing to a new provider, and/or providing additional resources as needed to support the individual's pursuit of employment. The additional strategies will be documented for each Client and kept in the Client's file(s). (8) If after twelve (12) months the Client remains unemployed, an additional review will be conducted. The provider will address steps outlined in the previous six month progress report in the next six month progress report. The Client may request to participate in Community Inclusion activities or the Client may choose to remain in an employment program. When requesting to participate in Cl, the Client shall communicate directly with his or her DDA Case Manager. The DDA Case Manager is responsible for authorizing CI services. Page 8 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (9) For Individual Employment where the service provider is also the Client's employer, long term funding will remain available to the service provider employer for six months after the employee DDA Client's date of hire. At the end of the six month period, if the DDA Client continues to need support on the job, another service provider who is not the employer of record must provide the support unless the County or DDA issues prior written approval for the service provider to continue to provide long-term supports if needed. If the County or DDA approves the continuation of long-term supports where the service provider is also the Client's employer, the County or DDA will regularly monitor these positions to assure fading efforts occur when appropriate and any potential conflict of interest is addressed. (10) Individual Employment staff hours must be attributed to the "Individual Employment and Billable Activity Phase(s)". (11) For Group Supported Employment (GSE), Clients must have paid work. The total number of direct service staff hours provided to the group should be equal to or greater than the group's collective amount of individual support monthly base hours. If the direct service staff hours are less than the collective amount, then the provider will be reimbursed only for the number of hours staff actually provided. (a) The collective group's individual hours should be the minimum staff hours delivered to support the group. (a) A GSE client must be on-site/at work at least their base individual hours as a minimum per month. If a client is not on-site/at work for all of their base hours, the county should verify that the provider delivered the collective group's individual hours to the group (what was the number of staff hours provided to the group during the month? If it was less than the collective group's total the provider can only bill for the staff hours that were provided). (b) A GSE agency may not bill for a GSE client who does not receive services during an entire service month. (c) A GSE agency must have a record of which staff is supporting which clients on any given day. (d) A GSE agency must have supportive documentation that provides clear evidence of support helping with specific activities as identified in the client plan to move a client on their pathway towards their employment goal(s). (e) Running a GSE service is a part of the business operation and not billable to individuals (contract procurement, contract maintenance, or administration functions associated with GSE). (f) Individual time in the community working towards the individual employment goal, separate from the group time, must include phase information (refer to Employment Phases and Billable Activities - see Phases 1 — 4 for element / activity description). (12) Employment and day services must adhere to the Home and Community Based settings (HCBS) requirements of 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; Page 9 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (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. Quality Assurance and Service Evaluation: The County shall develop and have available an evaluation system to review services. The evaluation system must have both a Quality Assurance and a Quality Improvement component, and both must include objective measures. The objective measures at a minimum will include performance indicators, by acuity, that include the number of new jobs; job loss and reasons for job loss; the percentage employed earning minimum wage or better; and the average number of hours worked. The County's service evaluation system shall serve as the method by which current providers demonstrate that they continue to be qualified providers. A copy of such evaluation system shall be provided upon request to DDA for review and approval. m. On -Site Evaluation: The County shall evaluate and review services delivered to reasonably assure compliance and quality. The County shall conduct at least one on -site visit to each subcontractor during the biennium. The County shall maintain written documentation of all evaluations, recommendations and corrective action plans for each subcontractor. Copies of such documentation will be provided to the DDA upon request. n. The County shall work with local developmental disability advisory groups to plan for and coordinate services. o. The County shall participate in regularly scheduled meetings between County DD staff and DDA staff to remain updated and current including ACHS and Regional Meetings. p. AWA Data System: The County shall use the AWA data system for all billing requests, service provider address and phone number maintenance, evaluation dates and to provide employment outcome information. (1) Monthly provide all data described in the Billing Instructions and in the Employment Outcomes Instructions, which is hereby incorporated by reference. (2) Assure the integrity of data submitted to the State. When data is submitted and rejected due to errors or an error is later identified, the County will correct and resubmit the data within thirty (30) days. 7. Consideration: a. Fees: (1) Approval of fees is the responsibility of the DDA. The DDA Region reserves the right to approve fees/rates for the services being provided. The County will submit a fee/rate schedule with the initial Program Agreement. The County will submit updated fee/rate schedules to the DDA Regional Employment Specialist for approval as changes occur. The rate schedule will include the following information: (a) County(s) name; (b) Time period for which the schedule is applicable; and (c) Each contracted direct service OE, GSE, Cl, ITA, CDS) and its associated rate. Page 10 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (2) Fee Limitations: The DDA will set limitations on the Hourly Rate for each direct service. Hourly rates must be divisible by four. The current rates are as follows: (a) Employment services. i. Individual Employment services will not exceed $75.00/hour. ii. Group Supported Employment services will not exceed $65.00/hour. (b) Community Inclusion services will not exceed an hourly rate of $35.00. (c) Child Development services will not exceed a monthly rate of $500.00. b. Budget and Spending Plan, attached as Exhibit B: (1) Budget amount listed in Exhibit B: The County may not exceed the state only revenue dollar amount or the total revenue dollar amount indicated on the Program Budget Agreement included in Exhibit B. The waiver revenue dollar amount may be exceeded to accommodate Clients moving from state -only employment and day services to waiver employment and day services. (2) Spending Plan: DDA will provide the initial Spending Plan. Funding shall be distributed under planned expenditures as well as allocated under State and Medicaid shall function as a line item budget for expenditures under this agreement. The planned expenditures for Consumer Support are based on Client numbers as well as planned additional consumer services expenditures. The spending plan may only be modified by mutual agreement of the parties in writing and shall not require a program agreement. (a) Funds Designated for Additional Consumer Services: If a County provides Community Information and Education services under additional consumer services, then activities must include outreach efforts to federally recognized local tribes. (b) Funds Designated for Adult Day Care Consumers: Funds designated for Adult Day Care Consumers are available to Clients who were served between December 1996 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level II or III services (Adult Day Health). Level II and III services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. These Clients may be referred to services defined in the statement of work, or to an Adult Day Care service other than Level II or III. If a Client no longer needs and wants services, the funds are available for other Clients who are not part of the group of original Clients identified between December 1996 and 2003. An Adult Day Care service shall only be provided by Adult Day Care agencies certified by the local Area Agency on Aging. Adult Day Care service is not a waiver approved service. Program Agreement Amendments: A County can request an amendment at any time. An amendment for additional client(s) may be supported when clients exceed the number used to develop the contract. An amendment for additional service hours authorized may be supported when county provides evidence. An amendment request for expenditures exceeding contract total due to hourly rates paid to service provider may not be supported as the county is responsible to manage contract and rates paid to their providers. d. Exemptions: The DDA Assistant Secretary may approve in writing an exemption to a specific Page 11 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 program agreement requirement. 8. Billing and Payment: a. Program Agreement Budget: DSHS shall pay the County all allowable costs, which are defined by DDA as cost incurred by the program for: (1) Administration: Costs of the County Human Services Department or similar county office, responsible for administration of the Developmental Disabilities Program. Allowable costs include personnel and overhead costs directly related to the administration and coordination of the program, including such activities as program planning, budgeting, contracting, monitoring, and evaluation. Also included are departmental and county indirect and/or direct administrative costs, to the extent that such costs are appropriately allocated to the program using an established methodology consistent with grants management guidelines. For a County whose designated coordinator manages multiple programs, the County must be able to provide evidence of the time the coordinator spent working on the Developmental Disabilities program. (2) Additional Consumer Services: (a) Training: i. Staff Training: Costs incurred by the program for planned, structured activities for the purpose of providing, or improving, or enhancing job -related knowledge and skills of staff, providers, volunteers, or interning students in the provision of developmental disabilities services. ii. Board Training: Costs incurred by the program for planned, structured activities designed to provide, improve, or enhance program -related skills of board and advisory committee members. (b) Community Information and Education: to inform and/or educate the general public about developmental disabilities and related services. These may include information and referral services; activities aimed at promoting public awareness and involvement; and community consultation, capacity building and organization activities. (c) Other Activities. i. Infrastructure projects: Projects in support of Clients (services not easily tracked back to a specific working age Client) or that directly benefit a Client(s) but the Client is not of working age. Examples include planning services like benefits planning and generic job development e.g. "Project Search." ii. Start-up projects: Projects that support an agency or directly benefit the agency. Examples include equipment purchases and agency administrative support. iii. Partnership project: Collaborative partnerships with school districts, employment providers, DVR, families, employers and other community collaborators needed to provide the employment supports and services young adults with developmental disabilities require to become employed during the school year they turn twenty-one (21). (3) Consumer Support. (a) Adult Day Care services are available to Clients who were served between December 1996 Page 12 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 and December 2003 in Adult Day Health agencies and were subsequently determined ineligible for Level 11 or III services (Adult Day Health). Level 11 and III services are licensed rehabilitation and skilled nursing services along with socialization. Level I services (Adult Day Care) are supervised day programs where frail and disabled adults can participate in social, educational, and recreational programs without the need for skilled nursing. (b) Community Inclusion services are individualized services provided in typical integrated community settings for individuals in retirement. Services will promote individualized skill development, independent living and community integration for persons to learn how to actively and independently engage in their local community. Activities will provide opportunities to develop relationships and to learn, practice and apply skills that result in greater independence and community inclusion (per the Community Inclusion Billable Activities . These services may be authorized instead of employment support (Individual Employment or Group Supported Employment) for working age individuals who have received nine (9) months of employment support. (c) Child Development Services are designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child's development. Services may include specialized instruction, speech -language pathology, occupational therapy, physical therapy, assistive technology, and vision services. Services are provided in natural environments to the maximum extent appropriate. (d) Individual Supported Employment services are a part of an individual's pathway to employment and are tailored to individual needs, interests, and abilities to promote career development. These are individualized services necessary to help persons with developmental disabilities obtain and continue integrated employment at or above the state's minimum wage in the general workforce. These services may include intake, discovery, assessment, job preparation, job marketing, job supports, record keeping and support to maintain a job (per the Individual Employment Phases & Billable Activities) (e) Individualized Technical Assistance services are a part of an individual's pathway to employment. This service provides assessment and consultation to the employment provider to identify and address existing barriers to employment. This is in addition to supports received through supported employment services for individuals who have not yet achieved their employment goal. (f) Group Supported Employment services are a part of an individual's pathway to integrated jobs in typical community employment. These services are intended to be short term and offer ongoing supervised employment for groups of no more than eight (8) workers with disabilities in the same setting. The service outcome is sustained paid employment leading to further career development in integrated employment at or above minimum wage. Examples include enclaves, mobile crews, and other business models employing small groups of workers with disabilities in integrated employment community settings. b. Reimbursement for the state Fiscal Year shall not exceed the total amount listed in Exhibit B to this Program Agreement. However, with a Program Agreement amendment, the parties may increase or decrease the Program Agreement amount. Counties will work with DDA HQ on amendments to the Program Agreement. c. Monthly Invoice with Signed Documentation: All requests for reimbursement amounts must be entered and posted into the AWA system. The Contractor may post a combined claim of all programs/services covered by this Program Agreement. DSHS shall make all payments due to the Contractor for all invoices submitted pursuant to this section within sixty (60) days following posting Page 13 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 of required information. d. Clients will be assisted in accessing DVR services per the DDA/DVR MOU. Client services shall not be reimbursed under this Program Agreement when the same services are paid for under the Rehabilitation Act of 1973 by DVR, Public Law 94-142 or any other source of public or private funding. e. Reimbursement of Client Services: A claim for each individual is made on the AWA system by indicating the number of service units delivered to each individual listed and the fee per unit. Units are defined as: (1) An "Hour" is at least fifty (50) minutes of direct service. Partial hour to the quarter may be recorded. (2) A "Day" is at least four (4) hours of direct service and will only be used in connection with Adult Day Care reimbursement. (3) A "Month" represents a minimum of at least fifty (50) minutes of direct service for CDS reimbursement. Program Administration: The County will provide program administration and coordination including such activities as planning, budgeting, contracting, monitoring, evaluation and may bill for administrative costs as identified in Exhibit B. Administrative costs reimbursement will not exceed 7% of the total combined allocation for Consumer Support and Other Consumer Support services unless the Assistant Secretary of DDA approves a request for an exception under chapter 388-850 WAC. Monthly claims for administrative costs will be 1/12 of the maximum Administration amount identified in Exhibit B, or the lessor of the two. g. The Individual Employment Phases & Billable Activities document defines the individual Client services that DDA reimburses. That document is located on the DSHS DDA County Best Practices Web site at https://www.dshs.wa,gov/dda/countv-best-r)ractices. h. The Community Inclusion Billable Activities document defines the individual Client services DDA reimburses. That document is located on the DSHS DDA County Best Practices Web site at https://www.dshs.wa.gov/dda/county-best-practices. Timeliness of and Modification to Billings: All initial invoices with signed documentation must be received by the DDA Region within sixty (60) calendar days following the last day of the month in which the service is provided. Corrected invoices and documentation including re -posted billing information will be accepted throughout the fiscal year as long as they are received within sixty (60) calendar days of the associated fiscal year unless an extension is approved by the DDA Regional Administrator or designee. Payment will not be made on any invoice submitted past sixty (60) calendar days after the Program Agreement fiscal year. j. Recovery of Fees: If the County bills and is paid fees for services that DSHS later finds were (a) not delivered or (b) not delivered in accordance with Program Agreement standards, DSHS shall recover the fees for those services and the County shall fully cooperate during the recovery. k. PASRR Administration: The County may bill for administration costs as identified in Exhibit B. Monthly claims for administration cost will be based on the actual PASRR expenditures multiplied by 7%. 9. Intermediate Care Facilities for Intellectual Disabilities (ICF/ID) Agreement. If applicable per 42 Page 14 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 CFR 483.410, the County shall assure that all county -operated or subcontracted programs serving persons living in ICF/ID facilities develop a plan and coordinate their services with the facility on behalf of the ICF/ID resident. DDA will supply to the County a list of ICF/ID residents who attend a day program. 10. Single State Medicaid Agency —Health Care Authority (HCA): HCA, as the single state Medicaid Agency, has administrative authority for Title XIX coverage per 42 CFR 431.10. DSHS is the operating agency for the Home and Community Based Waivers for services for people with developmental disabilities. The County only has responsibility for services covered in this agreement. 11. DSHS/DRW Access Agreement: The DRW February 27, 2001 Access Agreement with DDA is incorporated by reference. The County assures that it and its subcontractors have reviewed the Access Agreement. The agreement covers DRW's access to individuals with developmental disabilities, Clients, programs and records, outreach activities, authority to investigate allegations of abuse and neglect, and other miscellaneous matters and is binding for all providers of DDA contracted services. Page 15 DSHS Central Contract Services, 1769CS County Agreement 5-1-2019 Exhibit A— Data Security Requirements 1, Definitions. The words and phrases listed below, as used in this Exhibit, shall each have the following definitions: a. "AES" means the Advanced Encryption Standard, a specification of Federal Information Processing Standards Publications for the encryption of electronic data issued by the National Institute of Standards and Technology (http://nvipubs.nist.gov/nistpubs/FIPS/NIST.FIPS.197.pdf). b. "Authorized Users(s)" means an individual or individuals with a business need to access DSHS Confidential Information, and who has or have been authorized to do so. c. "Category 4 Data" is data that is confidential and requires special handling due to statutes or regulations that require especially strict protection of the data and from which especially serious consequences may arise in the event of any compromise of such data. For purposes of this contract, data classified as Category 4 refers to data protected by: the Health Insurance Portability and Accountability Act (HIPAA). d. "Cloud" means data storage on servers hosted by an entity other than the Contractor and on a network outside the control of the Contractor. Physical storage of data in the cloud typically spans multiple servers and often multiple locations. Cloud storage can be divided between consumer grade storage for personal files and enterprise grade for companies and governmental entities. Examples of consumer grade storage would include iCloud, Dropbox, Box.com, and many other entities. Enterprise cloud vendors include Microsoft Azure, Amazon Web Services, 0365, and Rackspace. e. "Encrypt" means to encode Confidential Information into a format that can only be read by those possessing a "key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 128 bits (256 preferred and required to be implemented by 6/30/2020) for symmetric keys, or 2048 bits for asymmetric keys. When a symmetric key is used, the Advanced Encryption Standard (AES) must be used if available. f. "Hardened Password" means a string of at least eight characters containing at least three of the following four character classes: Uppercase alphabetic, lowercase alphabetic, numeral, and special characters such as an asterisk, ampersand, or exclamation point. g. "Mobile Device" means a computing device, typically smaller than a notebook, which runs a mobile operating system, such as iOS, Android, or Windows Phone. Mobile Devices include smart phones, most tablets, and other form factors. h. "Multi -factor Authentication" means controlling access to computers and other IT resources by requiring two or more pieces of evidence that the user is who they claim to be. These pieces of evidence consist of something the user knows, such as a password or PIN; something the user has such as a key card, smart card, or physical token; and something the user is, a biometric identifier such as a fingerprint, facial scan, or retinal scan. "PIN" means a personal identification number, a series of numbers which act as a password for a device. Since PINs are typically only four to six characters, PINs are usually used in conjunction with another factor of authentication, such as a fingerprint. i. "Portable Device" means any computing device with a small form factor, designed to be transported from place to place. Portable devices are primarily battery powered devices with base computing resources in the form of a processor, memory, storage, and network access. Examples include, but Page 16 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 are not limited to, mobile phones, tablets, and laptops. Mobile Device is a subset of Portable Device. j. "Portable Media" means any machine readable media that may routinely be stored or moved independently of computing devices. Examples include magnetic tapes, optical discs (CDs or DVDs), flash memory (thumb drive) devices, external hard drives, and internal hard drives that have been removed from a computing device. k. "Secure Area" means an area to which only authorized representatives of the entity possessing the Confidential Information have access, and access is controlled through use of a key, card key, combination lock, or comparable mechanism. Secure Areas may include buildings, rooms or locked storage containers (such as a filing cabinet or desk drawer) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. In otherwise Secure Areas, such as an office with restricted access, the Data must be secured in such a way as to prevent access by non -authorized staff such as janitorial or facility security staff, when authorized Contractor staff are not present to ensure that non -authorized staff cannot access it. I. 'Trusted Network" means a network operated and maintained by the Contractor, which includes security controls sufficient to protect DSHS Data on that network. Controls would include a firewall between any other networks, access control lists on networking devices such as routers and switches, and other such mechanisms which protect the confidentiality, integrity, and availability of the Data. m. "Unique User 1D" means a string of characters that identifies a specific user and which, in conjunction with a password, passphrase or other mechanism, authenticates a user to an information system. 2. Authority. The security requirements described in this document reflect the applicable requirements of Standard 141.10 (https://ocio.wa.gov/policies) of the Office of the Chief Information Officer for the state of Washington, and of the DSHS Information Security Policy and Standards Manual. Reference material related to these requirements can be found here: https://www.dshs.wa.,qovtfsa/central- contract-services/keeping-dshs-client-information-private-and-secure, which is a site developed by the DSHS Information Security Office and hosted by DSHS Central Contracts and Legal Services. 3. Administrative Controls. The Contractor must have the following controls in place: a. A documented security policy governing the secure use of its computer network and systems, and which defines sanctions that may be applied to Contractor staff for violating that policy. b. If the Data shared under this agreement is classified as Category 4 data, the Contractor must be aware of and compliant with the applicable legal or regulatory requirements for that Category 4 Data. c. If Confidential Information shared under this agreement is classified as Category 4 data, the Contractor must have a documented risk assessment for the system(s) housing the Category 4 Data. 4. Authorization, Authentication, and Access. In order to ensure that access to the Data is limited to authorized staff, the Contractor must: Page 17 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 a. Have documented policies and procedures governing access to systems with the shared Data b. Restrict access through administrative, physical, and technical controls to authorized staff. c. Ensure that user accounts are unique and that any given user account logon ID and password combination is known only to the one employee to whom that account is assigned. For purposes of non -repudiation, it must always be possible to determine which employee performed a given action on a system housing the Data based solely on the logon ID used to perform the action d. Ensure that only authorized users are capable of accessing the Data. e. Ensure that an employee's access to the Data is removed immediately: (1) Upon suspected compromise of the user credentials. (2) When their employment, or the contract under which the Data is made available to them, is terminated. (3) When they no longer need access to the Data to fulfill the requirements of the contract. f. Have a process to periodically review and verify that only authorized users have access to systems containing DSHS Confidential Information g. When accessing the Data from within the Contractor's network (the Data stays within the Contractor's network at all times), enforce password and logon requirements for users within the Contractor's network, including: (1) A minimum length of 8 characters, and containing at least three of the following character classes: uppercase letters, lowercase letters, numerals, and special characters such as an asterisk, ampersand, or exclamation point. (2) That a password does not contain a user's name, logon ID, or any form of their full name. (3) That a password does not consist of a single dictionary word. A password may be formed as a passphrase which consists of multiple dictionary words. (4) That passwords are significantly different from the previous four passwords. Passwords that increment by simply adding a number are not considered significantly different. h. When accessing Confidential Information from an external location (the Data will traverse the Internet or otherwise travel outside the Contractor's network), mitigate risk and enforce password and logon requirements for users by employing measures including: (1) Ensuring mitigations applied to the system don't allow end -user modification. (2) Not allowing the use of dial -up connections. (3) Using industry standard protocols and solutions for remote access. Examples would include RADIUS and Citrix. (4) Encrypting all remote access traffic from the external workstation to Trusted Network or to a component within the Trusted Network. The traffic must be encrypted at all times while traversing any network, including the Internet, which is not a Trusted Network. Page 18 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (5) Ensuring that the remote access system prompts for re -authentication or performs automated session termination after no more than 30 minutes of inactivity. (6) Ensuring use of Multi -factor Authentication to connect from the external end point to the internal end point. All Contractors must be in compliance by 6/30/2020. i. Passwords or PIN codes may meet a lesser standard if used in conjunction with another authentication mechanism, such as a biometric (fingerprint, face recognition, iris scan) or token (software, hardware, smart card, etc.) in that case: (1) The PIN or password must be at least 5 letters or numbers when used in conjunction with at least one other authentication factor (2) Must not be comprised of all the same letter or number (11111, 22222, aaaaa, would not be acceptable) (3) Must not contain a "run" of three or more consecutive numbers (12398, 98743 would not be acceptable) j. If the contract specifically allows for the storage of Confidential Information on a Mobile Device, passcodes used on the device must: (1) Be a minimum of six alphanumeric characters. (2) Contain at least three unique character classes (upper case, lower case, letter, number). (3) Not contain more than a three consecutive character run. Passcodes consisting of 12345, or abcd12 would not be acceptable. k. Render the device unusable after a maximum of 10 failed logon attempts. 5. Protection of Data. The Contractor agrees to store Data on one or more of the following media and protect the Data as described: a. Hard disk drives. For Data stored on local workstation hard disks, access to the Data will be restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User ID and Hardened Password or other authentication mechanisms, which provide equal or greater security, such as biometrics or smart cards. Network server disks. For Data stored on hard disks mounted on network servers and made available through shared folders, access to the Data will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted to such servers must be located in an area, which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as long as the disks remain in a Secure Area and otherwise meet the requirements listed in the above paragraph. Destruction of the Data, as outlined below in Section 8 Data Disposition, may be deferred until the disks are retired, replaced, or otherwise taken out of the Secure Area. Page 19 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 c. Optical discs (CDs or DVDs) in local workstation optical disc drives. Data provided by DSHS on optical discs which will be used in local workstation optical disc drives and which will not be transported out of a Secure Area. When not in use for the contracted purpose, such discs must be Stored in a Secure Area. Workstations which access DSHS Data on optical discs must be located in an area which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers. Data provided by DSHS on optical discs which will be attached to network servers and which will not be transported out of a Secure Area. Access to Data on these discs will be restricted to Authorized Users through the use of access control lists which will grant access only after the Authorized User has authenticated to the network using a Unique User ID and Hardened Password or other authentication mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on discs attached to such servers must be located in an area, which is accessible only to authorized personnel, with access controlled through use of a key, card key, combination lock, or comparable mechanism. e. Paper documents. Any paper records must be protected by storing the records in a Secure Area, which is only accessible to authorized personnel. When not in use, such records must be stored in a Secure Area.. f. Remote Access. Access to and use of the Data over the State Governmental Network (SGN) or Secure Access Washington (SAW) will be controlled by DSHS staff who will issue authentication credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users on Contractor's staff. Contractor will notify DSHS staff immediately whenever an Authorized User in possession of such credentials is terminated or otherwise leaves the employ of the Contractor, and whenever an Authorized User's duties change such that the Authorized User no longer requires access to perform work for this Contract. g. Data storage on portable devices or media. (1) Except where otherwise specified herein, DSHS Data shall not be stored by the Contractor on portable devices or media unless specifically authorized within the terms and conditions of the Contract. If so authorized, the Data shall be given the following protections:: (a) Encrypt the Data. (b) Control access to devices with a Unique User ID and Hardened Password or stronger authentication method such as a physical token or biometrics. (c) Manually lock devices whenever they are left unattended and set devices to lock automatically after a period of inactivity, if this feature is available. Maximum period of inactivity is 20 minutes. (d) Apply administrative and physical security controls to Portable Devices and Portable Media by: L Keeping them in a Secure Area when not in use, ii. Using check-in/check-out procedures when they are shared, and iii. Taking frequent inventories. Page 20 DSHS Central Contract Services 1769CS County Agreement 5-1.2019 (2) When being transported outside of a Secure Area, Portable Devices and Portable Media with DSHS Confidential Information must be under the physical control of Contractor staff with authorization to access the Data, even if the Data is encrypted. h. Data stored for backup purposes. (1) DSHS Confidential Information may be stored on Portable Media as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. Such storage is authorized until such time as that media would be reused during the course of normal backup operations. If backup media is retired while DSHS Confidential Information still exists upon it, such media will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition. (2) Data may be stored on non -portable media (e.g. Storage Area Network drives, virtual media, etc.) as part of a Contractor's existing, documented backup process for business continuity or disaster recovery purposes. If so, such media will be protected as otherwise described in this exhibit. If this media is retired while DSHS Confidential Information still exists upon it, the data will be destroyed at that time in accordance with the disposition requirements below in Section 8 Data Disposition L Cloud storage. DSHS Confidential Information requires protections equal to or greater than those specified elsewhere within this exhibit. Cloud storage of Data is problematic as neither DSHS nor the Contractor has control of the environment in which the Data is stored. For this reason: (1) DSHS Data will not be stored in any consumer grade Cloud solution, unless all of the following conditions are met: (a) Contractor has written procedures in place governing use of the Cloud storage and Contractor attest to the contact listed in the contract and keep a copy of that attestation for your records in writing that all such procedures will be uniformly followed. (b)The Data will be Encrypted while within the Contractor network. (c) The Data will remain Encrypted during transmission to the Cloud. (d) The Data will remain Encrypted at all times while residing within the Cloud storage solution. (e) The Contractor will possess a decryption key for the Data, and the decryption key will be possessed only by the Contractor. (f) The Data will not be downloaded to non -authorized systems, meaning systems that are not on the contractor network (g) The Data will not be decrypted until downloaded onto a computer within the control of an Authorized User and within either the DSHS or Contractor's network. (2) Data will not be stored on an Enterprise Cloud storage solution unless either: (a) The Cloud storage provider is treated as any other Sub -Contractor, and agrees in writing to all of the requirements within this exhibit; or, (b) The Cloud storage solution used is HIPAA compliant. Page 21 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 (3) If the Data includes protected health information covered by the Health Insurance Portability and Accountability Act (HIPAA), the Cloud provider must sign a Business Associate Agreement prior to Data being stored in their Cloud solution. 6. System Protection. To prevent compromise of systems which contain DSHS Data or through which that Data passes: a. Systems containing DSHS Data must have all security patches or hotfixes applied within 3 months of being made available. b. The Contractor will have a method of ensuring that the requisite patches and hotfixes have been applied within the required timeframes. c. Systems containing DSHS Data shall have an Anti-Malware application, if available, installed. d. Anti-Malware software shall be kept up to date. The product, its anti -virus engine, and any malware database the system uses, will be no more than one update behind current. 7. Data Segregation. a. DSHS category 4 data must be segregated or otherwise distinguishable from non-DSHS data. This is to ensure that when no longer needed by the Contractor, all DSHS Data can be identified for return or destruction. It also aids in determining whether DSHS Data has or may have been compromised in the event of a security breach. As such, one or more of the following methods will be used for data segregation (1) DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will contain no non-DSHS Data. (2) DSHS Data will be stored in a logical container on electronic media, such as a partition or folder dedicated to DSHS Data. (3) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or, (4) DSHS Data will be stored within a database and will be distinguishable from non-DSHS data by the value of a specific field or fields within database records. (5) When stored as physical paper documents, DSHS Data will be physically segregated from non- DSHS data in a drawer, folder, or other container. b. When it is not feasible or practical to segregate DSHS Data from non-DSHS data, then both the DSHS Data and the non-DSHS data with which it is commingled must be protected as described in this exhibit. 8. Data Disposition. When the contracted work has been completed or when the Data is no longer needed, except as noted above in Section 5.b, Data shall be returned to DSHS or destroyed. Media on which Data may be stored and associated acceptable methods of destruction are as follows: Data stored on: Will be destroyed b Server or workstation hard disks, or Using a "wipe" utility which will overwrite the Data at least three (3) times using either random or single Removable media (e.g. floppies, USB flash drives, character data, or portable hard disks) excluding optical discs Page 22 DSHS Central Contract Services 1769CS County Agreement 5-1-2019 Degaussing sufficiently to ensure that the Data cannot be reconstructed, or Physically destroying the disk Paper documents with sensitive or Confidential Information Recycling through a contracted firm, provided the contract with the recycler assures that the confidentiality of Data will be protected. _ Paper documents containing Confidential Information requiring special handling (e.g. protected health information On -site shredding, pulping, or incineration Optical discs (e.g. CDs or DVDs) Incineration, shredding, or completely defacing the readable surface with a coarse abrasive Magnetic toe De aussing, incinerating or crosscut shredding 9. Notification of Compromise or Potential Compromise. The compromise or potential compromise of DSHS shared Data must be reported to the DSHS Contact designated in the Contract within one (1) business day of discovery. if no DSHS Contact is designated in the Contract, then the notification must be reported to the DSHS Privacy Officer at dshsprivacyofficer@dshs.wa.gov. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. 10. Data shared with Subcontractors. If DSHS Data provided under this Contract is to be shared with a subcontractor, the Contract with the subcontractor must include all of the data security provisions within this Contract and within any amendments, attachments, or exhibits within this Contract. If the Contractor cannot protect the Data as articulated within this Contract, then the contract with the sub - Contractor must be submitted to the DSHS Contact specified for this contract for review and approval. Exhibit A DSHS Central Contract Services 1769CS County Agreement 5-1-2019 Page 23 Exhibit B Program Agreement Budget X Original Budget Budget Revision REVENUES Fiscal Year Fund Source Oriqinal 1s' Revision 2nd Revision 3rd Revision 2020 State only 182,203 Waiver 161,722 Total Rev. $343,925 $ $ $ Fiscal Year Fund Source Original 1 sc Revision 2"d Revision 31d Revision 2021 State oniv Waiver Total Rev. $ $ $ $ Medicaid PASRR Funds State Funds Funds TOTAL ADMINISTRATION (CMISIAWA BARS 11 545 12,075 9,8$0 22,500 OTHER CONSUMER SUPPORTS (CMIS/A A Code 31, 32, 41, 92, 93 94) 0 11,587 9,481 CONSUMER SUPPORT STATE=ONLY 0 0 Z2232 Child Develo ment 16.125 138. 222 a rain w r% n1 1 C[ive. 7 78S 1-iA,299 `; ITOTAL DSHS Central Contract Services 1769CS County Agreement 5-1-2019 8,333 178,009 1 157,583 1 343,925 Page 24