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Consent Agenda
Public Health
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Mark McCauley, Interim County Administrator
FROM: Vicki Kirkpatrick, Director
Anna McEnery, DD & BH Coordinator
DATE: fi\*l Wst �- ` DM
SUBJECT: Agenda Item — Amendment #3 to the Professional Services Agreement —
Skookum Contract Services for Community Inclusion Services; July 1, 2019
— June 30, 2021; Additional $1,961.49 for a total of $32,730.49
STATEMENT OF ISSUE:
Jefferson County Public Health, (JCPH), Developmental Disabilities Program; is requesting Board approval of
Amendment #3 to the Professional Services Agreement with Skookum Contract Services to provide Community
Inclusion Services; July 1, 2019 — June 30, 2021; Additional $1,961.49 for a total of $32,730.49.
Another Employment/Day Program Provider had underspent funding due to client not accessing services
because of Covid; the underspent funds moved to the Skookum Community Inclusion Program for additional
client services.
ANALYSIS/STRATEGIC GOALS/PRO'S and COWS:
The Professional Services Agreement with Skookum Contract Services; is for Community Inclusion Services.
Skookum will provide services that are tailored to individual needs, interests, and abilities of adults with
developmental disabilities. These individualized services are necessary to help adults with developmental
disabilities connect and contribute to their community.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
Funding for the agreement with Skookum Contract Services is through the Developmental Disabilities
Administration, with DSHS; and is identified in the budget under vocational services.
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
Always working for a safer and healthier community
Environmental Public Health
360-385-9444
(f) 360-379-4487
RECOMMENDATION:
JCPH management requests approval of the Amendment #3 to the Professional Services Agreement; with
Skookum Contract Services; to provide Community Inclusion Services; July 1, 2019 — June 30, 2021; Additional
$1,961.49 for a total of $32,730.49.
REVIEWED BY:
Mark McCauley, Interim County Administra
Community Health
Developmental Disabilities
360-385-9400
360-385-9401 (f)
21 2- i
Date
Always working for a safer and healthier community
Environmental Public Health
360-385-9444
(f) 360-379-4487
Contract Amendment #3
Between
Skookum Contract Services
And
Jefferson County Public Health
Developmental Disabilities Program
WHEREAS, Skookum Contract Services (Subcontractor) and Jefferson County (County) entered into
an agreement on July 1, 2019 for Professional Services to be provided in connection with the provision
of Community Inclusion Services to Persons who experience Intellectual/Developmental Disabilities in
Jefferson County.
WHEREAS, the parties desire to amend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
1. Subcontractor's contract will be increased by $1,961.49. Total compensation under this
Agreement shall not exceed $32,730.49 without express written amendment signed by
both parties.
2. work performed between July 1, 2019 and the execution of this Agreement that is
consistent with the provisions of this Agreement is hereby ratified.
3. All other terms and conditions of the agreement will remain the same.
Dated this day of
By,
, 2021
Kate Dean, Chair
Jefferson Board of County Commissioners
Ryan Wiese, Contracts Manager
Skookum Contract Services Corporation
ATTEST:
Bv:
Carolyn Gallaway, Clerk of the Board
APPROVED AS TO FORM ONLY:
By:
Philip Hunsucker, Chief Civil Deputy Prosecuting
Attorney
Contract Amendment #2
Between
Skookum Contract Services
And
Jefferson County Public Health
Developmental Disabilities Program
WHEREAS, Skookum. Contract Services (Subcontractor) and Jefferson County (County) entered into
an agreement on July 1, 2019 for Professional Services to be provided in connection with the provision
of Community Inclusion Services to Persons With Intellectual/Developmental Disabilities in Jefferson
County as amended by Amendment 1 executed on November 2, 2020.
WHEREAS, the parties desire to amend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
1. From March of 2021 to June of 2021; Subcontractor's unit of billable Community
Inclusion Service will be $49.00. A unit is defined as one `hour" of direct service to one
eligible client.
2. One unit of Community Inclusion Service is defined as one (1) "hour" of direct service or
assigned service level to one eligible client. An "hour's is at least fifty (50) minutes of
direct service; (partial hour to the quarter may be recorded); ten (10) minutes of every
"hour" of direct service to one eligible client can be used for documentation and/or
meeting times.
3. Work performed between July 1, 2019 and the execution of this Agreement that is
consistent with the provisions of this Agreement is hereby ratified.
4. All other terms and conditions of the agreement Will remain the same.
(SIGNATURES FOLLOW ON THE NEXT PAGE)
r�
Dated this - day of 12021
9^
By.
.ate bean, Chair
Jefferson Board of County Commissioners
By;
Ryan Wiese, Contracts Manager
Skookum Contract Services Corporation
ATTEST:
By. #J
Carolyn Galla ay, Clerk of the BoX rd
APPROVED AS TO FORM O LY:
By.f
Philip Hunsucker, Chief evil Yeputy
Prosecuting Attorney
Contract Amendment #1
Between
Skookum Contract Services
And
Jefferson County Public Health
Developmental Disabilities Program.
WHEREAS, Skookum Contract Services (Subcontractor) and Jefferson County (County) entered into
an agreement on July 1, 2019 for Professional Services to be provided in connection with the provision
of Community Inclusion Services to Persons with Developmental Disabilities in Jefferson County.
WHEREAS, the parties desire to amend the terms of that agreement.
IT IS AGREED BETWEEN BOTH PARTIES AS NAMED HEREIN AS FOLLOWS:
1. The term of the above referenced agreement ends June 30, 2021.
2. Subcontractor's contract will be increased by $17,328 in. funding for services rendered
during the term of July 1, 2019 through June 3 0, 2021. Total compensation under this
Agreement shall not exceed $30,769 without express written amendment signed by both
parties.
3. work performed between -July 1, 2019 and the execution of this Agreement that is
consistent with the provisions of this Agreement is hereby ratified.
4. Adding two new sections as follows effective 7/1/2019:
A. Section 12. Confidential Information. All Counties and their subcontractors must:
i. Ensure the security of Confidential Information;
ii. Use a Trusted Network when available;
iii. 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.
iv. When transporting data containing DSHS Confidential Information
outside a Secure Area must encrypt the data.
B. 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.
5. Exhibit A — Data Security Requirements the following replaces existing language effective
71112020:
i. 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 6I3 012021 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.
ii. Section 4 Au rization, Authentication, and Access, i -1 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 6/3 0/2021.
6. All other terms and conditions of the agreement will remain the same.
t
Dated this -day of q 42 92020
AAB y : Y.`
Gr rotherton, Chair
Jefferson Board of County Commissioners
By •
Ryan Wiese, Contracts Manager
Skookum Contract Services Corporation
ATTEST:
By:
Carolyn Gallab4y, Deputy Clerk of ta Board
APPROVED AS TO FORM ONLY:
B y 0
Philip Hunsucker, Chief Civil De uty Prosecuting
Attorney
Skookum Contract Services Community Inclusion Contract 2019-2020
Page 1 of 19
SUBCONTRACT FOR PROFESSIONAL SERVICES
COMMUNITY INCLUSION SERVICES
Agreement Between
JEFFERSON COUNTY PUBLIC HEALTH
And
SKOOKUM CONTRACT SERVICES
This agreement is made and entered into between Jefferson COUNTY Public Health (COUNTY) and Skookum Contract
Services (SUBCONTRACTOR) for provision of Community Inclusion Services to persons with developmental
disabilities in Jefferson COUNTY. The term of this agreement is July 1, 2019 through June 30, 2020. Either party upon
60 days' written notice may terminate this Contract. Termination of this Contract shall not constitute a breach.
It is agreed Upon by Both Parties as Named Herein as Follows:
A. PROFESSIONAL SERVICES
Professional services to be provided by SUBCONTRACTOR shall include:
(1 ) "Community Inclusion Services" - Opportunities to build relationships, to contribute and to feel a sense of
belonging to the community, to access generic resources with peers without disabilities and volunteer
opportunities in order to enhance- versatility, individualized education/self-advocacy and skill development
necessary for new tasks in order to address growth and interaction needs of eligible persons per Exhibit
A - Statement of work attached hereto.
(2) Program management.
B. OBLIGATIONS
SUBCONTRACTOR. shall fulfill the following obligations:
(1) SUBCONTRACTOR shall comply with all state and federal requirements regarding the confidentiality of
Client records. Client information is not disclosable to the public. Information acquired pursuant to RCW
7IA. 14.070 requires a signed Release of Information or a signed Oath of Confidentiality Form.
(2) SUBCONTRACTOR is required provide background checks, pursuant to RCW 43.43.830-845, RCW
74.15.030, and Chapter 388-06 WAC, which state that any prospective employee or volunteer who will or may
have unsupervised access to a vulnerable person with a developmental disability in the course of his or her
employment, or involvement with the business or organization, must have a background/criminal history
clearance before they have unsupervised access. The DSHS Background Check Central Unit (BCCU) must
be utilized to obtain background clearance.
(3) If SUBCONTRACTOR reviews the application and elects to hire or retain an individual after receiving
notice that the applicant has a conviction for an offense that would disqualify the applicant 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.
(4) COUNTY and its SUBCONTRACTOR are mandated reporters under RCW 74.34.020(13) and must
comply with reporting requirements described in RCW 74.34.03 5, .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.
(5) SUBCONTRACTOR is required pursuant to RCW 74.15.030, that if any prospective employee who has not
resided in Washington State during the last three years, and who will or may have unsupervised access to a
vulnerable person with a developmental disability in the course of his or her employment, or involvement with
the business or organization, must have an F.B.I. Fingerprint Check before they have unsupervised access and
Skookum Contract Services Community Inclusion Contract 2019-2020
Page 2 of 19
before prospective employer begins working. The DSHS Background Check Central Unit (BCCU) must be
utilized to obtain background clearance.
(6) SUBCONTRACTOR is required to repeat the background/criminal history clearance for all employees or
volunteers who will or may have unsupervised access to a vulnerable person with a developmental disability in
the course of his or her employment, or involvement with the business or organization, every three years. The
DSHS Background Check Central Unit (BCCU) must be utilized to obtain background clearance in
accordance with RCW 43.43.830=845, RCW 74.15.030 and Chapter 388-06 WAC.
(7) SUBCONTRACTOR shall comply, as mandated reporters under RCW 74.34.020 (11), with all state and federal
requirements under RCW 74.34.035, .040 Abuse and neglect of Vulnerable Adults; RCW 26.44, Abuse of
Children; the WACs: 275-26 Division of Developmental Disabilities Services Rules; 296-24 General Safety
& Health; 296-62 General Occupational Health Standards; WACs: 388-828 Developmental Disabilities
Administration, (DDA) Assessment; 388-845 Home and Community Based waivers; Definitions 0001;
Criteria for HOBS Services 0030; Basic waiver Services 0200; Basic Plus Waiver Services 0210; Core
Waiver Services 0215; Community Protection waiver Services 0220; 0600-0610 Community Access
Service; Supported Employment Service 2100.
(8) SUBCONTRACTOR shall comply with the following Developmental Disabilities Administration, (DDA)
Policies: 3.01 Client Service Plans; 5.01 Criminal History Background Checks and Safeguarding Personal
Information; 5.02 Necessary Supplemental Accommodation (NSA); 5.03 Client Complaints; 5.05 Limited
English Proficiency (LEP) Clients; 5.06 Client Rights; 5.13 Protections From Abuse; 5.14 Positive Behavior
Support; 5.15 Use of Restrictive Procedures; 6.08 Mandatory Reporting Requirements for Employment and
Day Program Services Providers; 6.13 Employment/Day Program Provider Qualifications; 9.07 Human
Immunodeficiency Virus (HIV) -and Acquired Immune Deficiency Syndrome (AIDS); 12.01 Incident
Management; 13.04 DRW Access Agreement, and County Guide to Achieve Developmental Disability
Administration's Guiding Values.
(9) The COUNTY staff who performs 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 7IA. 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.
(10) SUBCONTRACTOR shall comply with the following referenced documents found at DDA Internet site
gps-://www.dshs.wa.gov/dda/cou!Lty-best-practices under "Counties":
(1 ) DDA Policy 4.11, County Services for working Age Adults;
(2) WAC 388-850, WAC 388-828, WAC 388-845-00013 00303 0205,0210, 02159 0220, 0600w0610,
1200-12105 1400-14105 2100, 2110;
(3) Criteria for Evaluation;
(11� SUBCONTRACTOR shall meet the definition of Quality Assurance, by adherence to all Program
Agreement requirements and reasonably expected levels of performance, quality, and practice by adherence
to:
DDA Policy 6.13, EmploymentlDay Program Provider Qualifications,
hqps://www.dshs.wa.gov/dda/policies-and-rules/Tolicy-manual;
County Guide to Achieve Developmental Disability Administration's Guiding Values
Skookum Contract Services Community Inclusion Contract 2019-2020
Page 3 of 19
(12) The DRW Access Agreement with DDA, assures that the COUNTY and SUBCONTRACTORS have
reviewed the Access Agreement. The Access Agreement covers DRW's access to individuals with
developmental disabilities, to clients, to programs and records, to outreach activities, to authority to
investigate allegations of abuse, neglect, and other miscellaneous matters, and it is binding for all providers
of DDA contracted services.
(13) SUBCONTRACTOR shall have written policies regarding sexual harassment and nondiscrimination (said
policies must guarantee human/civil rights); regarding a person's right to privacy, regarding safeguarding
personal information and abuse of participants; regarding agency medication procedure; regarding respectful
staff -to -participant interactions (i.e.: including a person's right to be treated with dignity and respect free of
abuse).
(14) SUBCONTRACTOR shall assure that participants, in accordance with Necessary Supplemental
Accommodation (NSA) Policy 5.02, have been informed of their rights; what services and benefits may be
expected from the program; the program's expectations of them; and, if necessary, shall assure that the
participant's family, guardian or advocate is also informed.
(15) SUBCONTRACTOR shall have a grievance policy that:
® negotiates conflicts and advises participants of grievance procedures
• is explained to participants and others in accordance with the NSA, DDA Policy 5.02
• prohibits retaliation for using the grievance process
0 includes a non -retaliation statement
• assure that advocates are available and encourages participants to bring advocates to help negotiate
■ includes a mediation process that promotes the use of someone who is unaffected by the outcome if
conflicts remain unresolved (a DDA Case Resource Manager may be included as an alternative option)
® includes a process for tracking and reporting grievances
(16) SUBCONTRACTOR shall obtain and retain in the clients' files signed proof of client's and/or family's
review of all policies, provider expectation, and receipt of information about services and benefits to be
provided by the program. The signed proof required by this section shall be reviewed and renewed, with new
documentation, annually.
(17) SUBCONTRACTOR will encourage participant involvement in policy development.
(18) SUBCONTRACTOR shall update Client Intake Forms every 6 months during the Client Review meeting.
(19) SUBCONTRACTOR shall assure potential conflict of interest, real or apparent, will not arise. Such a conflict
will arise when: The employee, officer or agent, any member of immediate family, Guardian / decision
maker, or an organization that employs or is about to employ any of the above has financial or other interest
in the client(s).
(20) SUBCONTRACTOR shall have adequate staffing ratios and patterns to maintain quality and safety
(21) All services for persons with developmental disabilities must be provided with attention to their health and
safety. SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health, and safety
regulations.
(22) SUBCONTRACTOR shall track and analyze incident reports for potential trends and patterns.
(23) Current emergency contact and medical information (medications, diet, allergies, etc.) needed during the
hours of service is readily available for each participant.
(24) The COUNTY and all SUBCONTRACTORS are mandated reporters under RCW 74.34.020(l 1). All
parties must comply with reporting requirements described in RCW 74.34.035, 040 and Chapter 26.44 and
must adhere to DDA Policy, 6.08 Mandatory Reporting Requirements for Employment and Day Program.
Service Providers. All service provider employees, contractors, and volunteers are mandatory reporters
Skookum Contract Services Community Inclusion Contract 20 Z 9-2020
Page 4 of 19
and must report every incident of'observed, reported, or suspected abuse, improper use of restraint,
neglect, sel&neglect, personal or financial exploitation, abandonment andlor mistreatment of clients.
(25) The 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.wL.gov/dda/counly-best--oractice.s
(26) SUBCONTRACTOR is required to maintain the following minimum organizational capacity in order to meet
the performance standards set forth in this agreement. Failure or inability of SUBCONTRACTOR to meet any
or all of these minimum capacity requirements, as determined solely by COUNTY, may be cause for termination
of this agreement as provided herein.
(a) Accreditation: SUBCONTRACTOR must be able to demonstrate conformance to Commission on
Accreditation of Rehabilitation Facilities (CARF) standards for quality assurance and CARF accreditation.
(b) Confidentiality: SUBCONTRACTOR shall protect and maintain all Confidential Information gained by
reason of the Program Agreement against unauthorized use, access, disclosure, modification or loss. This
duty requires the COUNTY to employ reasonable security measures, which includes restricting access to
Confidential Information by:
(27) Data Transport: when transporting DSHS Confidential Information electronically, including via email, the
Data will be protected by:
(a) Transporting the Data within the (State Governmental Network) SGN or Contractor's internal network,
or;
(b) Encrypting any Data that will be in transit outside the SGN or Contractor's internal network. This
includes transit over the public Internet.
(28) Protection of Data: The Contractor agrees to store Data on one or more of the following media and protect
the Data as described. All electronic Data must be encrypted using at least an encryption standard of AES
128 bit. Electronic Data can be on desktops, laptops and other portable devices, servers and external media:
(a) Hard disk drives: Data stored on local workstation hard disks. Access to the Data will be
restricted to Authorized User(s) by requiring logon to the local workstation using a Unique User
ID and Hardened Password or other authentication mechanisms which provide equal or greater
security, such as biometrics or smart cards.
(b) Network server disks: Data stored on hard disks mounted on network servers and made available
through shared folders. Access to the Data will be restricted to Authorized Users through the use
of access control lists which will grant access only after the Authorized User has authenticated to
the network using a Unique User ID and Hardened Password or other authentication mechanisms
which provide equal or greater security, such as biometrics or smart cards. Data on disks mounted
to such servers must be located in an area which is accessible only to authorized personnel, with
access controlled through use of a key, card key, combination lock, or comparable mechanism.
(c) For DSHS Confidential Information stored on these disks, deleting unneeded Data is sufficient as
long as the disks remain in a Secured Area and otherwise meet the requirements listed in the above
paragraph. Destruction of the Data as outlined in Section 5. Data Disposition may be deferred
until the disks are retired, replaced, or otherwise taken out of the Secured Area,
(d) Optical discs (CDs or DVDs) in local workstation optical disc drives: Data provided by DSHS on
optical discs which will be used in local workstation optical disc drives and which will not be
transported out of a Secured Area. when not in use for the contracted purpose, such discs must be
locked in a drawer, cabinet or other container to which only Authorized Users have the key,
combination or mechanism required to access the contents of the container. Workstations which
access DSHS Data on optical discs must be located in an area which is accessible only to
authorized personnel, with access controlled through use of a key, card key, combination lock, or
comparable mechanism.
(e) Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers: Data provided by DSHS
on optical discs which will be attached to network servers and which will not be transported out of
a Secured Area. Access to Data on these discs will be restricted to Authorized Users through the
use of access control lists which will grant access only after the Authorized User has authenticated
to the network using a Unique User ID and Hardened Password or other authentication
mechanisms which provide equal or greater security, such as biometrics or smart cards. Data on
discs attached to such servers must be located in an area which is accessible only to authorized
Skookum Contract Services Community Inclusion Contract 2019-2020
Page 5 of 19
personnel, with access controlled through use of a key, card key, combination lock, or comparable
mechanism.
(f) Paper documents: Any paper records must be protected by storing the records in a Secured Area
which is only accessible to authorized personnel. When not in use, such records must be stored in
a locked container, such 'as a file cabinet, locking drawer, or safe, to which only authorized
persons have access.
(g) Remote Access: Access to and use of the Data over the State Governmental Network SGN or
Secure Access Washington SAw will be controlled by DSHS staff who will issue authentication
credentials-(e.g.. a Unique User ID and Hardened Password to Authorized Users on Contractor
staff. Contractor will. notif
y 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.
(h) 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:
(2) Encrypt the Data with a key length of at least 128 bits
(3) Control access to devices with a Unique User ID and Hardened Password or stronger
authentication method such as a physical token or biometrics.
(4) Manually lock devices whenever they are left unattended and set devices to lock
automatically after a period of inactivity, if this feature is available. Maximum period of
inactivity is 20 minutes.
Physically Secure the portable devices and/or media -by:
(5) Keeping them in locked storage when not in use
(6) Using check-in/check-out procedures when they are shared, and
(7) Taking frequent inventories
(8) When being transported outside of a Secured Area, portable devices and media with
DSHS Confidential Information must be under the physical control of Contractor staff
with authorization to access the Data.
(9) Portable devices include, but are not limited to; smart phones, tablets, flash memory
devices (e.g. USB flash drives, personal media players), portable hard disks, and
laptop/notebook/netbook computers if those computers may be transported outside of a
Secured Area.
(10) Portable media includes, but is not limited to; optical media (e.g. CDs, DVDs), magnetic
media (e.g. floppy disks, tape), or flash media (e.g. CompactFlash, SD, MMC).
(i). Data stored for backup purposes:
(1 } DSHS data may be stored on portable media as part of a Contractor's existing,
documented backup process for business continuity or disaster recovery purposes. Such
storage is authorized until such time as that media would be reused during the course of
normal backup operations. If backup media is retired while DSHS Confidential
Information still exists upon it, such media will be destroyed at that time in accordance
with the disposition requirements in Section 5. Data Disposition
(2) DSHS Data may be stored on non -portable media (e.g. Storage Area Network drives,
virtual media, etc.) as part of a Contractor's existing, documented backup process for
business continuity or disaster recovery purposes. If so, such media will be protected as
otherwise described in this exhibit. If this media is retired while DSHS Confidential
Information still exists upon it, the data will be destroyed at that time in accordance with
the disposition requirements in Section 5. Data Disposition.
} Data Segregation:
(1) DSHS 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.
Skookum Contract Services Community Inclusion Contract 2019-2020
Page 6 of 19
(2) DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which will
contain no non -'DSHS data. And/or,
(3) DSHS Data will be stored in a logical container on electronic media, such as a partition
or folder dedicated to DSHS Data.. And/or,
(4) DSHS Data will be stored in a database which will contain no non-DSHS data. And/or,
(5) 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.
(6) when stored as physical paper documents, DSHS Data will be physically segregated
from non-DSHS data in a drawer, folder, or other container.
(7) 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.
(29) Data Disposition:
When the contracted work has been completed or when no longer needed, except as noted in Section 3.
Protection of Data B. Network Server Disks above, Data shall be returned to DSHS or destroyed. Media on
which Data may be stored and associated acceptable methods of destruction are as follows:
Data stored on:
will be destroyed by:
Server or workstation hard disks, or
Using a "wipe" utility which will overwrite the Data at
least three (3) times using either random or single
Removable media (e.g. floppies, USB flash drives,
character data, or
portable hard disks) excluding optical discs
Degaussing sufficiently to ensure that the Data cannot
be reconstructed, or
Physically destroying the disk
Paper documents with sensitive or Confidential
Recycling through a contracted firm provided the
.information
contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential Information
On -site shredding, pulping, or incineration
requiring special handling (e.g. protected health
information
Optical discs (e.g. CDs or DVDs)
Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Ma netic toe
Degaussing, incinerating or crosscut shredding
(30) 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 laws:
(31) SUBCONTRACTOR shall provide the following:
(a) Equal Access: SUBCONTRACTOR will assure equal access to persons who do not speak or have a
limited ability to speak, read, or write English well enough to understand and communicate effectively
(reference: DDA Policy 5.05, Limited English Proficient (LEP) Clients).
(c) Financial and Program Management: SUBCONTRACTOR will maintain an
administrative/organizational structure that clearly defines responsibilities; systems and personnel to
maintain accounting records that accurately reflect all program revenues and expenditures; prepare
monthly statements of activity (ADSA Reports); maintain appropriate client service records and progress
reports; and track key program performance indicators.
(d) Participants: SUBCONTRACTOR has a commitment to support integration of individuals with
developmental disabilities with people who are not disabled and has involved participants with
developmental disabilities in policy development.
Skookum Contract Services Community Inclusion Contract 2019-2020
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(e) Partner slniPs: SUBCONTRACTOR has a history of working cooperatively with community -based
organizations including Employers, other Agencies, the COUNTY DD Program, the Division of
Vocational Rehabilitation (DVR), and the Schools.
(f) Performance Plan: SUBCONTRACTOR has a written performance plan that describes its mission,
program objectives, expected outcomes, and describes how and when objectives will be accomplished;
and will assure the plan is evaluated at least biennially with revisions based on actual performance.
(g) Quality Assurance Plan: SUBCONTRACTOR has a written quality assurance plan that evaluates Client
progress every 6 months by looking at:
1) Increased wages (by acuity) if applicable
2) Increased number of working hours (by acuity) if applicable
3) The number of new jobs (by acuity) if applicable
4) Job loss and why -- retention rates (by acuity) if applicable
5) The percentage employed (by acuity) if applicable
5} Looking at Quantitative -(Data) vs. Qualitative -(Narrative)
(h) Internal Control Systems: SUBCONTRACTOR has sufficient policies and procedures for establishment
and maintenance of adequate internal control systems. SUBCONTRACTOR will maintain written policy
procedural manuals for information systems, personnel, and accounting/finance in sufficient detail such
that operations can continue should staffing change or prolonged absences occur.
(i) Qualified Staff: SUBCONTRACTOR will provide adequate, qualified staff with. skills and experience
in evaluation, training, supervision, counseling and support of adults with developmental disabilities
who are earning wages, per the attached Statement of work. SUBCONTRACTOR will assure that all
direct service staff are trained, and that training is documented. SUBCONTRACTOR will provide
COUNTY with information regarding staff qualifications upon request.
Safe SUBCONTRACTOR -will provide evidence that it employs safety protection based on the
environment in which the participant is working or receiving services.
(k) Integration: Employment and day services must adhere to the Home and Community Based settings
(HCB S) requirements of 42CFR 441 53 0(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 HOBS;
(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.
(32) SUBCONTRACTOR shall provide a Community Inclusion Individual Program Plan and/or Person
Centered planning/profiles delineating individual skills and needs plans within 30 days of the beginning
of services on all program clients. The SUBCONTRACTOR shall use the Community Inclusion Plan
Report Form for Individual Program Plans.
(1) The Community Inclusion Report Plans will include:
(a) Information that identifies and addresses the individualized goal and support needs for each
participant.
(b) Plans must consider individualization, integration, and safety and should be developed by the
provider in collaboration with the Case Resource Manager, participant, and his or her family (the
team).
(c) Initial plans will be completed within 60 days from date of service authorization and must be
signed by the participant and/or his or her guardian if any.
(d) Copies of the initial and subsequent revised plans will be distributed as appropriate to all team
members.
(e) Plans will be reviewed and signed annually.
(2) The Community Inclusion Report Plans will also include the information listed below:
(a) Current date: timeline for the Plan
(b) Client's name: fi�*st and last
(c) Client ADSA ID
(d) The client's skills, gifts, interests, and preferred activities
Skookum Contract Services Community Inclusion Contract 2019-2020
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(e) The Community Inclusion goal. The goal need to relate to one or more of the following
(per COUNTY' S Guidelines):
i. Identify integrated community places where the individual's interest, culture,
talent, and gifts can be contributed and shared with others with similar interests
ii. Identify clubs, associations, and organizations where the individual can be a
member and have decision -making capacities
iii. Identify opportunities where the individual can contribute to the community by
participating in new and interesting activities or activities the individual enjoys
iv. Building and strengthening relationships between family members and members
of the local community, who are not paid to be with the person
v. The Support Intensity Scale (SIS) subscale that most relates to the goal
(Community Living, Lifelong Learning, Employment, Health & Safety, Social,
and Protection & advocacy)
vi. Measurable strategies (action steps and supports) to meet the goal
vii. Identification of persons and/or entities available to assist the individual in
reaching his or her long-term goal
viii. Identification of other accommodations, adaptive equipment, and/or conditions
critical to achieve the goal
(33) The SUBCONTRACTOR will invite the COUNTY to all six-month client meetings at least 20 days before
the meeting occurs.
(34) Six-month progress reports describing the progress made towards achieving client's goal will be provided
by the service provider to the Case Resource Manager, participant, and/or guardian, if any, within 30 days
following the six-month period.
(35) The SUBCONTRACTOR will document all services that relate to the participant's individually identified
goal(s) as outlined in their six-month plan.
(36) The SUBCONTRACTOR shall report any injury or accident that requires more than simple first aid, and
any extraordinary incident that requires intervention by the SUBCONTRACTOR to the DSHS/DDA Case
Manager for the individual involved, and then report the injury, accident, or extraordinary incident to the
COUNTY Coordinator. This includes serious physical or emotional harm or potential harm.
(a) The initial report to the COUNTY may be done via documented telephone calls to the
COUNTY Coordinator.
(b) The SUBCONTRACTOR shall submit a written follow-up report within 10 days to the
COUNTY Coordinator. The report to the COUNTY Coordinator may be submitted by email,
facsimile (FAX) to 360-385-9401, or by mail to Jefferson COUNTY Public Health 615
Sheridan Port Townsend, WA 98368.
(c) Serious and emergent incidents shall be handled in accordance with DSHSIDDA Policy 12.01,
Incident Management.
(37) All services for persons with developmental disabilities must be provided with attention to their health and
safety. SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health and safety
regulations.
(38) Within 30 days of the effective date of this agreement and at least semi-annually thereafter,
SUBCONTRACTOR. will provide (a) company (b) program financial reports to COUNTY, including all
revenues and expenses generated by SUBCONTRACTOR., in sufficient detail to demonstrate the uses of funds
provided under this agreement.
(39) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all work
sites; all client records; records on productivity and client wages; and all documents, reports, and other data
applicable to this agreement. The COUNTY shall monitor services delivered, and conduct at least one on -site
visit with SUBCONTRACTOR during the period of this biennium to assure compliance with the DDA State
Work Order.
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(40) AUDIT REQUIREMENTS. Independent Audit will be submitted annually to the Jefferson COUNTY DD
COUNTY Coordinator in the following manner:
(a) SUBCONTRACTOR rnust be able to account for and manage public funds in compliance with
Generally Accepted Accounting Principles "GAAP". An agency, for -profit or non-profit, who
receives in excess of $100,000 in DDA funds during its fiscal year from the County, shall provide
Certified Public Accountant reviewed or audited financial statements within nine months
subsequent to the close of the subcontractor's fiscal year. Copies of the audit and management
letter shall be submitted to the Jefferson COUNTY Public Health Department within 9 months of
the end of the SUBCONTRACTOR'S fiscal year.
The SUBCONTRACTOR shall provide an independent audit of the entire organization which..
(a) Is performed by an independent Certified Public Accountant, the Washington State
Auditor's Office, or another entity the COUNTY and the SUBCONTRACTOR mutually approve.
(b) Provide statements consistent with the guidelines of Reporting for Other Non -Profit Organizations
AICPA SOP 78-10, and is performed in accordance with generally accepted auditing standards
and with Federal Standards for Audit of Governmental Organizations, Programs, Activities, and
Functions, and meeting all requirements of OBM Circular A-133 or A-128, as applicable.
(c) The SUBCONTRACTOR shall submit one (2) copies of the audit and/or the summary and the
management letter directly to the COUNTY immediately upon completion. The audit must be
accomplished by documentation indicating the SUBCONTRACTOR'S Board of Directors has
reviewed the audit.
(41) If the Developmental Disabilities'Program Coordinator finds indications of potential non-compliance during
the contract monitoring process or' learns that the SUBCONTRACTOR is out of compliance with any of the
terms or conditions of this contract, the following process will be pursued:
(a) Informal Notification: Informal process wherein the COUNTY Coordinator alerts the
SUBCONTRACTOR in writing of the potential non-compliance and an agreeable solution is
reached within ten (10) days.
(b) Official Notification.- If the informal notification does not result in resolution, the official
notification of possible non-compliance to establish a date, within ten (10) working days of
notification, when representatives of the COUNTY and the SUBCONTRACTOR shall meet to
discuss areas of contention and attempt to resolve the issues.
(c) Written Summary: Within ten (10) working days of such official notification, the COUNTY will
provide the SUBCONTRACTOR a written summary of the areas of non-compliance by certified
mail. Notice shall be sent to the address identified in the Agreement.
(d) Discussion: Within twenty (20) days of the date of the written summary, a discussion between
COUNTY and SUBCONTRACTOR shall be conducted to resolve areas of non-compliance or
potential non-compliance.
(e) Should the above procedures fail to resolve the compliance issue, the parties will obtain the
services of the Peninsula Dispute Resolution Center, or another agreed upon resource, and shall
share equally in any retainer fees or other costs of services. If no agreement is reached, the
mediator's decision in the matter will be binding on all parties, ex- that in no event will the
COUNTY honor a financial determination that is greater than the funds allowed in the scope of
this Agreement.
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(42) For six years following the end date of this agreement, SUBCONTRACTOR will maintain client records and
books, records, documents, reports and other evidence of accounting procedures and practices, which
sufficiently and properly reflect all.. direct and indirect expenditures of funds provided under this agreement.
()
43 Client records shall minimally include statement of client goals, documentation of training provided, training
hours, routine progress notes and semi-annual summary of progress toward meeting client goals.
(44) SUBCONTRACTOR will provide COUNTY with Adult Community Inclusion Plans (or Person Centered
Plan/Profile), client goals, and a summary of progress towards meeting those goals on a bi-annual basis.
(45) Make available for inspection, review, or audit by COUNTY DD Coordinator at all reasonable times: all client
records; and all documents, reports, and other data applicable to this agreement.
(46) SUBCONTRACTOR shall provide COUNTY with a copy of a signed DSHS Provider Agreement within 30
days of the effective date of this agreement.
(47) SUBCONTRACTOR agrees to assign to COUNTY its Medicaid Billing Rights for services to clients eligible
under Title XIX programs. Written documentation shall be available to COUNTY on request. If
SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX, COUNTY
agrees that funding intended for those clients shall be excluded from this agreement. If SUBCONTRACTOR
contracts directly with Social Security to provide covered services under a PASSARWE, COUNTY agrees that
funding intended for those clients shall be excluded from this agreement.
C. REIMBURSEMENTS
()
1 For said services rendered under this agreement, COUNTY shall reimburse SUBCONTRACTOR $35.00 per
unit of service, as defined in Exhibit A, Statement of work.
(2) SUBCONTRACTOR will bill COUNTY on a monthly basis, on or before the 5th day of the month, for units
of service provided under this agreement during the preceding month. SUBCONTRACTOR will submit a
Monthly DDA Services Report (ADSA) form for its billings. At no time shall the invoices for reimbursement
be submitted more than 60 calendar days following the last day of the month for which the services were
provided.
(3) COUNTY may, at its option, withhold reimbursement for any month for which required reports have not
been received or are inaccurate and/or complete.
(4) Total reimbursements for the fiscal year of 2019-2020 to SUBCONTRACTOR by COUNTY under this
contract shall not exceed $13,441.00 in completion of these services without express written amendment
signed by both parties to this Agreement. Work performed between July 1, 2019 and the execution of this
Agreement that is consistent with the provisions of this Agreement is hereby ratified. This total
reimbursement includes any amendment within the fiscal year of 2019-2020.
D. MISCELLANEOUS
(1) DSHS Developmental Disabilities Administration (DDA) shall determine client eligibility and service
referral are the responsibility of the DDA pursuant to Chapter 388-823 WAC (Eligibility) and Chapter 388-
825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under
this Program Agreement. It is .RDA'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.
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Skookum Contract Services Community Inclusion Contract 2019-2020
Page I I of 19
(2) DSHS Developmental Disabilities Administration (DDA) shall notify COUNTY of persons authorized for
services reimbursed under this agreement. Only persons referred to COUNTY by DDA through a County
Service Authorization, (CSA) shall be eligible for services reimbursed under this agreement.
(3 ) The SUBCONTRACTOR'S relation to the COUNTY shall at all times be that of independent
SUBCONTRACTOR. Any and all employees of the SUBCONTRACTOR, or other persons engaged in the
performance of any work or service required of the SUBCONTRACTOR under this Agreement, shall be
considered employees of the SUBCONTRACTOR only, and any claims that may arise on behalf of or
against said employees shall be the sole obligation and responsibility of the SUBCONTRACTOR.
(4) The SUBCONTRACTOR shall not sublet or assign any of the services covered by this Agreement without
the express written consent of the COUNTY. Assignment does not include printing or other customary
reimbursable expenses that may be provided in an Agreement.
(5) The SUBCONTRACTOR, by signature to this Agreement, certifies that the SUBCONTRACTOR is not
presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from
participating in this Agreement, or any Agreement by any Federal department or agency. The
SUBCONTRACTOR also agrees to include the above requirement to all subcontracts into which it enters.
(6) The SUBCONTRACTOR shall obtain and keep in force during the terms of the Agreement, or as
otherwise required, the following insurance with companies or through sources approved by the State
Insurance Commissioner pursuant to RCW 48:05:
(a} worker's compensation and employer's liability insurance as required by the State of Washington.
(b) Commercial Automobile, Liability or Business Use Insurance providing bodily injury and property
damage liability coverage for all owned and non -owned vehicles assigned to or used in the
performance of the work for a combined single limit of not less than $1,000,000 each occurrence
with the COUNTY named as an additional insured in connection with the SUBCONTRACTOR'S
performance of the contract.
(c) General Commercial Liability Insurance in an amount not less than a single limit of one million
dollars ($1,000,000.00) per occurrence and an aggregate of not less than two (2) times the
occurrence amount ($2,000,000.00 minimum) for bodily injury, including death and property
damage, unless a greater amount is specified in the contract specifications. The insurance
coverage shall contain no limitations on the scope of the protection provided and include the
following minimum coverage:
(1 ) Broad Form Property Damage, with no employee exclusion
(2) Personal Injury Liability, including extended bodily injury
(3) Broad Form Contractual/Commercial Liability - including completed operations
(4) Premises - Operations Liability (M&C)
(5) Independent Contractors and Subcontractors
(d) Blanket Contractual Liability
(7) All employees or subcontractors of SUBCONTRACTOR who are required to be professionally certified by
the State in the performance of services under this agreement shall maintain professional liability insurance
in the amount of not less than one .million dollars ($1,000,000). In no case shall such professional liability
to third parties be limited in any way.
(8) It shall be the responsibility of the SUBCONTRACTOR to insure that any and all persons engaged in the
performance of any work or service. required of the SUBCONTRACTOR under this Agreement, shall comply
with the same insurance requirements that SUBCONTRACTOR is required to meet. .
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Skookum Contract Services Community Inclusion Contract 2019-2020
Page 12 of 19
9) Failure on the part of the SUBCONTRACTOR to maintain the insurance as required shall constitute a
material breach of contract upon which the COUNTY may, after giving five working days' notice to the
SUBCONTRACTOR to correct the breach, immediately terminate the contract or, at its discretion, procure
or renew such insurance and pay any and all premiums there with, with any sums so expended to be repaid
to the COUNTY on demand, or at the sole discretion of the COUNTY, offset against funds due the
SUBCONTRACTOR from the COUNTY.
(10) All cost for insurance shall be considered incidental to and included in the unit contract prices and no
additional payment will be made.
01) Excepting the Workers Compensation insurance and any professional liability insurance secured by the
SUBCONTRACTOR, the COUNTY will be named on all certificates of insurance as an additional insured.
The SUBCONTRACTOR shall furnish the COUNTY with verification of insurance and endorsements
required by this Agreement. The COUNTY reserves the right to require complete, certified copies of all
required insurance policies at any time.
(12) All insurance shall be obtained from an insurance company authorized to do business in the State of
Washington. The SUBCONTRACTOR shall submit a verification of insurance as outlined herein within 14
days of the execution of this Agreement to the COUNTY. All insurance policies obtained by the
SUBCONTRACTOR shall be primary to any equivalent or applicable policies held by the COUNTY. All
insurance policies obtained by the SUBCONTRACTOR shall include a waiver of subrogation rights, Any
insurance self -insured retention, deductible or risk retention maintained, or participated in, by the COUNTY
shall be excess and shall be non-contributory to the insurance policies provided by the SUBCONTRACTOR
in order to comply with the insurance requirements of this Subcontract. All policies provided by the
SUBCONTRACTOR in order to comply with the insurance requirements of this Subcontract must be
endorsed to show this primary coverage.
(13) The COUNTY will pay no progress payments under Section C until the SUBCONTRACTOR has fully
complied with this section. This r` emedy is not exclusive; and the COUNTY may take such other action as
is available to them under other provisions of this Agreement, or otherwise in law.
(14) Nothing in the foregoing insurance requirements shall prevent the COUNTY, at its option, from additionally
requesting that the SUBCONTRACTOR deliver to the COUNTY an executed bond as security for the faithful
performance of this contract and for payment of all obligations of the SUBCONTRACTOR.
(15) The SUBCONTRACTOR shall comply with all Federal, State, and local laws and ordinances applicable to
the work to be done under this Agreement. This Agreement shalt be interpreted and construed in accord
with the laws of the State of Washington and venue shall be in Jefferson COUNTY, WA.
(16) The SUBCONTRACTOR shall comply with the WA State Department of Labor and Industries Minimum Wage
Act, RCW 49.46, acknowledging persons with disabilities participating in job assessments are not considered
employees.
(17) The SUBCONTRACTOR shall indemnify and hold the COUNTY, and their officers employees, and agents
harmless from and shall process and defend at its own expense, including all costs, attorney fees and expenses
relating thereto, all claims, demands, or suits at law or equity arising in whole or in part, directly or indirectly,
from the SUBCONTRACTOR'S negligence or breach of any of its obligations under this Agreement;
provided that nothing herein shall require a SUBCONTRACTOR to indemnify the COUNTY against and
hold harmless the COUNTY from claims, demands or suits based solely upon the conduct of the COUNTY,
their officers, employees and agents, and provided further that if the claims or suits are caused by or result
from the concurrent negligence of:
(a) the SUBCONTRACTOR'S agents or employees; and, (b) the COUNTY, its officers, employees
and agents, this indemnity provision with respect to (1 ) claims or suits based upon such negligence,
and/or (2) the costs to the COUNTY of defending such claims and suits, etc,, shall be valid and
enforceable only to the extent of the SUBCONTRACTOR'S negligence or the negligence of the
SUBCONTRACTOR'S agents or employees.
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Skookum Contract Services Community Inclusion Contract 2019-2020
Wage 13 of 19
( 1 S) Claims against the COUNTY shall include, but not be limited to assertions that the use and transfer of any
software, book, document, report,,. film, tape, or sound reproduction of material of any kind, delivered there
under, constitutes an infringement.of any copyright, patent, trademark, trade name, or otherwise results in an
unfair trade practice or an unlawful restraint of competition.
(19) The SUBCONTRACTOR. specifically assumes potential liability for actions brought against the COUNTY by
SUBCONTRACTOR'S employees, including all other persons engaged in the performance of any work or
service required of the SUBCONTRACTOR under this Agreement and, solely for the purpose of this
indemnification and defense, the SUBCONTRACTOR specifically waives any immunity under the state
industrial insurance law, Title 51 R.CW. The SUBCONTRACTOR recognizes that this waiver was
specifically entered into pursuant to provisions of RCw 4.24.115 and was subject of mutual negotiation.
(20) SUBCONTRACTOR shall not discriminate against any person presenting themselves for services based on
race, religion, color, sex, age, or national origin.
(21) COUNTY reserves the right to terminate this contract in whole or in part, without prior written notice, in the
event that contractual terms are not fulfilled, or if expected or actual funding from the Department of Social
and Health Services Division of Developmental Disabilities is withdrawn, reduced, or limited in any way after
the effective date of this agreement. In the event of termination under this clause, COUNTY shall be liable
only for payment for services rendered prior to the effective date of termination.
(22) No portion of this contract may be assigned or subcontracted to any other individual, firm, or entity without
the express and prior written approval of COUNTY. If the COUNTY agrees in writing that all or a portion of
this Contract may be subcontracted to a third -party, then any contract or agreement between the
SUBCONTRACTOR and a third -party subcontractor must contain all provisions of this Agreement and the
third -party subcontractor must agree to be bound by all terms and obligations found in this agreement,
ADOPTED THIS ,.;2 ' -Ida of �, �- ��`r'�9
2020
y ..
_ _..
By
Cry
Jefferson County Board of Commissioners
Attest, Clerl�af the Board.
By:
Ryan Wiese, Contracts Manager
Skookum Contract Services
9
APPROVED AST FO, ONLY:
feyo
By:
Philip Hunsucker, hie ivil Deputy Prosecutor
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Skookum Contract Services Community Inclusion Contract 2019-2020
Page 14 of 19
EXHIBIT A
STATEMENT DE WORK
COMMUNITY INCLUSION
I. WORK STATEMENT
SUBCONTRACTOR shall provide Community Inclusion services for program clients as described hereinafter.
SUBCONTRACTOR shall be reimbursed for. such services on a unit of service basis, pursuant to Section E.,
Reimbursements, of this contract.
II. PROGRAM DESCRIPTION
A. Program Coals
1. Transfer or reduction of specialized supports as a result of increased personal independence and/or
community support systems,
2. Frequent opportunities to participate in community social, recreational, commercial, and/or
volunteer/contribution activities also utilized by peer's/community members without disabilities.
3. Assisting individuals to participate in- activities that promote individualized skill development,
independent living, and Community Inclusion.
4. Activities that provide individuals with opportunities to develop personal relationships with others
in their local communities and to learn to practice and apply life skills that promotes greater
independence and community inclusion.
5. Development of social contacts, friendships, and support systems with people without disabilities.
6. Frequent outings on an individual basis away from their home setting.
7. An opportunity to acquire supplemental training in a volunteer/job situation to enhance versatility and
individualized education/self-advocacy skill development necessary for new tasks in order to address
growth and interaction needs.
B. Definitions
I . Community Inclusion is;
• an opportunity to experience choice, power, and status in the community
• an opportunity to build relationships, to contribute and, to feel a sense of belonging to the
community
• opportunities to learn, to practice and apply life skills that promotes greater independence and
community inclusion
® an opportunity to access generic resources with peers without disabilities
® an opportunity to access volunteer opportunities in order to enhance versatility
• an opportunity for self -advocacy and skill development for new tasks, and to contribute to the
community
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Skookum Contract Services Community Inclusion Contract 201.9-2020
Page 15 of 19
C. Program Requirements
1, SUBCONTRACTOR shall provide Community Inclusion Services. These services, as defined in
Section 113 above & are in the Community Inclusion Billable Activities Form.
2. SUCONTRACTOR shall provide Monthly Community Inclusion service support hours that are based
on the Client's Community Inclusion service level per wAC 388-828-9310.
3. SUBCONTRACTOR shall provide an. Individual Program Plan and/or Person Centered
planning/profiles delineating individual skills and needs within 30 days of the beginning of services
with all program clients. The SUBCONTRACTOR will use the Community Inclusion Plan Report
Form, which will serve as an aid in matching program clients to appropriate services in the
community; and will serve as a transition tool towards the advancement of the individual's increased
personal independence in the community; an opportunity to build relationships; to contribute and to
feel a sense of belonging to the community, while accessing volunteer opportunities in order to
enhance versatility and develops skills necessary for new tasks.
4. SUBCONTRACTOR shall provide evidence that volunteer opportunities comply with U.S,
Department of Labor standards (htt ://www.dol. ov/o a/aboutdol/laws ro .htm) and applicable state
standards.
5. SUBCONTRACTOR shall schedule a six-month review of meetings for all program participants. The
review shall include an assessment of the need for continued Community Inclusion services and an
evaluation of the Individual Program plan goals and objectives in the form of a Semi -Annual Progress
Report. The SUBCONTRACTOR shall use the Community Inclusion Plan Report Form, to report on
the semi-annual progress of the client.
6. The 6-month Community Inclusion progress reports shall demonstrate the implementation strategy,
client goals, and how the individual is advancing towards meeting the outcomes of his or her goals;
training provided and a written synopsis showing progress toward meeting objectives or a description
of the reasons for any shortfall concerning the outcomes and proposed actions for correction,
7. COUNTY shall receive the dates for the 6-month reviews for program clients 20 days before the required
meetings.
8. SUBCONTRACTOR will assure that 6-month progress reports describe the service activities and
outcomes of those activities by documenting them in each Client's progress reports; and that the
reports are sent to the COUNTY, DDA Case Management, Residential Provider, Parent/Guardian and
others as appropriate. The report will summarize the progress made towards the Client's individualized
goals.
9. The SUBCONTRACTOR will use the Community Inclusion Report Form, to report on the six-month
progress of the client.
10. The SUBCONTRACTOR will review Quality Assurance questions during each six-month review.
11. The frequency of. the Semi -Annual Progress Reports for this contractual period will be one every six (6)
months after the initial plan.
12. SUBCONTRACTOR will contact every Client according to Client need and at least once per month.
13. Services shall promote the use of natural supports, which means personal associations and
relationships typically developed in the community that enhance the quality and security of life for
people, including but not limited to friendships reflecting the diversity of the neighborhood and the
community, associations with fellow students in community classes, and associations developed
through participation in clubs,, organizations, and civic activities.
15
Skookum Contract Services Comxnuni' Inclusio
n Contract 2p 1 �_�o�p
Page 16 of 19
14. Evidence that the opportunity is provided far p connection and relationship buildin between th
Participant and people without disabilities who are g e
not paid to provide services to the participant.
15. Community Inclusion services will foc
public. Evidence that each us on
activities that are typically experienced by the general
participant is assisted
to participate in typical and integrated activities
events and organizations in the Indivldual's neighborhood '
of same age. Support to g od or local community in ways similar to others
pp Participate in segregated activities and/or specialized
reimbursed. P ed activities will not be
16. Services shall provide support to those individuals v�duals washing to seek volunteer activities; such public transportation, assisting with referrals tot h as using
he appropriate agencies, and other agreed u on
vocationally related goals in preparation for volunteerangg p
.
17. The SUBCONTRACTOR shall provide coordination ordination of activities to develop a diverse sched
activities based on the client's needs and interests ule of
as connected to their Inclusion Program
plan. Each participant is assisted to tale art in .. g
p activities on an individualized basis.
18. The SUBCONTRACTOR shall provide Co
and achieve: p mmunity Inclusion services in the community that promote
(a) health and safety,
(b) a positive image,
(c) relationships,
(d) increased competence,
(e) individualized skill -building
(f) and other expected benefits of Community Inclusion.
19. The SUBCONTRACTOR shall assess and document in the Community Inclusion Plan Re
each participant's transportation needs. The Provider shall assistport Form
each participant to access public
specialized transportation for some activities s or
sponsored P
expected that public ors ecialize p Died as a part of Community Inclusion services. It i
p on will be utilized, exce t as detailed s
d transportation
transportation plan. The cast of transportation is included in the feep led in the
far service that a Provider receives
20• Program participants must be authorized fo
r service by the .Developmental Disabilities Administration
(DDA) and referred to the COUNTY. Onlyon
persons referred to COUNTY by DDA through a County
Service Authorization, (CSA� shall be eligible f tY
g or services reimbursed under this agreement.
21. A client receiving Community Inclusion services vices will not receive Employment services
simultaneously.
22. A client receiving Community Inclusion services vices may at any time choose to leave Community Inclusion
to pursue work and to receive Individual Employment services.
23. If a client is not satisfied with employment'
services after nine �9} months in an em la ment
(an unsuccessful. job search), the client may c p y pi ogram,
y choose Community Inclusion services.
24. SUBCONTRACTOR must ensure there is
a legal requirement and a clear delineation for staff
qualifications and proof of background criminal off
S45 and RCw 74.1 S.a3 0 a history clearance an accordance with RCS 43
and Chiipter 3 S S-o6 wA.0 on all staff. .43 . S3 �-
25. SUBCONTRACTOR will provide COUNTY
Y with information regarding staff qualifications cations
documented trainings upon request. and
26. SUBCONTRACTOR shall submit a written Program Staff Training Plan to CpIJNTy for
disapproval within 30 days of the effective date of approval or
reorganization occurs which this agreement, semi-annually therea�er or when
minimally includes:
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Skoakum Contract Services CommunityInclusion
Page l7 of i9 Contract 20I9-2020
�. SUBCONTRACTpR's procedure to tram new w direct service staff, training must include
DDA Policies & Competencies (see Section C- a
RCw's & wAC's refer Number 23�29)
referenced on page 1 & 2 of the County Contract under Obligations Section B.
agency policies & procedures
skills on how ' to instruct/teach clients
skills on how 'to document data collection d
client files . alylweekly notes, & 6-month reports in
skills on how to write Communi
(creating client tY Inclusion Client Plans and/or Person Centered P
g goals/objectives) laps
SUBCONTRACTOR's plan to irovid provide staff who are skilled in applying trainin techni related skills of program clients g ques to
enhance the work
iv. FTE levels, jab descriptions, and organization chart pertaining to program staff
V. SUBCONTRACTOR is required to send one '
s an diirect service staff to a minimum of 1
workshops, trainin6 hour g , and/or conferences about developmental disabili s of
SUBCONTRACTOR fail to access trainin s f disabilities. Should
g or direct service staff, the SUBCONTRACTORwill reimburse the COUNTY
at the rate of $35.00 an hour for eve hour of tr
accessed for staff (for not more than a total of $560.oD)rY aining riot.
27. SUBCONTRACTOR must assure new sta
ff are informed specifically of ail agency Policies/procedures
'
and have documentation that assures all directs g Y p cieslprocedures
service staff 1 S years of age or older are trained in the
following DDA Policies P�•io�• to �'orkin wit
h Clients: ADA training, APS Reporting R
client confidentiality, current individual instructionp g Requirements
and Acton StepslVocational Plans for each client
with whom the employee works; DDA Policyent
Policy 5.06 Client Rights; • D 4.1 I Working Age Adult (adult services only);
g DDA Policy 5.13 Protection from Abuse Y)' DDA
Policy 12.0 Incident Management. ,Mandatory Reporting; DDA
28' SUBCONTRACTOR. must ensure that ne
w direct service staff demonstrate the f_ollowin
competencies: g
1) Values that support the abilities of. individuals
2) Effective Communication —The obi '
understood
liy to effectively listen and to make oneself
3) Planning methods
4) Crisis Prevention and Intervention
29. within one month o em to Lent; SUBCONTRACTOR must ensure that direct servi
areas: ce staff received
training and are knowledgeable in the following eas. Overview of DDA Polices including:DDA
.Policy 3.01 Service Plans; DDA PolicyS,o3
.Intervention Techniques; • Client Complaints; DDA Policy 5. 17 Physical
q s DDA Policy 6.13 Employment/Da Program Y
Policy 13.44 DRU4l Access Agreement • DDA Y g Provider qualifications; DDA
Employment/Da Programs; Policy l5•D3 Community Protection Standards
Y g ms; and all reporting requirements related t ds for
a these DDA Policies.
30• Kithin six months o eL to Lent: SUBC
DNTRACTOR must ensure that direct service
training and are knowledgeable in the followi staff received
ng areas: Program skill development, DDA Folic 5,42
Necessary Supplemental Accommodation; D Y
13A Policy 5.14 Positive Behavior Support; DD
5.15 Use of Restrictive Procedures; DDA poll Pp � A Policy
Policy 9.07 HIV and AIDS and Program Skill Development.
3 1. SUBCONTRACTOR will have s`
igned documentation that staff training took lace
listed above in Section C-Number 25-29. p within the timelines
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Skookum Contract Services Community Inclusion Contract 2019-2020
Page 18 of 19
32. within 30 days of the effective date of this agreement, and annually thereafter, SUBCONTRACTOR
will develop and submit to COUNTY a Community Inclusion program -operating budget detailing the
projected allocation of contract funds, other sources and amounts of funding, program staffing
expenses and other cost allocations. within 30 days of the effective date of this agreement and at least
semi-annually thereafter, SUBCONTRACTOR will provide company and program operating financial
reports to COUNTY, including all revenues and expenses generated by SUBCONTRACTOR, in
sufficient detail to demonstrate the uses of funds provided under this agreement.
33. Every six months, SUBCONTRACTOR will develop and submit to COUNTY, Community Inclusion
financial reports reflecting the actual revenues received and expenses incurred compared to the
projected program budget submitted, along with the overall operating budget.
D. Performance Standards
1. SUBCONTRACTOR shall provide Community Inclusion services for up to three program clients who
are authorized for service by DSHSIDDA and have been referred by COUNTY.
E. Service Level Guidelines
1. Client Acuity is determined through the DDA assessment. Acuity reflects conditions typically
related to individual disabilities that are not likely to change, and are generally not impacted by
outside factors. Client acuity is determined as "High", "Medium", or "Low" as defined within. wAC
388-828.
2. Prior to beginning service or prior to an expected change in service, the provider will clearly
communicate to the Client and the County the maximum service hours per month the Client can
expect to receive. Service. changes will not occur until the Client has received proper notification
from DDA.
(a) The Client's DDA Person Centered Service Plan (PCSP) is the driver for service. The
County Service Authorization and updated Planned Rates information will not exceed
the Client's DDA County Service Authorization (CSA).
(b) The amount of service the Client receives should match with the County Service
Authorization (CSA) and updated Planned Rates information
(c) All Clients will have an individualized plan to identify Client's preferences. Minimum
plan elements are outlined in the reference document "Criteria for an Evaluation." A
copy of the Client's individualized plan will be provided to their CRM, guardian and
others as appropriate.
3. Service Level Guidelines reflect Client Acuity and other considerations, (see Table below); the
assigned support levels typically reflect direct service staff time provided to or on behalf of the client
on an individual basis, to participate in age appropriate community activities similar to those without
disabilities. Allowable activities are defined in the Community Inclusion Billable Activities
document.
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Skookum Contract Services Community Inclusion Contract 2019-2020
Page 19 of 19
4. The expectation is that all hours reported are documented specific to the client, authorized and relate
to the goals and support:, outlined within the client's Community Inclusion Plan.
COMMUNITY INCLUSION- ASSIGNED SERVICE LEVEL -
Monthly Support HOURS
ACUITY LEVEL
Monthly Support Hours
Level A
Up to 3 hours
Level B
Up to 6 hours
Level C
Up to 9 hours
Level D
Up to 12 hours
Level E
Up to 15 hours
Level F
Up to 18 hours
Level G
Up to 20 hours
i
F. Community Inclusion Unit of Service
1. One UNIT of Community Inclusion service is defined as one ( 1 ) or more "HOUR" of direct service or
ASSIGNED SERVICE LEVEL to one eligible client. A UNIT is defined as a "HOUR" which is at
least fifty (50) minutes of direct service; (partial hour to the quarter may be recorded), ten (10) minutes
of every "HOUR" can be used for documentation and/or meeting times.
2. Community Inclusion service support hours per month will be based on the client's Community
Inclusion Acuity Level per WAC.
3. SUBCONTRACTOR will provide a UNIT of service at $35.00 an HOUR,
19