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Port Townsend, WA 98368
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Consent Agenda
Public Healt
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:
SUBJECT: Agenda Item —Professional Services Agreement—Skookum Contract Services for
Individual Supported Employment Services; July 1, 2021 —June 30, 2022;
$111,600
STATEMENT OF ISSUE:
Jefferson County Public Health, Developmental Disabilities Division is requesting Board approval of the
Professional Services Agreement with Skookum Contract Services, to provide Individual Supported
Employment Services; July 1, 2021 —June 30, 2022; $111,600.00
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
The Professional Services Agreement with Skookum Contract Services; is for Individual Supported Employment
Services. Skookum Contract Services will provide employment services that are tailored to individual needs,
interests, and abilities of adults who experience intellectual/developmental disabilities. These individualized
services are necessary to help adults with developmental disabilities obtain and continue integrated
employment in the general workforce, at or above the state's minimum wage and to promote career
development.
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 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
DD-21-040
RECOMMENDATION:
JCPH management requests approval of the Professional Services Agreement with
Skookum Contract Services; to provide Individual Supported Employment Services; July 1, 2021 —June 30,
2022; $111,600.00.
REVIEWED BY:
//1,41,6/,%e 9/2/0 /
Mark McCauley, Interim County Administrator Date
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
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
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SUBCONTRACT FOR PROFESSIONAL SERVICES
INDIVIDUAL SUPPORTED EMPLOYMENT 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 Individual Supported Employment Services to persons who experience
intellectual/developmental disabilities in Jefferson County. The term of this agreement is July 1,2021 through June 30,
2022. 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) Individual Supported Employment" or "IE": services are a part of an individual's pathway to
employment,are tailored to individual needs,interests,abilities,and promote career development. These are
individualized services necessary to help persons with intellectual/developmental disabilities obtain and
continue integrated employment in the general workforce at or above the state's minimum wage. These
services may include intake, discovery, assessment, job marketing & development, job placement, job
replacement, worksite job training coaching/supports, development of natural supports, follow-along,
support,record keeping to support and/or maintain a job;(per the Individual Employment Phases&Billable
Activities). Specific service deliverables are delineated in 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
71A.14.070 requires a signed Release of Information or a signed Oath of Confidentiality Form.
(2) SUBCONTRACTOR is required to assure that each employee has a current (within three years) DSHS
background check in accordance with RCW 43.43.830-845, RCW 74.15.030 and WAC 388-825. 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 74.34.035, .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.
(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; who will or may have unsupervised access to a
DD-21-040
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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
before the 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 HCBS Services 0030; Basic Waiver Services 0200; Basic Plus Waiver Services 0210; Core
Waiver Services 0215; Community Protection Waiver Services 0220; 0600-0610 Community Access
Service; Supported Employment Service 2100.
(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 DDA'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:
(a) 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,
(b) 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
https://www.dshs.wa.gov/dda/county-best-practices under"Counties":
(a) DDA Policy 4.11,County Services for Working Age Adults;
(b) Chapter WAC 388-850, chapter 388-828 WAC, WAC 388-845-0001, 0030, 0210, 0215, 0220, 0600-
0610, 1030-1040,2100,2110;
(c) Criteria for Evaluation;
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/Criteria%20for%20Evaluation%2020
21-2023.docx
(d) DDA Guiding Values;
(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:
(a) DDA Policy 6.13,Employment/Day Program Provider Qualifications,
https://www.dshs.wa.gov/dda/policies-and-rules/policy-manual;
(b) County Guide to Achieve DDA's Guiding Values;
(c) DDA Guidelines for Community Assessments within Employment and Vocational Programs.
(12) The DRW Access Agreement with DDA; assures that the COUNTY and SUBCONTRACTORS have
reviewed the Access Agreement; Disability Rights Washington (formerly Washington Protection and
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Advocacy System) 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 that protect individual rights that include but are not limited
to; sexual harassment and non-discrimination(said policies must guarantee human/civil rights); a person's
right to privacy, safeguarding personal information; abuse of participants; agency medication procedure;
respectful staff-to-participant interactions (i.e.: including a person's right to be treated with dignity and
respect and free of abuse).
(14) SUBCONTRACTOR shall assure that participants, in accordance with DDA Policy 5.02, Necessary
Supplemental Accommodation; 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 for participants;that has been approved by the COUNTY
and:
(a) Is explained to participants and others in accordance with DDA Policy 5.02,Necessary Supplemental
Accommodation;
(b) Negotiates conflicts and advises participants of grievance procedures;
(c) Prohibits retaliation for using the grievance process;
(d) Includes a non-retaliation statement
(e) States advocates are available and participants are encouraged to bring advocates to help negotiate;
(f) 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)
(g) Includes a process for tracking and reporting grievances.
(16) Participants and others, in accordance with DDA Policy 5.06, Client Rights, 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,the participant's family,guardian or advocate is also informed.
(17) SUBCONTRACTOR shall obtain and retain in the Clients' files signed proof of Client's and/or family's
review of all policies, Provider expectations, 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.
(18) SUBCONTRACTOR will encourage participant involvement in policy development.
(19) SUBCONTRACTOR shall update Client Intake Forms every 6 months during the Client Review meeting.
(20) 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).
(21) SUBCONTRACTOR shall have adequate staffmg ratios and patterns to maintain quality and safety.
(22) The COUNTY and all SUBCONTRACTORS are mandated reporters under RCW 74.34.020(11). All parties
must comply with reporting requirements described in RCW 74.34.035, 040 and Chapter 26.44 and must
adhere to DDA Policy,6.08 Mandatory Reporting Requirements for Employment and Day Program Service
Providers. All service Provider employees, contractors, and volunteers are mandatory reporters and must
report every incident of observed, reported, or suspected abuse, improper use of restraint, neglect, self-
neglect,personal or financial exploitation, abandonment and/or mistreatment of Clients.
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(23) The Individual Employment Phases & Billable Activities document defines the individual Client services
that DDA reimburses.
(24) 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.
(a) 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 following,DDA—Data Security Requirements.
(25) 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.gov/fsa/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.
(26) 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.
(27) Authorization,Authentication, and Access. In order to ensure that access to the Data is limited to authorized
staff,the Contractor must:
(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.
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4. That passwords are significantly different from the previous four passwords.
(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 do not allow end-user modification. Examples would
include but not be limited to installing key loggers, malicious software, or any software that will
compromise DSHS data.
2. Not allowing the use of dial-up connections.
3. Using industry standard protocols and solutions for remote access. Examples include, but are not
limited to RADIUS Microsoft Remote Desktop(RDP)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.
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 abcdl2
would not be acceptable.
(k) Render the device unusable after a maximum of 10 failed logon attempts.
(28) 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.
(b) 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(31)Data Disposition, may be deferred until the
disks are retired,replaced,or otherwise taken out of the Secure Area.
(c) Optical discs(CDs or DVDs)in local workstation optical disc drives. Data provided by DSHS on optical
discs which will be used in local workstation optical disc drives and which will not be transported out of
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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:
i. 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.
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(31)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(31)Data Disposition.
(i) 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:
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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 the 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.
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.
(29) 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.
(30) 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.
(31) Data Disposition. When the contracted work has been completed or when the DSHS Data is no longer
needed,except as noted above in Section(30(b),DSHS Data shall be returned to DSHS or destroyed. Media
on which Data may be stored and associated acceptable methods of destruction are as follows:
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Data stored on: Will be destroyed by:
Server or workstation hard disks,or Using a"wipe"utility which will overwrite the
Removable media(e.g. floppies,USB flash drives, Data at least three(3)times using either random or
portable hard disks)excluding optical discs single character data,or
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 On-site shredding,pulping,incineration,or
Information requiring special handling(e.g. contractor
protected health information)
Optical discs(e.g.CDs or DVDs) Incineration,shredding,or completely defacing the
readable surface with a coarse abrasive
Magnetic tape Degaussing, incinerating or crosscut shredding
(32) 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.
(33) 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.
(34) 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.
(35) 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).
(b) The date policies are implemented or the date,they are revised.
(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 Six(6)
Month(semi-annual)Progress Report;track key program performance indicators and Quality Assurance
and a Quality Improvement components; listed under on page 9-Section(g).
(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.
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(e) Partnerships: SUBCONTRACTOR has a history of working cooperatively with community-based
organizations including Employers, other Agencies, the COUNTY DD Program, the Division of
Vocational Rehabilitation(DVR),and the Schools.
(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.
SUBCONTRACTOR will document progress on performance indicators identified in DDA Policy 6.13,
Provider Qualificationsfor Employment and Day Program Services.
(g) Quality Assurance and Service Evaluation Plan: SUBCONTRACTOR will have an evaluation system
to review services. The evaluation system must have both a Quality Assurance and a Quality
Improvement component, and both must include performance indicators/objective measures, that
evaluate Client progress every 6 months. The objective measures at a minimum will include:
1. Increased wages(by acuity)
2. Increased number of working hours(by acuity)
3. The number of new jobs(by acuity)
4. Job loss and why—retention rates(by acuity)
5. The percentage employed(by acuity)
6. Average number of hours worked(by acuity)
7. Performance Indicators,(by acuity)
8. Looking at Quantitative-(Data)vs.Qualitative-(Narrative)
(h) SUBCONTRACTOR will collect, analyze and compare all the performance indicators/objective
measures listed above in Section:(g) 1-8.The results will be sent to the County in an excel spreadsheet
every 6 months.
(i) The COUNTY'S Service Evaluation System: shall serve as the method by which current Providers
demonstrate that they continue to be qualified as Providers. A copy of the COUNTY'S Service
Evaluation System shall be provided upon request,to DDA for review.
(j) 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.
(k) 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 the
COUNTY,that direct service staff are trained and have experience in accordance with DDA Policy 6.13.
SUBCONTRACTOR will assure that all direct service staff trainings are documented;and will provide
COUNTY with information regarding staff qualifications upon request.
(I) Safety: SUBCONTRACTOR will provide evidence that it employs safety protection based on the
environment in which the participant is working or receiving services.
(m) Integration: Employment and day services must adhere to the Home and Community Based settings
(HCBS)requirements of 42CFR 441 530(a)(1),including that:
1. The setting is integrated in the greater community and supports individuals to have full access to the
greater community;
2. Ensures the individual receives services in the community to the same degree of access as
individuals not receiving Medicaid HCBS;
3. The setting provides opportunities to seek employment and work in competitive integrated settings;
and
4. The setting facilitates individual choice regarding services and supports,and who provides them.
(36) SUBCONTRACTOR shall identify settings that isolate people from the broader community or that have the
effect of isolating individuals from the broader community of individuals who do not receive Medicaid HCB
services. These settings are presumed not to be home and community-based.
(37) SUBCONTRACTOR shall provide an initial Individual Employment/Vocational Client Plan that will include
the information listed below;and should be developed by the SUBCONTRACTOR in collaboration with the
COUNTY,the Client,their DDA Case Manager,Residential Staff,Guardian/Family Members and others as
appropriate (the team). Initial plans will be completed within 60 days from date of the County Service
Authorization and must be signed by the Client and/or his or her Guardian if any. Copies of the initial
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Individual Employment/Vocational Client Plan and subsequent Six(6)Month(semi-annual)Progress Reports
will be distributed as appropriate to all team members.
(38) The initial Individual Employment/Vocational Client Plan and subsequent Six (6) Month (semi-annual)
Progress Reports will include:
(a) Current date;
(b) Timeline for the plan;
(c) Participant's name first and last;
(d) Participant ADSA ID;
(e) Employment goal;
1. The preferred(job type)the participant wishes to obtain or maintain;
2. The preferred wages/salary the participant wishes to earn;
3. The number of hours the participant prefers to work;
4. The agreed upon time line to achieve the employment goal.
(f) The participant's skills,gifts,interests and preferred activities;
(g) Measurable strategies and timelines(action steps and supports)to meet the employment goal;
(h) Identification of persons and/or entities available to assist the participant in reaching his/her employment
goal(example: a family member,Vocational Rehabilitation services,etc.)and;
(i) Identification of other accommodations, adaptive equipment and/or supports critical to achieve
employment goal.
(39) SUBCONTRACTOR must assure that Individual Employment staff hours are attributed to the Client via the
Individual Employment Phases&Billable Activities)
(40) SUBCONTRACTOR shall identify the provision of supports necessary for job success to each participant.
Supports may include, but are not limited to, identification of resources necessary for transportation,job
restructuring, work materials or routine adaptation, work environment modifications, identification of job
counseling needs,etc.
(41) SUBCONTRACTOR will provide training and support to employers and co-workers,in each job placement
to ensure jobs are maintained and fading is occurring. This also includes the development of natural supports.
(42) The SUBCONTRACTOR will document all employment services activities and outcomes to those activities
that relate to the participant's individually identified goal(s)as outlined in their Six(6)Month(semi-annual)
Progress Report.
(43) The SUBCONTRACTOR will provide the following:
(a) Training and support is provided as a part of an individual's pathway to integrated employment in
accordance with DDA Policy 4.11,County Services for Working Age Adults.
(b) Information about wages,productivity,benefits,and work hours for each participant.
(c) Progress in achieving increased wages and work hours for each participant.
(44) The SUBCONTRACTOR will provide a Six (6) Month (semi-annual) Progress Report; describing the
progress made towards achieving Client goals; to the Client, their DDA Case Manager, Residential Staff,
Guardian/Family Members and others as appropriate,within 30 days following the six-month period.
(45) 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) Incidents involving injury,health or safety issues are reported to DDA and the County reference DDA
Policy 6.08,Mandatory Reporting Requirements for Employment and Day Program Services Providers.
(b) The initial report to the COUNTY may be done via documented telephone calls to the COUNTY
Coordinator.
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(c) 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.
(d) Serious and emergent incidents shall be handled in accordance with DSHS/DDA Policy 12.01,Incident
Management.
(e) Incident reports are tracked and analyzed for potential trends and patterns.
(f) Mandatory reporting is done in accordance with Chapter 74.34 RCW,Abuse of Vulnerable Adults and
Chapter 26.44 RCW,Abuse of Children.
(46) SUBCONTRACTOR shall comply with all applicable federal, state and local fire, health and safety
regulations and the following:
(a) Current policies address confidential/private information for participant and their documents.
(b) Current emergency contact and medical information(medications,diet,allergies,etc.)needed during the
hours of service is readily available for each participant.
(c) All services for participants must be provided with attention to their health and safety.
(47) 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.
(48) 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.
(49) AUDIT REQUIREMENTS. Independent Audit will be submitted annually to the Jefferson COUNTY DD
COUNTY Coordinator in the following manner:
(a) SUBCONTRACTOR must be able to account for and manage public funds in compliance with Generally
Accepted Accounting Principles"GAAP". An agency, for-profit or non-profit,who receives in excess
of $100,000 in DDA funds during its fiscal year from the County, shall provide Certified Public
Accountant reviewed or audited financial statements within nine months subsequent to the close of the
SUBCONTRACTOR's fiscal year. Copies of the audit,financial statements 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.
(b) The SUBCONTRACTOR shall provide an independent audit of the entire organization which:
1. Is performed by an independent Certified Public Accountant,the Washington State Auditor's Office,
or another entity the COUNTY and the SUBCONTRACTOR mutually approve.
2. 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.
3. 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.
(50) 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.
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(b) Official Notification: If the informal notification does not result in resolution,the official notification of
possible non-compliance to establish a date, within ten (10) working days of notification, when
representatives of the COUNTY and the SUBCONTRACTOR shall meet to discuss areas of contention
and attempt to resolve the issues.
(c) Written Summary: Within ten(10)working days of such official notification,the COUNTY will provide
the SUBCONTRACTOR a written summary of the areas of non-compliance by certified mail. Notice
shall be sent to the address identified in the Agreement.
(d) Discussion: Within twenty(20)days of the date of the written summary,a discussion between COUNTY
and SUBCONTRACTOR shall be conducted to resolve areas of non-compliance or potential non-
compliance.
(e) Should the above procedures fail to resolve the compliance issue,the parties will obtain the services of
the Peninsula Dispute Resolution Center,or another agreed upon resource,and shall share equally in any
retainer fees or other costs of services.If no agreement is reached,the mediator's decision in the matter
will be binding on all parties,except that in no event will the COUNTY honor a financial determination
that is greater than the funds allowed in the scope of this Agreement.
(51) 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.
(52) 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.
(53) SUBCONTRACTOR shall provide COUNTY with a copy of a signed DSHS Provider Agreement within 30
days of the effective date of this agreement.
(54) SUBCONTRACTOR agrees to assign to COUNTY its Medicaid Billing Rights for services to Clients
eligible under Title XIX programs. Written documentation shall be available to COUNTY on request. If
SUBCONTRACTOR contracts directly with DSHS to provide covered services under Title XIX,COUNTY
agrees that funding intended for those Clients shall be excluded from this agreement. If SUBCONTRACTOR
contracts directly with Social Security to provide covered services under a PASS/IRWE, COUNTY agrees
that funding intended for those Clients shall be excluded from this agreement.
C. REIMBURSEMENTS
(1) For said services rendered under this agreement, COUNTY shall reimburse SUBCONTRACTOR up to
$84.00, per UNIT of Individual Employment service from July 1, 2021 to December 31, 2021. If the
SUBCONTRACTOR looks to be overspent during this period,the UNIT of Individual Employment service
will be paid at a lower rate of$75.00;as defined in Exhibit A, Statement of Work.
(2) The COUNTY shall reimburse SUBCONTRACTOR$75.00, per UNIT of Individual Employment service,
from January 1,2022 to June 30,2022;as defined in Exhibit A,Statement of Work.
(3) 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.
(4) COUNTY may, at its option, withhold reimbursement for any month for which required reports have not
been received or are inaccurate and/or complete.
(5) Total reimbursements for the fiscal year of 2021-2022 to the SUBCONTRACTOR by the COUNTY under
this contract shall not exceed$111,600.00 in completion of these services without express written amendment
signed by both parties to this Agreement. Work performed between July 1,2021 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 2021-2022.
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D. DEBARMENT
(1) By signing this Agreement, the SUBCONTRACTOR certifies that it is not presently debarred, suspended,
proposed for debarment, declared ineligible, or voluntarily excluded in any Washington State or Federal
department or agency from participating in transactions (debarred). The SUBCONTRACTOR agrees to
include the above requirement in any and all subcontracts into which it enters,and also agrees that it will not
employ debarred individuals. The SUBCONTRACTOR must immediately notify the County if, during the
term of this Agreement, the SUBCONTRACTOR becomes debarred. The County may immediately
terminate this Agreement by providing the SUBCONTRACTOR written notice,if the SUBCONTRACTOR
becomes debarred during the term of this Agreement.
E. FUNDING WITHDRAWN,REDUCED OR LIMITED
(1) If the COUNTY determines in its sole discretion that the funds it relied upon to establish this Agreement
have been withdrawn,reduced or limited,or if additional or modified conditions are placed on such funding
after the effective date of this Agreement but prior to the normal completion of this Agreement, then the
COUNT,at its sole discretion,may: (1)Terminate this agreement;(2)Renegotiate this Agreement under the
revised funding conditions; or, (3) Suspend the SUBCONTRACTOR's performance under this Agreement
upon five (5)business days' advance notice to the SUBCONTRACTOR, if the COUNTY determines that
there is a reasonably likelihood that the funding insufficiency may be resolved in time to allow the
SUBCONTRACTOR's performance to resume prior to the normal completion date of this Agreement.
F. OVERPAYMENTS OR ERRONEOUS PAYMENTS TO SUBCONTRACTOR
(1) If overpayments or erroneous payments have been made to the SUBCONTRACTOR under this Agreement,
the COUNTY will provide notice to the SUBCONTRACTOR and the SUBCONTRACTOR shall refund the
full amount of the overpayment within thirty(30)calendar days of the notice. If the SUBCONTRACTOR
fails to make timely refund,the COUNTY may charge the SUBCONTRACTOR one percent(1%)per month
on the amount due,until paid in full.
G. RECORDS AND DOCUMENTS REVIEW
(1) The SUBCONTRACTOR must maintain books,records, documents, magnetic media,receipts, invoices or
other evidence relating to this Agreement and the performance of the services rendered, along with
accounting procedures and practices,all of which sufficiently and properly reflect all direct and indirect costs
of any nature expended in the performance of this Agreement.At no additional cost,these records,including
materials generated under this Agreement,are subject at all reasonable times to inspection,review, or audit
by the Agency, the Office of the State Auditor, and state and federal officials so authorized by law, rule,
regulation,or agreement.
(2) The SUBCONTRACTOR must retain such records for a period of six(6)years after the date of final payment
under this Agreement.
(3) If any litigation,claim or audit is started before the expiration of the six(6)year period,the records must be
retained until all litigation,claims,or audit fmdings involving the records have been resolved.
H. RISK ASSESSMENT AND MONITORING FOR COMPLIANCE BY THE COUNTY.
(1) SUBCONTRACTOR shall immediately report to the COUNTY any failure to perform under this Agreement.
(2) Along with every request for reimbursement under this Agreement,the SUBCONTRACTOR shall submit a
Monitoring Certification using the form attached as Exhibit B for purposes of the County performing the risk
assessment of the SUBCONTRACTOR and compliance monitoring of this Agreement that is required under
the Program Agreement.
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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 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.
(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 amount of service the Client receives should match with the AWA CSA and updated Planned Rates
information.
(4) 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.
(5) 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.
(6) 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.
(7) 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
6. Blanket Contractual Liability
(8) All employees or subcontractors of the 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.
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(9) 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.
(10) 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.
(11) All cost for insurance shall be considered incidental to and included in the unit contract prices and no
additional payment will be made.
(12) 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.
(13) 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.
(14) The COUNTY will pay no progress payments under Section C until the SUBCONTRACTOR has fully
complied with this section. This remedy is not exclusive;and the COUNTY may take such other action as
is available to them under other provisions of this Agreement,or otherwise in law.
(15) 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.
(16) The SUBCONTRACTOR shall comply with all Federal,State,and local laws and ordinances applicable to the
work to be done under this Agreement. This Agreement shall be interpreted and construed in accord with
the laws of the State of Washington and venue shall be in Jefferson COUNTY,WA.
(17) 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.
(18) 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 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
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extent of the SUBCONTRACTOR'S negligence or the negligence of the SUBCONTRACTOR'S agents or
employees.
(19) 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.
(20) The SUBCONTRACTOR specifically assumes potential liability for actions brought against the COUNTY
by SUBCONTRACTOR'S employees, including all other persons engaged in the performance of any work
or service required of the SUBCONTRACTOR under this Agreement and, solely for the purpose of this
indemnification and defense, the SUBCONTRACTOR specifically waives any immunity under the state
industrial insurance law, Title 51 RCW. The SUBCONTRACTOR recognizes that this waiver was
specifically entered into pursuant to provisions of RCW 4.24.115 and was subject of mutual negotiation.
(21) SUBCONTRACTOR shall not discriminate against any person presenting themselves for services based on
race,religion,color,sex,age,or national origin.
(22) 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.
(23) Noportion of this contract maybe assigned or subcontracted to anyother individual,firm,or entitywithout
g
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.
(24) The parties agree that:
(a) No representation or promise not expressly contained in this Agreement has been made.
(b) They are not entering into this Agreement based on any inducement, promise or representation,
expressed or implied,which is not expressly contained in this Agreement.
(c) This Agreement supersedes all prior or simultaneous representations, discussions, negotiations, and
agreements,whether written or oral,within the scope of this Agreement.
(25) Provided it does not result in a material change in the terms of this Agreement, if any provision of this
Agreement or the application of this Agreement to any person or circumstance shall be invalid, illegal, or
unenforceable to any extent,the remainder of this Agreement and the application this Agreement shall not
be affected and shall be enforceable to the fullest extent permitted by law.
(26) No consent by either party to, or waiver of, a breach by either party, whether express or implied, shall
constitute a consent to,waiver of,or excuse of any other,different,or subsequent breach by either party.
(27) The Contractor shall not sell,assign,or transfer any of rights obtained by this Agreement without the express
written consent of the County.
(28) The parties do not intend, and nothing in this Agreement shall be construed to mean, that any provision in
this Agreement is for the benefit of any person or entity who is not a party.
(29) This Agreement may be amended or supplemented only by a writing that is signed by duly authorized
representatives of all the parties.
(30) This Agreement may be executed in one or more counterparts, each of which shall be deemed an original,
and all of which counterparts together shall constitute the same instrument which may be sufficiently
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 17 of 29
evidenced by one counterpart. Execution of this Agreement at different times and places by the parties shall
not affect the validity of this Agreement,so long as all the parties execute a counterpart of this Agreement.
(31) The parties agree that facsimile and electronic signatures shall have the same force and effect as original
signatures.
(32) Notwithstanding any provisions of this Agreement to the contrary, to the extent any record, including any
electronic, audio, paper or other media, is required to be kept or indexed as a public record in accordance
with the Washington Public Records Act,Chapter 42.56 RCW(as may be amended),the Contractor agrees
to maintain all records constituting public records and to produce or assist the County in producing such
records,within the time frames and parameters set forth in state law. The Contractor also agrees that upon
receipt of any written public record request,the Contractor shall,within two business days,notify the County
by providing a copy of the request per the notice provisions of this Agreement.
(SIGNATURES FOLLOW ON NEXT PAGE)
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 18 of 29
ADOPTED THIS day of ,2021
By: By: l `ems
Kate Dean,Chairman Contracts Manager
Jefferson County Board of Commissioners Skookum Contract Services,LLC
14-1,56ct.. Cc�ur�Q-
ATTEST:
By:
Carolyn Gallaway,Clerk of the Board
APPROVED A,S TO FORM ONLY:
By: August 19, 2021
Philip Hunsucker,
Chief Civil Deputy Prosecuting Attorney
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 19 of 29
EXHIBIT A
STATEMENT OF WORK
INDIVIDUAL SUPPORTED EMPLOYMENT
WORK STATEMENT
SUBCONTRACTOR shall provide Individual Supported Employment Services for program Clients as described
hereinafter. SUBCONTRACTOR shall be reimbursed for such services on a unit of service basis pursuant to Section C.,
Reimbursements of this contract.
IL PROGRAM DESCRIPTION
A. Program Goals:
1. To support and strengthen Skookum Contract Services capacity to provide quality, cost effective
individual supported employment services.
III 2. To assure that businesses employingindividuals with developmental disabilities in Jefferson County
p
will meet the Employment Quality Indicators from the County Guide to Achieve DDA's Guiding
Values.
3. To provide employment services that are designed to meet specific needs of individuals based on
personal preferences and individualized goals and outcomes.
(a) To provide appropriate job matching and necessary vocational support services to assure that
program Clients placed in individual community jobs maintain continuous employment for at
least one year.
(b) To provide an Employment Plan, a discovery process, detailed action steps/timelines that will
serve as a transition tool towards the advancement of the individual's pathway and as an aid in
the implementation of matching program Clients to appropriate employment services in the
community.
(c) When appropriate, to provide assessment and consultation, in order to identify and address
existing barriers to employment for individuals who have not yet achieved their employment goal,
through consulting and assessment. (This is in addition to supports received through Supported
Employment services or Group Employment services for individuals who have not yet achieved
their employment goal).
(d) Clients in an Employment program will be supported to work toward a living wage. A living
wage is the amount needed to enable an individual to meet or exceed his or her living expenses.
Clients should average twenty(20)hours of community work per week or eighty-six(86)hours
per month; however, each individual's preferred hours of employment should be taken into
consideration.
(e) To identify settings that isolate people from the broader community or that have the effect of
isolating individuals from the broader community of individuals who do not receive Medicaid
HCB services. Clients will not access these settings because they are presumed not to be home
and community-based.
B. Definitions
1. 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.
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 20 of 29
2. Competitive Integrated Employment means work performed by an individual on a part-time or
fulltime 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.
3. Placement is defmed as employment in a first job or in multiple jobs arranged by SUBCONTRACTOR
for 90 calendar days. Placements may be: full-time,average workweek of 20 to 40 hours;part-time,
average work week of 12 hours to 20 hours,or less than average work week of 2 to 12 hours.
4. Replacement is defmed as being assisted by the same SUBCONTRACTOR in any subsequent
employment(second,third,fourth job,etc.)for 90 calendar days. Employment may be full-time,part-
time,or other as defmed in B.2 above.
5. Placement and Replacement Services may include:vocational counseling and job analysis to assist in
the identification of work objectives and the job match process;job development,locating a suitable
community job for the worker; initial placement and post-hire training of the supported employee,
employer and/or coworkers at the employment site;job restructuring and worksite modifications;
supporting the worker,employer,and other interested persons(parents,unions,other employees,etc.)
to develop natural workplace supports and ensure stability on the job; assisting the worker to obtain
other services necessary for continued employment; feedback to the worker,COUNTY and to DDA
Field Services regarding progress and/or problems.
6. Follow along Services begin at the time of placement or replacement and may include: visiting with
the worker,the employer,and other interested parties(parents,unions,etc.)to insure stability on the
job; providing feedback to the worker, COUNTY, and to DDA Field Services regarding progress
and/or problems;counseling the worker and his/her family on vocational issues.
7. The development of an Individual Employment Plan that will serve as a transition tool toward the
advancement of the individual's employment pathway and as an aid in the implementation of
matching program Clients to appropriate employment services in the community.
8. Planning is defined as facilitating the development of a Pathway to Employment Plan; delineating
individual vocational skills, experiences, preferences, strengths, support needs, skills, goals and
objectives, education on system navigation and the Discovery Process related to vocational skills
and capabilities.
9. Implementation of the Action Steps that detail tasks timelines and entities responsible for leading to
the community employment will reflect that 75%of the direct service hours with the Client will be
at employment sites in the community. The amount of service a Client receives will be based on
his/her demonstrated need,acuity level,and work history.
C. Program Requirements
1. The SUBCONTRACTOR will clearly communicate to the Client and the COUNTY, prior to
beginning service,an expected change in 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 AWA
County Service Authorization and updated Planned Rates information will not exceed the Client's
DDA PCSP.
(b) Service changes will not occur until the Client has received proper notification from DDA.
(c) The amount of service the Client receives should match with the AWA County Service
Authorization and updated Planned Rates information.
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 21 of 29
2. If SUBCONTRACTOR is selected as the Client's Provider, SUBCONTRACTOR shall provide an
Individual Employment/Vocational Client Plan for Client's in service delineating individual skills,
experiences,preferences,strengths,support needs,skills,and goals and objectives within 30 days of
the beginning of services for the Client, in order to promote Individual Employment. (Minimum
Individual EmploymentNocational Client Plan and each Six (6) Month (semi-annual) Progress
Report; elements are outlined in the reference document called "Criteria for Evaluation"
https://www.dshs.wa.gov/sites/default/files/DDA/dda/documents/Criteria%20for%20Evaluation%20
2021-2023.docx)
3. SUBCONTRACTOR must ensure that Client goals and objectives are based on an Individual
EmploymentNocational Client Plan and each Six(6)Month(semi-annual)Progress Report:
(a) Shows that documentation,data collected,training reflects those goals and objectives;
(b) Shows how it has identified and addressed support needs of each participant by demonstrating
methods for providing individualized services outlined in the Plan;
(c) Shows how the Six (6) Month (semi-annual) Progress Report demonstrates the participants
progression on his/her goals and objectives;
(d) Describes the reasons for any shortfall concerning the action steps and propose steps for
correction in the Six(6)Month(semi-annual)Progress Report.
4. SUBCONTRACTOR will provide a copy of the Individual Employment/Vocational Client Plan and
each Six(6)Month(semi-annual)Progress Report; that describe the outcome of activities;to the
Client, their DDA Case Manager, Residential Staff, Guardian/Family Members and others as
appropriate. The Six(6)Month(semi-annual)Progress Report will summarize the progress made
towards the Client's individualized goals.
5. SUBCONTRACTOR's employment services; may include a personal discovery process related to
skills, capabilities, goals; education on system navigation; action steps detailing steps, timelines,
and entities responsible for the accomplishment of tasks of vocational services leading to
employment.
6. SUBCONTRACTOR must ensure that job coaching and supervision of Clients, will be based on
goals established in an Individual Employment/Vocational Client Plan and each Six (6) Month
(semi-annual) Progress Report. Client goals/objectives, training provided, and progress toward
meeting said goals/objectives shall be documented in each Client record or file.
7. SUBCONTRACTOR will assure quality Individual EmploymentNocational plans and each Six(6)
Month Progress Report,by measuring them against the Employment Plan Quality Review Tool,DDA
created in 2016 and the DDA document called, Quality Employment Plan-6 Values of an Excellent
Employment Plan.
8. SUBCONTRACTOR will support Clients in an employment program to work towards a living
wage. A living wage is the amount needed to enable an individual to meet or exceed his/her living
expenses. Clients should average twenty(20)hours of community work per week or eighty-six(86)
hours per month; however, each individual's preferred hours of employment should be taken into
consideration.
9. SUBCONTRACTOR must ensure that the amount of service hours a Client receives will be based
on his/her demonstrated need,acuity level and work history per WAC 388-828.
10. SUBCONTRACTOR will contact all Clients according his/her demonstrated need,acuity level and
work history;at least once per month.
11. If SUBCONTRACTOR fails to provide the minimum number of monthly service hours for the
Client, the COUNTY will advise the Client, Parent/Guardian, and/or Residential Provider
concerning the minimum and maximum number of service hours the Client should be receiving and
inform them of the option of choosing another Employment Provider.
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 22 of 29
12. SUBCONTRACTOR shall schedule a review meeting every six(6)months for all program Clients,
(a minimum of twice a year for every Client). For every new Client, a meeting will be scheduled
every six(6)months after the initial plan.
13. SUBCONTRACTOR shall schedule the Six (6)-Month meeting; by sending a series of available
dates/times 20 days ahead; to the COUNTY, DDA Case Managers, Client, Guardian/Family and
Residential Services one month before the required meeting.
14. SUBCONTRACTOR will submit a copy of the updated Six (6)-Month (semi-annual) Progress
Report with updated Action Steps of the Individual Employment/Vocational Client Plan to the
Client,the DDA case manager,the COUNTY Coordinator,and Residential Support Staff/Parent or
Guardian within two weeks of the scheduled Six(6)-Month meeting.
15. SUBCONTRACTOR shall provide an updated Six (6) Month (semi-annual) Progress Report for
every program Client at or before the six (6) month review meeting. The Six (6) Month (semi-
annual) Progress Report shall demonstrate how the individual is progressing on his/her goals and
objectives;in order to assess if they are continuing to meet the individual's pathway to employment
goals; of the Individual Employment/Vocational Client Plan. The Six (6) Month (semi-annual)
Progress Report shall describe the reasons for any shortfall concerning the action steps and propose
steps for correction.
16. The Six(6)-Month(semi-annual)Progress Report with updated Action Steps,will reflect that 75%
of the direct service hours with the Client will be at employment sites in the community. The focus
will be on real work experience in a community setting delineating individual skills, experiences,
preferences,strengths,support needs and vocational interests.
17. If the SUBCONTRACTOR is also the Client's employer or the Employer of Record, long term
funding will remain available to the Provider/Employer for six(6)months after the DDA Client's
date of hire.
(a) At the end of the six-month period, if the Client continues to need support on the job, another
Provider who is not the Employer of Record must provide the support, unless the County or
DDA issues prior written approval, for the SUBCONTRACTOR to continue to provide long-
term supports,if needed.
(b) If the COUNTY or DDA approves the continuation of long-term supports, where the
SUBCONTRACTOR is the Employer of Record;the COUNTY or DDA will regularly monitor
these positions to assure fading efforts occur when appropriate and any potential conflict of
interest is addressed.
18. If Clients in Individual Supported Employment have not obtained paid employment at minimum
wage or better within six (6) months, the SUBCONTRACTOR will assure the COUNTY 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.
(d) Strategies may include:
i. Requesting and providing technical assistance,
ii. Choosing a new Employment Provider,
iii. Providing additional resources as needed to support the individual's pursuit of
employment.
iv. Additional strategies will be documented for each Client and kept in the Client's file(s).
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 23 of 29
19. If after twelve (12) months the Client remains unemployed, the SUBCONTRACTOR will assure
the COUNTY the following steps are taken:
(a) Reviews will be conducted every month,until the Client is employed or no longer working with
the Employment Provider.
(b) The Provider will address steps outlined in the next Six (6) Month (semi-annual) Progress
Report; with input from the Client,the COUNTY, DDA Case Manager, Residential staff and
Guardian/Family.
(c) The Client may request to participate in Community Inclusion activities or the Client may
choose to remain in an Employment Program.
(d) When requesting to participate in Community Inclusion,the Client shall communicate directly
with his or her DDA Case Manager. The DDA Case Manager is responsible for authorizing CI
services.
20. SUBCONTRACTOR must ensure that every Client file has a copy of DDA Client Service
Authorization(CSA), a copy of the participant's DDA Person Centered Service Plan; (PCSP),the
Individual Employment Plan and updated Six (6) Month (semi-annual) Progress Reports as
applicable.
21. SUBCONTRACTOR must ensure that all Incident Reports are retained in Client files; that they
have a policy to retain records at least 5 years; that emergency contact and medical information
(medications,diet,allergies,etc.)needed during the hours of service is available for each participant
on the face sheet of the Client file;that the emergency and contact information is updated yearly,or
when needed;and that services are provided in a natural or integrated environment or there is a goal
to achieve that.
22. Worker wages shall be commensurate with the local industry accepted norms and comply with
applicable Federal Department of Labor standards.
23. Recommendations for program participant's termination in Individual Employment or transfer into
another Individual Employment agency must be authorized by the DDA Case Manager,and will be
reviewed in consultation with the COUNTY and others as appropriate. SUBCONTRACTOR will
facilitate the development of a transition plan and schedule. The transition plan will be developed
in consultation with the Client,DDA case management,COUNTY,Guardian/Family members and
other service Providers as applicable and within 30 working days of Clients request to change
agencies.
24. SUBCONTRACTOR shall submit a written Program Staff Training Plan to COUNTY for approval
or disapproval within 30 days of the effective date of this agreement,semi-annually thereafter or when
reorganization occurs,which minimally includes:
(a) SUBCONTRACTOR's procedure to train new direct service staff,training must include,
• DDA Policies&Competencies(see Section C-Number 23-28)
• RCW's & WAC's referenced on page 1 & 2 of the County Contract under Section B.
Obligations
• agency policies&procedures
• skills on how to instruct/teach Clients
• skills on how to document data collection,daily/weekly notes,&6-month reports in Client
files
• skills on how to write Vocational Client Plans and/or Person Centered Plans(creating Client
goals/objectives)
(b) SUBCONTRACTOR's plan to provide staff who are skilled in applying training techniques to
enhance the work related skills of program Clients
(c) FTE levels,job descriptions,and organization chart pertaining to program staff
(d) SUBCONTRACTOR is required to send one direct service staff to a minimum of 16 hours of
workshops, trainings, and/or conferences about developmental disabilities. Should
SUBCONTRACTOR fail to access trainings for direct service staff,the SUBCONTRACTOR
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 24 of 29
will reimburse the COUNTY at the rate of$75.00 an hour for every hour of training not
accessed for staff(for not more than a total of$1,200.00).
25. SUBCONTRACTOR must assure new staff are informed specifically of all agency
policies/procedures and have documentation that assures all direct service staff 18 years of age or
older are trained in the following DDA Policies Prior to Working with Clients: ADA training,APS
Reporting Requirements, Client confidentiality, current individual instruction and Action
Steps/Vocational Plans for each Client with whom the employee works;DDA Policy 4.11 Working
Age Adult(adult services only);DDA Policy 5.06 Client Rights;DDA Policy 5.13 Protection from
Abuse,Mandatory Reporting; DDA Policy 12.0 Incident Management.
26. SUBCONTRACTOR must ensure that new direct service staff demonstrate the following
competencies:
(a) Values that support the abilities of individuals
(b) Effective Communication—The ability to effectively listen and to make oneself understood
(c) Planning methods
(d) Crisis Prevention and Intervention
27. Within one month of employment: SUBCONTRACTOR must ensure that direct service staff
received training and are knowledgeable in the following areas: Overview of DDA Policies
including: DDA Policy 3.01 Service Plans;DDA Policy 5.03 Client Complaints;DDA Policy 5.17
Physical Intervention Techniques; DDA Policy 6.13 Employment/Day Program Provider
Qualifications; DDA Policy 13.04 DRW Access Agreement; DDA Policy 15.03 Community
Protection Standards for Employment/Day Programs;and all reporting requirements related to these
DDA Policies.
28. Within six months of employment: SUBCONTRACTOR must ensure that direct service staff
received training and are knowledgeable in the following areas: Program skill development, DDA
Policy 5.02 Necessary Supplemental Accommodation;DDA Policy 5.14 Positive Behavior Support;
DDA Policy 5.15 Use of Restrictive Procedures; DDA Policy 9.07 HIV and AIDS and Program
Skill Development.
29. SUBCONTRACTOR will have signed documentation that staff training took place within the
timelines listed above in Section C-Number 24-28.
30. Within 30 days of the effective date of this agreement, and annually thereafter,
SUBCONTRACTOR will develop and submit to COUNTY an Employment 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.
31. Every six months, SUBCONTRACTOR will develop and submit to COUNTY, Individual
Employment 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 Individual Employment services that are referred for service by
DSHS/DDA and have been authorized by the COUNTY.
(a) Job development,job coaching,follow-along and replacement services as necessary
(b) for Individual Employment Clients
(c) Individual Employment/Vocational Client Plan must contain:
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 25 of 29
i. Action Steps detailing steps,timelines and entities responsible for the accomplishment of
tasks leading to employment,
ii. Provide the minimum number of monthly service hours for the client,
iii. Implement Action Steps that affirm 75%of the direct service hours with the client will be
at employment sites in the community.
E. Service Level Guidelines
1. Client Employment Acuity is determined through the DDA assessment. Acuity reflects conditions
typically related to the individual's disabilities that are not likely to change, and are generally not
impacted by outside factors. Client acuity is determined as"High", either"Medium" or"Low" as
defined within WAC 388-828. Other considerations are generally related to the job or service
environment,which may impact the individual's level of support,regardless of acuity.
2. Employment Service Levels reflect Client Employment Acuity and other considerations(see Table
One-Base Hours below);the Guidelines typically reflect direct service staff time provided to or on
behalf of the client to pursue or maintain employment. You may be eligible to receive additional
Add-On Hours (see Table Two, Add-On Hours on page 26). Add-on Hours for Employment
Supports are considered short-term and is a service that allows DDA to approve additional service
hours,in addition to the amount of your employment service Base Hours.
The COUNTY can approve additional Add-On Hours for up to three months when:
(a) A Client is beginning a new job;or
(b) There is a planned or unexpected change in the Client's job or job duties;or
(c) The Client's current employment is at risk and short-term supports are needed to assist them
in maintaining their current job.
3. The expectation is that all hours reported are documented specific to the client authorized and relate
to the goals and supports outlined within the client's Individual Employment Plan.
4. Allowable activities are defined in the Employment Phases and Billable Activities.
TABLE ONE-Base Hours
DDA DETERMINES YOUR EMPLOYMENT SERVICE LEVEL USING THE
FOLLOWING TABLE;
CLIENT YOUR THEN YOUR AND YOUR
ACUITY EMPLOYMENT EMPLOYMENT EMPLOYMENT
LEVEL STATUS SERVICE SERVICE BASE
IE: IS: LEVEL IS: HOURS PER
MONTH MAY BE:
WORKING A 0
NONE
NOT WORKING B 0
WORKING C 4
LOW
WORKING E 7
MEDIUM
==-
= === Ewa'.
$'"�... .r„r., o Er ,. � � � y; ?z' r,r- ,
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 26 of 29
WORKING G 11
HIGH
NOT WORKING H 12
TABLE TWO-Add-On Hours
DDA USES THE FOLLOWING TABLE TO
DETERMINE THE MAXIMUM NUMBER
OF ADD-ON HOURS YOU ARE ELIGIBLE
TO RECEIVE.
IF YOU MEET ONE YOU MAY BE
OF THE BELOW ELIGIBLE TO
CONDITIONS AND RECEIVE UP TO
YOUR THE
EMPLOYMENT FOLLOWING
LEVEL IS: AMOUNT OF
ADD-ON
HOURS:
A 0
B 0
C 5
r �,�
k Grp, re
E 5
� N1114111 q ffi "V"fir;,4,, 'ire
G 12
H ., 14
F. Individual Employment Unit of Service
1. One UNIT of Individual Employment/Individualized Technical Assistance service is defined as one
(1)"HOUR"of direct service or assigned service level to one eligible client. An"HOUR"is at least
fifty(50)minutes of direct service;(partial hour to the quarter may be recorded);ten(10)minutes
of every"HOUR" of direct service or assigned service level to one eligible client can be used for
documentation and/or meeting times or ASSIGNED SERVICE LEVEL as defined in Section D,
Performance Standard,Number 1.
2. Individual Employment service support hours will be based on the client's Individual Employment
Level per WAC.
3. One UNIT of Individual Employment service will be up to$84.00,from July 1,2021 to December
31, 2021; and is defined as one "HOUR" of direct service to one eligible client. If the
SUBCONTRACTOR looks to be overspent during this period,the UNIT of Individual Employment
service will be paid at a lower rate of$75.00.
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 27 of 29
4. One UNIT of Individual Employment service will be$75.00,from January 1,2022 to June 30,2022;
and is defined as one"HOUR"of direct service to one eligible client.
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 28 of 29
EXHIBIT B-COMPLIANCE AND RISK MONITORING FORM
This Compliance and Risk Monitoring Form shall be submitted before the Subrecipient Agreement can be approved
and also shall be submitted along with every request for reimbursement.
AGENCY CONTRACT NO: IhD - ZL - G 4O
DATE: J'ZQ IZOZ t
NAME OF SUBRECIPIENT: 4n:1e-f a- CO LfSQ.,
By signing below,I declare under penalty of perjury of the laws of the State of Washington and the United States
that the forgoing is true and correct. (Check the applicable boxes.)
DATE CERTIFICATION ITEM YES NO
Subrecipient is not presently debarred,suspended,proposed for
debarment,declared ineligible,or voluntarily excluded from �[
transactions by any Federal,State,or local department or agency
Subrecipient has not within a 3-year period preceding the submission of
this Compliance and Risk Monitoring Form been convicted of or had a
civil judgment rendered against them for commission of fraud or a
criminal offense in connection with obtaining,attempting to obtain,or
performing a public(Federal, State,or local)transaction or contract
under a public transaction;violation of Federal or State antitrust
statutes or commission of embezzlement,theft,forgery,bribery,
falsification or destruction of records,making false statements,or
receiving stolen property
Subrecipient is not presently indicted for or otherwise criminally or
civilly charged by a governmental entity(Federal, State,or local)with
commission of fraud or a criminal offense in connection with obtaining,
attempting to obtain,or performing a public(Federal,State,or local)
transaction or contract under a public transaction;violation of Federal ✓�(\
or State antitrust statutes or commission of embezzlement,theft,
forgery,bribery,falsification or destruction of records,making false
statements,or receiving stolen property
Subrecipient has not within a 3-year period preceding the submission of
this Compliance and Risk Monitoring Form one or more public
transactions(Federal, State,or local)terminated for cause or default
Subrecipient has provided all written reports required by the Agency
Contract and this Subrecipient Agreement as of the submission of this
Compliance and Risk Monitoring Form
Subrecipient has provided any audit report received by it from any
government agency since the last certification for its performance
related to the Program Agreement J�
Subrecipient certifies that all of the deliverables and other work
required since the last certification have been completed
All the work being billed for in the invoice being certified by this
Compliance and Risk Monitoring Form actually has been performed,
including any timesheet or other backup
Subrecipient agrees to submit to an audit within 30 days of a request
from the County
Subrecipient has corrected any deficiencies identified since the last
certification
Signed at '6 r e-.,n @"lm, ,
CITY STATE
Skookum Contract Services-Individual Supported Employment-Contract 2021-2022
Page 29 of 29
J. — 14 $lug /O Z-1
SUBRE LIP IENT SIGNATURE DATE
4h �A. COS
WRITTEN NAME OF PERSON SIGNING CERTIFICATION
APPROVED BY THE COUNTY:
COUNTY APPROVALSIGNATURE DATE
WRITTEN NAME OF PERSON APPROVING CERTIFICATION