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Consent Agenda
JEFFERSON COUNTY PUBLIC HEALTH
615 Sheridan Street.. Port Townsend" \i'v'ashmgton .. 98368
www.jeffersoncountypublichealth.or9
May 3, 2010
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director
DATE: June 28, 2010
SUBJECT: Agenda Item - Professional Services Agreement - Port Townsend School
District for Birth - 3 Years Program, Amendment #1;
October 1, 2009 - June 30, 2010; additional $2,246; total $13,246.00
STATEMENT OF ISSUE:
Jefferson County Public Health, Developmental Disabilities Division, is requesting Board approval of the
Professional Services Agreement - Port Townsend School District for Birth - 3 Years Program,
Amendment #1; October 1, 2009 - June 30, 2010; additional $2,246; total $13,246.00
ANALYSIS/STRATEGIC GOALS/PRO'S and CON'S:
Port Townsend School District will continue to provide assessment, intervention, education, and specialized
therapy for infants and pre-school children who are suspected of having a developmental delay or disability.
Port Townsend School District develops Individualized Family Service Plans (IFSP's) designed to meet the
needs of each eligible infant or toddler while meeting the needs of the family related to enhancing the infant
or toddler's deveiopment. Each IFSP contains parent planned priorities and outcomes for each child. Each
contains goals and objectives as well as evaluative and documentation tools for intervention service and
funding sources.
FISCAL IMPACT/COST BENEFIT ANALYSIS:
The agreement is funded through the biennial agreement with the DSHS Department of Developmental
Disabilities contract. Total compensation for amendment will not exceed $13,246.00.
RECOMMENDATION:
JCPH management request approval of the Professional Services Agreement - Port Townsend School District
for Birth - 3 Years Program, Amendment #1; October 1, 2009 - June 30, 2010; additional $2,246; total
$13,246.00.
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COMMUNITY HEALTH
DEVELOPMENTAL DISABILITIES
MAiN (350) 385-9400
FAX: (350) 385-9401
PUBLIC HEALTH
HEALTHIER COMMUNITY
nNlr,ONMENT Al. HEALTH
V'/f\ lER QUALITY
MA!N !350) 385-9444
FAX (350) 379-4487
Con ract Amendment #1
A reement Between
Port T wnsend School District
And
Jeffers n County Public Health
Develop ental Disabilities Program
WHEREAS, Port Townsend Schpo District (Contractor) and Jefferson County (County)
entered into an agreement on Octob r 1 st 2009 for Professional Services to be provided in
connection with Early Intervention ervices for East Jefferson County children age birth to three
years and their families.
WHEREAS, the parties desire to a end the terms of that agreement.
1. The term of the above refereced agreement is time limited and ends June 30th
2010.
IT IS AGREED BETWEEN DO H PARTIES AS NAMED HEREIN AS FOLLOWS:
2. The Subcontractor will cont.nue to provide for provision of Multi-disciplinary
Evaluation and Assessment f children age birth to 2 years 8 months,
Individualized Family Servi e Plans (IFSP) with parent planning
priorities/outcomes and chil outcomes, educational and therapeutic services for
Jefferson County children a e birth to three years and their families and
evaluation and documentati n of funding sources available for intervention
servl ces.
3. Subcontractor shall receive ,unding for: Speech Therapy I, II & III, Occupational
Therapy, Physical Therapy, , pecial Instruction and Group Education per Unit for
Birth to Three Services; as efined in Attachment One, the Fee Schedule on page
ten (10) of the original Co ty Contract. A Unit is defined as a "Contact" which
is up to one (1) hour of Dire t Service or Assigned Service Responsibility provided
in a service month.
4. Subcontractor will be entitl d to an additional $2,246.00 in funding for services
rendered during the term of his contract amendment. Total compensation under
this Agreement shall not ex eed $13,246.00 without express written amendment.
5. All other terms and conditio s of the agreement will remain the same.
Dated this
day of
, 2010
--,.1 as to forn1 c:'~:._..; .~
l)J})v
David Sullivan, Chairman
Jefferson Board of County
By:
By:
This agreement is made and entered into etween Jefferson County Public Health (COUNTY) and Port
Townsend School District (SUBCONT CTOR) for provision of educational and therapeutic services
for Jefferson County children age birth t three years and their families. The term of this agreement is
October 1, 2009 through June 30, 2010. Either party upon 60 days written notice may terminate this
contract. Termination of this Contract sha 1 not constitute a breach.
ALSER~CESAGREEMENT
Between
COUNTY PUBLIC HEALTH
And
NSEND SCHOOL DISTRICT
Birth - 3 . Years
It is Agreed etween Both Parties as Named
Herein as Follows:
A. PROFESSIONAL SERVICES
Upon written request by COUNTY Dev lopmental Disabilities Coordinator or a COUNTY authorized
Family Resource Coordinator (FRC), pro essional services to be provided by SUBCONTRACTOR shall
include:
1. Multi-disciplinary Evaluation and As essment of children age birth to 2 years 8 months of age that
are suspected of having developmen al delay or disability. The evaluation tools and procedures
selected will conform to WAC 275-27 026 requirements.
2. Individualized Family Service Plans (IFSP) developed in collaboration with the family and other
providers. SUBCONTRACTOR and he family will write the IFSP jointly on approved forms.
3. Evaluation and documentation of fun ing sources available for intervention services, both educational
and therapeutic services will be spe ified in the IFSP. Potential funding sources to be evaluated
include private insurance, military he lth benefits, Medicaid / healthy options, aSPI, and other public
or private sources.
4. IFSP will contain parent planning prio ities/outcomes and child outcomes.
5. Specialized Services (developmental, corrective, and other services) to assist infants and toddlers to
achieve developmental goals as speci led in the IFSP include occupational therapy, physical therapy,
speech-language therapy, and speciali ed instruction/education.
6. Program management.
B. OBLIGATIONS
SUBCONTRACTOR shall fulfill the fall wing obligations:
1. SUBCONTRACTOR shall com Iy with all state and federal requirements regarding the
confidentiality of client records. lient information is not disclosable to the public. Information
acquired pursuant to RCW 71A.l .070 requires a signed Release of Information or a signed Oath
of Confidentiality Form.
PTSD Contract 2009.2010
Page I
2. SUBCONTRACTOR shall requir pursuant to RCW 43.43.830-845, any prospective employee,
who will or may have unsupervised access to a person with a developmental disability, in the course
of his or her employment, or invol ement with the business or organization, to have a Washington
State Patrol Criminal (W.S.P.) Bac ground Check.
3. SUBCONTRACTOR is required ursuant to RCW 74.15, that if any prospective employee, who
has not resided in Washington S ate during the last three years, and who' will or may have
unsupervised access to a person ith a developmental disability, in the course of his or her
employment, or involvement wit the business or organization, must have a F.B.I. Fingerprint
Check. This fingerprint check mus occur before employment begins working.
4. SUBCONTRACTOR is required with respect to existing employees, to repeat the W.S.P.
Criminal Background Check eve three years. W.S. P. Criminal Background Check and tbe
F.B.I. Fingerprint Check must g through the Background Check Central Unit Office within
DSHS in Olympia.
5. SUBCONTRACTOR shaH campi with all state and federal requirements under RCW 74.34,
Abuse of Vulnerable Adults, RC 26.44, Abuse of Children, the WACs: 275-27 Division of
Developmental Disabilities Servi es Rules; 296-24 General Safety & Health, 296-62 General
Occupational Health Standards; e DOD Policies: 3.01 Client Service Plans, 5.01 Criminal
History Background Checks and Safeguarding Personal Information, 5.03 Client Complaints,
5.05 Limited English Proficienc (LEP) Clients, 5.06 Client Ri-ghts, 5.13 Protections From
Abuse, 5.14 Positive Behavi r Support, 5.15 Use of Restrictive Procedures, 6.13
Employment/Day Program Provid r Qualifications, 9.07 Human Immunodeficiency Virus (H.IV)
and Acquired Immune Deficienc Syndrome (AIDS), 12.01 Incident Management and the 1992
County Guidelines.
6. If SUBCONTRACTOR is found 0 have a substantiated finding of abuse, neglect, abandonment
or financial exploitation they shall comply with the following CPS guidelines:
. Upon receiving documentatio of a substantiated finding of abuse, neglect, exploitation or
abandonment from CPS, the egional DDD office will send a copy of the CPS substantiation
report to the COUNTY within one working day.
. Upon receiving documentatio of a substantiated finding of abuse, the COUNTY will send a
letter to the SUBCONTRACT R within one working day.
1) The contracted provider is required to:
a. Document the steps th agency has taken to protect the vulnerable
person(s) immediately and
b. Submit a corrective ac ion plan, if needed, to the COUNTY within 10
working days.
2) The COUNTY will resp nd to the steps taken and the sufficiency of the proposed
corrective action plan wit in 10 working days. If the corrective action is not accepted the
plan will be returned to th provider for correction and an amended plan will be required
within 5 working days.
PTSD Contract 2009-2010
Page 2
3) Once accepted, the CO TY will send the corrective action plan to DDD for final
approval. DDD Region 1 staff will respond as to plan sufficiency and whether any
additional information is needed within 10 working days. The Region wi II send a copy to
Central Office.
7. SUBCONTRACTOR is required 0 maintain the following minimum organizational capacity in
order to meet the performance s andards set forth in this agreement. Failure or inability of
SUBCONTRACTOR to meet any or all of these minimum capacity requirements, as determined
solely by COUNlY, may be cause for termination of this agreement as provided herein.
(a) Qualified Staff: Adequate, qu lified staff with certification, skills and experience in evaluation,
teaching, therapeutic service and support of infants and toddlers with developmental
disabilities. SUBCONTRAC OR will provide COUNTY with information regarding staff
qualifications upon request.
(b) Performance Plan: SUBCON RACTOR has a written performance plan which describes its
mission, program objective, expected outcomes, how and when objectives will be
accomplished; and that the pI n is evaluated at least biennially and revised based on actual
performance.
(c) TOR has a commitment to support integration of infants and
toddlers with developmental isabilities with others who do not have a disability and has
involved family members of infants and toddlers with developmental disabilities in policy
development.
(d) Partnerships: SUBCONTRA TOR has a history of working cooperatively with community-
based organizations includi g other Agencies, Infant and Toddler Early Intervention
Program, (ITEIP), the Lead gency for ITEIP, the County DD Program, the Division of
Developmental Disabilities a d other School Districts.
(e) Financial and Pro am Mana ement: Systems and personnel to: maintain accounting records
that accurately reflect all pro am revenues and expenditures; prepare monthly statements of
activity (ADSA Reports); mai tain appropriate Client service records and progress reports; and
track key program performanc indicators.
8. All services for infants and to dlers with developmental disabilities must be provided with
attention to their health and safe . SUBCONTRACTOR shall comply with all applicable federal,
state and local fire, health and s fety regulations. Staffing ratios and patterns are adequate to
maintain quality and safety.
9. SUBCONTRACTOR shall report ny injury or accident, which requires more than simple first aid,
and any extraordinary incident tha requires intervention, first to the DSHS/DDD Case Manager for
the individual involved and then to the County Coordinator. This includes serious physical or
emotional harm or potential harm.
PTSD Contract 2009-2010
Page 3
1) The initial report may e done through documented telephone calls to the County
Coordinator.
2) SUBCONTRACTOR shal submit a written follow-up report within 10 days to the County
Coordinator. The report t the County Coordinator may be submitted by email, facsimile
(FAX) to (360) 385-9410 r by mail to Jefferson County Public Health, 615 Sheridan Street
Port Townsend, W A 9836 .
3) Serious and emergent inci eots shall be handled in accordance with DSHS/DDD Policy
12.01 Incident Manageme t.
10. Within 30 days of the effective date of this agreement and at least semi-annually thereafter,
SUBCONTRACTOR will provid financial reports to COUNTY, including all revenues and
expenses generated by SUBCON RACTOR, in sufficient detail to demonstrate the uses of funds
provided under this agreement.
11. Make available for inspection, re iew or audit by COUNTY DD Coordinator at a 11- reasonable
times: all work sites; all client reco ds; 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 isit with SUBCONTRACTOR during the biennuim to assure
compliance with the ODD State W rk Order.
12. For five years following the end d te of this agreement, SUBCONTRACTOR will maintain client
records and books, records, docu ents, reports and other evidence of accounting procedures and
practices which sufficiently and roperly reflect all direct and indirect expenditures of funds
provided under this agreement lient records shall minimally include statement of client goals,
documentation of training provide , training hours, routine progress notes and biannual summary
progress toward meeting client goa s.
13. Make available for inspection, revew or audit by County DO Coordinator at all reasonable times:
all client records; and all document, reports and other data applicable to this agreement.
14. SUBCONTRACTOR agrees to as ign to COUNTY its Medicaid Billing Rights for services to
clients eligible under Title XIX pr grams. Written documentation shall be available to COUNTY
on request. If SUBCONTRACTO contracts directly with DSHS to provide covered services
under Title XIX, COUNTY agree that funding intended for those clients shall be excluded from
this agreement.
15. If the Developmental Disabilities rogram Coordinator finds indications of potential non-
compliance during the contract m nitoring process or learns that the SUBCONTRACTOR is out
of compliance with any of the te s or conditions of this contract, the following process will be
pursued:
(a) Informal Notification: Inform I process wherein the County Coordinator alerts the
SUBCONTRACTOR in writi g of the potential non-compliance and an agreeable solution is
reached within five (5) days.
PTSD Contract 2009-20 I 0
Page 4
(b) Official Notification: If the in rmal notification does not result in resolution, the official
notification of possible non-co pliance to establish a date, within five (5) working days of
notification, when representati es of the County and the SUBCONTRACTOR shall meet to
discuss areas of contention an attempt to resolve the issues.
(c) Written Summary: Within flv (5) working days of such official notification the County will
provide the SUBCONTRACT R 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 (2 ) days of the date of the written summary, a discussion
between County and SUBCO TRACTOR shall be conducted to resolve areas of non-
compliance or potential non-c mpliance.
(e) Should the above procedures it to resolve the compliance issue, the parties wiJl obtain the
services of the Peninsula Disp te Resolution Center, or another agreed upon resource, and
shall share equally in any retai er fees or other costs of services. If no agreement is reached,
the mediator's decision in the atter 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 the
scope of this Agreement.
c. REIMBURSEMENTS
For said services rendered under t is agreement, COUNTY shall reimburse SUBCONTRACTOR
on a unit rate basis, as follows:
1. Early Intervention Services SUBC NTRACTOR will be paid per HOURLY Unit assigned Service
Responsibility of regular Program Service provided to eligible clients on a fee-for-service basis
according to Attachment 1, F e Schedule. Reimbursement to SUBCONTRACTOR by
COUNTY will be the net amou t of the applicable fee per Attachment 1, less any amounts
receivedfrom other funding sourc sfor the service provided.
2. All referrals or requests for servic s under this agreement will be in writing using a County
Service Authorization form, (CSA agreed to and signed by the parties.
3. SUBCONTRACTOR will bill CO TY on a monthly basis, on or before the 5th day of the month,
for units of service provide under this agreement during the preceding month.
SUBCONTRACTOR will submit Monthly DDD Services Report (ADSA) form for its billings.
At no time shall the invoices for re mbursement 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, wit hold reimbursement for any month for which required reports
have not been received or are not ccurate and/or complete.
PTSD Contract 2009-2010
Page 5
5. COUNTY may withhold reimbur ement for any service for which documentation that shows the
COUNTY as the second payer f last resort has not been provided. The IFSP must clearly
document funding source p r service for each service reimbursement requested.
SUBCONTRACTOR will provid documentation of County service reimbursements along with
all other funding sources pursu d by SUBCONTRACTOR at the end of the service period
lannually or during site monitori g. Documentation will identify the funding source(s), client
name, service provided, date of se ice, amount(s) paid and amount(s) denied.
6. Total reimbursements for the fisca year of2009-2010 to SUBCONTRACTOR by COUNTY under
this contract shall not exceed $11,000.00 in completion of these services without express written
amendment signed by both parties to this Agreement.
D. MISCELLANEOUS
1. Pursuant to WAC 275, DSHS Div. sian of Developmental Disabilities (DDD) shall determine
individual eligibility of persons fo services delivered under this agreement. DDD shall notify
COUNTY of persons authorized n r services reimbursed under this agreement. Only persons
referred to COUNTY by DDD sha 1 be eligible for services reimbursed under this agreement. The
SUBCONTRACTOR shall not su let or assign any of the services covered by this
AGREEMENT without the expre s written consent of the COUNTY. Assignment does not
include printing or other customa reimbursable expenses that may be provided in an
AGREEMENT.
2. The SUBCONTRACTOR'S relat on to the COUNTY shall be at all times as an independent
SUBCONTRACTOR and any of 11 employees of the SUBCONTRACTOR or other persons
engaged in the performance of an work or service required of the SUBCONTRACTOR under
this AGREEMENT shall be consi ered employees of the SUBCONTRACTOR only and any
claims that may arise on behalf 0 or against said employees shall be the sole obligation and
responsibility of the SUBCONT CTOR.
3. The SUBCONTRACTOR shall n t sublet or assign any of the services covered by this
AGREEMENT without the expre s written consent of the COUNTY. Assignment does not
include printing or other customa reimbursable expenses that may be provided in an
AGREEMENT.
4. The SUBCONTRACTOR shall 0 tain and keep in force during the terms of the AGREEMENT,
or as otherwise required, the folIo ing insurance with companies or through sources approved by
the State Insurance Commissione pursuant to RCW 48:05:
(a) Worker's compensation nd employer's liability insurance as required by the State of
Washington.
(b) Commercial Automobile iability or Business Use Insurance providing bodily injury and
property damage liability overage for all owned and non-owned vehicles assigned to or
used in the performance f the work for a combined single I imit of not less than
$1,000,000 each occurren e with the COUNTY named as an additional insured in
connection with the SUB ONTRACTOR'S performance of the contract.
PTSD Contract 2009-2010
Page 6
11. The COUNTY will pay no progre s payments under Section C until the SUBCONTRACTOR has
fully complied with this section. his remedy is not exclusive; and the COUNTY may take such
other action as is available to the under other provisions of this AGREEMENT, or otherwise in
law.
12. Nothing in the foregoing insuran e requirements shall prevent the COUNTY, at its option, from
additionally requesting that the S BCONTRACTOR deliver to the COUNTY an executed bond
as security for the faithful perfo ance of this contract and for payment of all obligations of the
SUBCONTRACTOR.
13. The SUBCONTRACTOR shall co ply with all Federal, State, and local laws and ordinances
applicable to the work to be done nder this AGREEMENT. This AGREEMENT shall be
interpreted and construed in accor with the laws of the State of Washington and venue shall be
in Jefferson COUNTY, W A.
14. The SUBCONTRACTOR, by si ature to this Agreement, certifies that the SUBCONTRACTC)R
is not presently debarred, suspen ed, proposed for debarment, declared ineligible, or voluntarily
excluded from participating in th's Agreement or any Agreement by any Federal department or
agency. The SUBCONTRACTO also agrees to include the above requirement to all subcontracts
into which it enters.
15. The SUBCONTRACTOR shall i demnify and hold the COUNTY, and their officers employees,
and agents harmless from and sh 11 process and defend at its own expense, including all costs,
attorney fees and expenses relatin thereto, all claims, demands, or suits at law or equity arising in
whole or in part, directly or indir ctly, from the SUBCONTRACTOR'S negligence or breach of
any of its obligations under this AGREEMENT; provided that nothing herein shall require a
SUBCONTRACTOR to indemni the COUNTY against and hold harmless the COUNTY frOITI
claims, demands or suits based solly upon the conduct of the COUNTY, their officers, employees
and agents, and provided further that if the claims or suits are caused by or result from the
concurrent negligence of: (a) t e SUBCONTRACTOR'S agents or employees; and, (b) the
COUNTY, its officers, employees nd 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 clailTIS
and suits, etc., shall be valid and enforceable only to the extend of the SUBCONTRACTOR'S
negligence or the negligence of the SUBCONTRACTOR'S agents or employees.
16. Claims against the COUNTY shall include, but not be limited to assertions that the use and transfer
of any software, book, document, r port, film, tape, or sound reproduction of material of any kind,
delivered there under, constitutes a infringement of any copyright, patent, trademark, trade name,
or otherwise results in an unfair tra e practice or an unlawful restraint of competition.
17. The SUBCONTRACTOR specific lly assumes potential liability for actions brought against the
COUNTY by SUBCONTRACTO '8 employees, including all other persons engaged in the
performance of any work or servic required of the SUBCONTRACTOR under this
AGREEMENT and, solely for the urpose of this indemnification and defense, the
SUBCONTRACTOR specifically aives any immunity under the state industrial insurance law,
Title 51 RCW. The SUBCONT CTOR recognizes that this waiver was specifically entered into
pursuant to provisions of RCW 4.2 .115 and was subject of mutual negotiation.
PTSD Contract 2009-2010
Page 8
18. SUBCONTRACTOR shall not dis riminate against any person presenting themselves for services
based on race, religion, color, sex, ge or national origin.
19. COUNTY reserves the right to te inate this contract in whole or in part, without prior written
notice, in the event that expected 0 actual funding from the Department of Social and Health
Services Division of Development 1 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 servi es rendered prior to the effective date oftennination.
20. No portion of this contract may be ssigned or subcontracted to any other individual, finn, or entity
without the express and prior writt n approval of COUNTY. If the County agrees in writing that all
or a portion of this Contract may b subcontracted to a third-party, then any contract or agreement
between the contractor and a third- arty subcontractor must contain all provisions of this contract
and the subcontractor must agree t be bound by all terms and obligations found in this agreement.
By:
, 2009.
By:
/Jk 7;011\pproyed as to form only:
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Jefferso~ Co. PrO~@Qll~t'fj ol9~~c
By: t < /~';"
Erin Lundgren
Clerk of the Boar
PTSD Contract 2009...2010
Page 9
ATTACHMENT 1
FEE SCHEDULE
Th ra (per hour)
Speech Therapy 1 $64.17
Speech Therapy 2 $60.53
Speech Therapy 3 $43.08
Occupational $53.98
Physical Therap $53.98
Special Instructi n 1 $50.25
Group Educatio $42.00
*Not to exceed $11,000 in completio of services for the duration of the contract without
express written amendment.
PTSD Contract 2009-2010
Page ] 0