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AG 10-095RETURN TO: EXT: CITY OF F EDERAL WAY LAW DEPARTMENT ROUTING FORM l. ORIGINATING DEPT./DIV: I�'� � C' 2. ORIGINATING STAFF PERSON: ���� ; EXT: - ��T 3. DATE REQ. BY:—�- TYPE OF DOCUMENT (CHECK ONE): ❑ CONTRACTOR SELECTION DOCUMENT (E.G., RFB, RFP, RFQ) ❑ PUBLIC WORKS CONTRACT ❑ SMALL OR LIMITED PUBLIC WORKS CONTRACT ❑ PROFESSIONAL SERVICEAGREEMENT ❑ MAINTENA�*]CE AGREEMENT ❑ GOODS AND SERVICE AGREEMENT ❑ HUMAN SERVICES / CDBG ❑ REAL ESTATE DOCUMENT ❑ SECURITY DOCUMENT (E.G. sorm xELnTED Docun�NTS> ❑ ORDINANCE ❑ RESOLUTION ❑ CONTRACT AMENDMENT (AG#): �INTERLOCAL ❑ OTHER 5. PROJECTNAME: LYl ��'(�(V C(�,�( AZY�t'.t�VYj�-��" ���� L�C9� �G`) yVLWi,l.t.l'1: �Jf'� i1�I,C �. , r . � , � _ ,. _ r r _. , i - --- � -.l � V �_ i ` f .i_ ._. 6. NAME OF CONTRACTOR: ADDRESS: � �-MAIL: kti` t Vl lLi SIGNATURE NAME: � k i Z Z- TELEPHONE ' L ` FAX:�a( �� '''l� (� - :.: . TITLE ��,; i� �� r�o_LC Y)1 � 7. EXHIBITS AND ATTACHMENTS: ❑ scoPE WORK OR SERVICES ❑ CQMPENSATION � INSURANCE I�EQUIREMENTS/CERTIFICATE 0 ALL OTHER REFERENCED EXHIBITS ❑ PROOF OF AUTHORITY TO SIGN ❑ REQUIRED LICENSES ❑ PRIOR CONTRACT/AMENDM�TITS 8. TERM: COMMENCEMENT DATE; � ` j 'j " �C� � � COMPLETION DATE: � "� �'.�j ] � c� I `� . 9: TOTAL COMPENSATION $ (Ir1CLUDE EXPENSES A1�1D SALES TAX, IF ArtY) (IF GALCULATED ON HOURLY LABOR CHARGE -ATTACH SCHEDULES OF EMPLOYEES TITLES AND HOLIDAY RATES) ; ° REIMBURSABLE EXPENSE: � 1�S ❑ NO IF YES, MAXIMUM DOLLAR AMOLINT: $ IS SALES TAX OWED ❑ YES ❑ NO IF YES, $ PAID BY: ❑ CONTRACTOR ❑ CITY ❑ PURCHASING: PLEASE CHARGE TO: 10. DOCUMENT/CONTRACT REVIEW l�ROJECT MANAGER - ❑ DIRECTOR ❑ RISK MANAGEMENT (iF arPLtC,aBLE) �LAW INITIAL / DATE RE VIEWED �' INITIAL / DATE APPRO�ED � �'._ 11c . _ k\P �t �� 1�1 � t U 11. COUNC APPROVAL (IF APPLICABLE) COMMITTEE APPROVAL DATE: � COUNCIL APPROVAL DATE� 1 � C� � i��10 . 12. CONTRACT SIGNATURE ROUTING ❑ SENT TO VENDOR/CONTRACTOR DATE SENT: DATE REC'D: ❑ ATTACH: SIGNATURE AUTHORITY, INSURANCE CERTIFICATE, LICENSES, EXHIBITS INITIAL / DATE SIGNED Y�LAW DEPARTMENT S �' - l � ���IGNATORY (CM OR DIRECTOR� , l./1��„ S'7 �iJL� O CITY CLERK Ac ❑ ASSIGNED AG# AG# �p -° �q� `� SIGNED COPY RETURNED� (�� DATE SENT: -�"-��'L£h ✓�U _ COMMENTS: ��f-bS �'S ✓ " V J ' � � ' � �� � ���� R INTERLOCAL AGREEMENT DEART OF � roc,ALbr,�r AGENCY RESPITE CARE SERVICES Check the box that applies: ❑ Out of Home in Licensed Residence or Facility ❑ Home Care Agency in ClienYs Home � Community Settings (excluding IFS Program Participants) 1064-89981 Check the box that a lies This Contract is between the State of Washington Department of Social and Health Program Contract Number: Services (DSHS) and the Contractor identified below, and is issued pursuant to the Contractor Contract Number: Interlocal Cooqeration Act, chapter 39.34 RCW. SSPS # 104021 CONTRACTOR doing business as City of Federal Way CONTRACTOR ADDRESS PO Box 9718 Federal Way WA 98063-9718 CONTRACTOR CONTACT Gina Shaw DSHS ADMINISTRATION Aging and Disability Services Administration DSHS CONTACT NAME AND TITLE Susan Winkler Contracts Coordinator (206) 568-5685 Ext: IS THE CONTRACTOR A No PI PU DSHS CONTACT ADDRESS 1700 E. Cherry St. Seattle WA 98122-4695 �ONTACTFAX 720-3334 NUMBER(S) CONTRACTOR DSHS NUMBER 70364 CONTRACTOR E-MAIL 1735LP-64 DSHS CONTACT E-MAIL ADDRESS W inklsm2(a�dshs.wa.qov CONTRACT START DATE CONTRACT END DATE CONTRACT MAXIMUM AMOUNT 4/15/2010 3/31 /2013 Fee For Service EXHIBITS. The following Exhibit is attached and hereby'incorporated into this Contract byreference: Exhibit A-'Rate Schedule The terms and conditions of this Agreement are an integration and representation of the finaf, entire and exclusive understanding between the parties superseding and merging all previous agrsements, writings, and communications, oral or othervvise,regarding the subject matter of this Agreement, beiween 4he parties. The parties signing 'below represent that they have read and understand this Contract, and have the authoriry to execute this A reement. This A reement shall be bindin on DSHS onl u onsi nature b DSHS. CONTRACSOF�t SIGNATURE PRINTED NAME AND TITLE DATE SIGNED DSHS BUSINESS IDENTIFIER (UBI) CONTRACTOR TELEPHONE CONTRA� 253 835-6924 Ext: - DSHS DIVISION Division of Developmental Disabilities �r�a.� J, l�,lr� C: PRINTED NAME AND TIT�E John Cordv, Business Mar //��u �h� ��� si����� DATE� DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 1 DSHS General Terms and Conditions 1. Definitions. The words and phrases listed below, as used in this Contract, shall each have the following definitions: a. "Central Contract Services" means the DSHS central headquarters contracting office, or successor section or office. ' b. "Confidential Information" means information that is exempt from disclosure to the public or other unauthorized persons under RCW 42.56 or other federal or state laws. Confidential Information includes, but is not limited to, Personal Information. c. "Contract" or "AgreemenY' means the entire written agreement between DSHS and the Contractor, including any Exhibits, documents, or materials incorporated by reference. The parties may execute this contract in multiple counterparts, each of which is deemed an original and all of which constitute only one agreement. E-mail or Facsimile transmission of a signed copy of this contract shalf be the same as delivery of an originaL d. "Contracts Administrator" means the manager, or successor, of Central Contract Services or successor section or office. e. "Contractor" means the individual or entity performing services pursuant to this Contract and includes the Contractor's owners, members, officers, directors, partners, employees, and/or agents, unless otherwise stated in this Contract. For purposes of any permitted Subcontract, "Contractor" includes any Subcontractor and its owners, members, officers, directors, partners, employees, and/or agents. f. "DebarmenY' means an action taken by a Federal agency or official to exclude a person or business entity from participating in transactions involving certain federal funds. g. "DSHS" or the "Department" means the state of Washington Department of Social and Health Services and its employees and authorized agents. h. "EncrypY' means to encode Confidential Information into a format that can only be read by those possessing a"key"; a password, digital certificate or other mechanism available only to authorized users. Encryption must use a key length of at least 128 bits. "Hardened Password" means a string of at least eight characters containing at least one alphabetic character, at least one number and at least one special character such as an asterisk, ampersand or exclamation point. "Personal Information" means information identifiable to any person, including, but not limited to, information that relates to a person's name, health, finances, education, business, use or receipt of governmental services or other activities, addresses, telephone numbers, Social Security Numbers, driver license numbers, other identifying numbers, and any financial identifiers. k. "Physically Secure" means that access is restricted through physical means to authorized individuals only. I. "Program AgreemenY' means an agreement between the Contractor and DSHS containing special terms and conditions, including a statement of work to be performed by the Contractor and payment to be made by DSHS. m. "RCW" means the Revised Code of Washington. All references in this Contract to RCW chapters or sections shall include any successor, amended, or replacement statute. Pertinent RCW chapters DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (415-09) Page 2 can be accessed at http://apps.leg.wa.gov/rcw/. ri: "Regulation" means any federal, state, or local regulation, rule, or ordinance. o. "Secured Area" means an area to which only authorized representatives of the entity possessing the Confidential Information have access. Secured Areas may include buildings, rooms or locked storage containers (such as a filing cabinet) within a room, as long as access to the Confidential Information is not available to unauthorized personnel. p. "Subcontract" means any separate agreement or contract between the Contractor and an individual or entity ("Subcontractor") to perform all or a portion of the duties and obligations that the Contractor is obligated to perform pursuant to this Contract. q. "Tracking" means a record keeping system that identifies when the sender begins delivery of Confidential Information to the authorized and intended recipient, and when the sender receives confirmation of delivery from the authorized and intended recipient of Confidential Information. "Trusted Systems" include only the following methods of physical delivery: (1) hand-delivery by a person authorized to have access to the Confidential Information with written acknowledgement of receipt; (2) United States Postal Service ("USPS") first class mail, or USPS delivery services that include Tracking, such as Certified Mail, Express Mail or Registered Mail; (3) commercial delivery services (e.g. FedEx, UPS, DHL) which offer tracking and receipt confirmation; and (4) the Washington State Campus mail system. For electronic transmission, the Washington State Governmental Network (SGN) is a Trusted System for communications within that Network. s. "Unique User ID" means a string of characters that identifies a specific user and which, in conjunction with a password, passphrase or other mechanism, authenticates a user to an information system. t. "WAC" means the Washington Administrative Code. All references in this Contract to WAC chapters or sections shall include any successor, amended, or replacement regulation. Pertinent WAC chapters or sections can be accessed at http://apps.leg.wa.gov/wac/. 2. Amendment. This Contract may only be modified by a written amendment signed by both parties. Only personnel authorized to bind each of the parties may sign an amendment. 3. Assignment. The Contractor shall not assign this Contract or any Program Agreement to a third party without the prior written consent of DSHS. 4. Billing Limitations. a. DSHS shall pay the Contractor only for authorized services provided in accordance with this Contract. b. DSHS shall not pay any claims for payment for services submitted more than twelve (12) months after the calendar month in which the services were performed. c. The Contractor shall not bill and DSHS shall not pay for services perFormed under this Contract, if the Contractor has charged or will charge another agency of the state of Washington or any other party for the same services. 5. Compliance with Applicable Law. At all times during the term of this Contract, the Contractor shall comply with all applicable federal, state, and local laws and regulations, including but not limited to, nondiscrimination laws and regulations. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (415-09) Page 3 6. Confidentiality. a. The Contractor shall not use, publish, transfer, sell or otherwise disclose any Confidential . Information gained by reason of this Contract for any purpose that is not directly connected with Contractor's performance of the services contemplated hereunder, except: (1) as provided by law; or, (2) in the case of Personal Information, with the prior written consent of the person or personal representative of the person who is the subject of the Personal Information. b. The Contractor shall protect and maintain all Confidential Information gained by reason of this Contract against unauthorized use, access, disclosure, modification or loss. This duty requires the Contractor to employ reasonable security measures, which include restricting access to the Confidential Information by: (1) Allowing access only to staff that have an authorized business requirement to view the Confidential I nformation. (2) Physically Securing any computers, documents, or other media containing the Confidential Information. (3) Ensure the security of Confidential Information transmitted via fax (facsimile) by; (a) Verifying the recipient phone number to prevent accidental transmittal of Confidential Information to unauthorized persons. (b) Communicating with the intended recipient before transmission to ensure that the fax will be received only by an authorized person. (c) Verifying after transmittal that the fax was received by the intended recipient. (4) When transporting six (6) or more records containing Confidential Information, outside a Secure Area, do one or more of the following as appropriate: (a) Use a Trusted System. (b) Encrypt the Confidential Information, including: Encrypting email and/or email attachments which contain the Confidential Information. ii. Encrypting Confidential Information when it is stored on portable devices or media, including but raot limited to laptop computers and flash memory devices. Note: If the DSHS Data Security Requirements Exhibit is attached to this contract, this item, 6.b.(4), is superseded by the language contained in the Exhibit. (5) Send paper documents containing Confidential Information via a Trusted System. (6) Following the requirements of the DSHS Data Security Requirements Exhibit, if attached to this contract. c. Upon request by DSHS, at the end of the Contract term, or when no longer needed, data shall be returned to DSHS or Contractor shall certify in writing that the they employed a DSHS approved method to destroy the information. Contractor may obtain information regarding approved DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (415-09) Page 4 destruction methods from the DSHS contact identified on the cover page of this Contract. d. Paper documents with Confidential Information may be recycled through a contracted firm, provided the contract with the recycler specifies that the confidentiality of information will be protected, and the information destroyed through the recycling process. Paper documents containing Confidential Information requiring special handling (e.g. protected health information) must be destroyed on-site through shredding, pulping, or incineration. e. Notification of Compromise or Potential Compromise. The compromise or potential compromise of Confidential Information must be reported to the DSHS Contact designated on the contract within one (1) business day of discovery. Contractor must also take actions to mitigate the risk of loss and comply with any notification or other requirements imposed by law or DSHS. 7. Debarment Certification. The Contractor, by signature to this Contract, certifies that the Contractor is not presently debarred; suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency from participating in transactions (Debarred). The Contractor also agrees to include the above requirement in any and all Subcontracts into which it enters. The Contractor shall immediately notify DSHS if, during the term of this Contract, Contractor becomes Debarred. DSHS may immediately terminate this Contract by providing Contractor written notice if Contractor becomes Debarred during the term hereof. 8. Governing Law and Venue. This Contract shall be construed and interpreted in accordance with the laws of the state of Washington and the venue of any action brought hereunder shall be in Superior Court for Thurston County. 9. Independent Contractor. The parties intend that an independent contractor relationship will be created by this Contract. The Contractor and his or her employees or agents performing under this Contract are not employees or agents of the Department. The Contractor, his or her employees, or agents performing under this Contract will not hold himself/herself out as, nor claim to be, an officer or employee of the Department by reason hereof, nor will the Contractor, his or her employees, or agent make any claim of right, privilege or benefit that would accrue to such officer or employee. 10. Inspection. The Contractor shall, at no cost, provide DSHS and the Office of the State Auditor with reasonable access to Contractor's place of business, Contractor's records, and DSHS client records, wherever located. These inspection rights are intended to allow DSHS and the Office of the State Auditor to monitor, audit, and evaluate the Contractor's performance and compliance with applicable laws, regulations, and these Contract terms. These inspection rights shall survive for six (6) years following thES ContracYs termination or expiration. 11. Maintenance of Records. The Contractor shall maintain records relating to this Contract and the performance of the services described herein. The records include, but are not limited to, accounting procedures and practices, which sufficiently and properly reflect all direct and indirect costs of any nature expended in the performance of this Contract. All records and other material relevant to this Contract shall be retained for six (6) years after expiration or termination of this Contract. Without agreeing that litigation or claims are legally authorized, if any litigation, claim, or audit is started before the expiration of the six (6) year period, the records shall be retained until all litigation, claims, or audit findings involving the records have been resolved. 12. Order of Precedence. In the event of any inconsistency or conflict between the General Terms and Conditions and the Special Terms and Conditions of this Contract or any Program Agreement, the inconsistency or conflict shall be resolved by giving precedence to these General Terms and Conditions. Terms or conditions that are more restrictive, specific, or particular than those contained in the General Terms and Conditions shall not be construed as being inconsistent or in conflict. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 5 13. Severability. If any term or condition of this Contract is held invalid by any court, the remainder of the Contract remains valid and in full force and effect. : 14. Survivability. The terms and conditions contained in this Contract or any Program Agreement which, by their sense and context, are intended to survive the expiration or termination of the particular agreement shall survive. Surviving terms include, but are not limited to: Billing Limitations; Confidentiality, Disputes; Indemnification and Hold Harmless, Inspection, Maintenance of Records, Notice of Overpayment, Ownership of Material, Termination for Default, Termination Procedure, and Treatment of Property. 15. Termination Due to Change in Funding. lf the funds DSHS relied upon to establish this Contract or Program Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, DSHS may immediately terminate this Contract by. providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. 16. Waiver. Waiver of any breach or default on any occasion shall not be deemed to be a waiver of any subsequent breach or default. Any waiver shall not be construed to be a modification of the terms and conditions of this Contract. Only the DSHS Chief Administrative Officer or designee has the authority to waive any term or condition of this Contract on behalf of DSHS. Additional Terms and Conditions — Interlocal Agreement 17. Disputes. Disputes shall be determined by a Dispute Board. Each party to this Agreement shall appoint one member to the Dispute Board. The members so appointed shall jointly appoint an additional member to the Dispute Board. The Dispute Board shall review the facts, Agreement terms, and applicable statutes and rules and make a determination of the dispute. As an alternative to this process, either party may request intervention by the Governor, as provided by RCW 43.17.330, in which event the Governor's process shall control. Participation in either dispute process shall precede any judicial or quasi-judicial action and shall be the final administrative remedy available to the parties. 18. Hold Harmless. a. The Contractor shall be responsible for and shall hold DSHS harmless from all claims, loss, liability, damages, or fines arising out of or relating to the Contractor's, or any Subcontractor's, performance or failure to perform this Agreement, or the acts or omissions of the Contractor or any Subcontractor. DSHS shall be responsible for and shall hold the Contractor harmless from all claims, loss, liability, damages, or fines arising out of or relating to DSHS' performance or failure to perform this Agreement. b. The Contractor waives its immunity under Title 51 RCW to the extent it is required to indemnify, defend, and hold harmless the State and its agencies, officials, agents, or employees. 19. Ownership of Material. Material creafed by the Contractor and paid for by DSHS as a part of this Contract shall be owned by DSHS and shall be "work made for hire" as defined by Title 17 USCA, Section 101. This material includes, but is not limited to: books; computer programs; documents; films; pamphlets; reports; sound reproductions; studies; surveys; tapes; and/or training materials. Material which the Contractor uses to perform the Contract but is not created for or paid for by DSHS is owned by the Contractor and is not "work made for hire"; however, DSHS shall have a perpetual license to use this material for DSHS internal purposes at no charge to DSHS, provided that such license shall be limited to the extent which the Contractor has a right to grant such a license. 20. Subrecipients. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 6 . a. General. If the Contractor is a subrecipient of federal awards as defined by Office of Management • and Budget (OMB) Circular A-133 and this Agreement, the Contractor shall: (1) Maintain records that identify, in its accounts, all federal awards received and expended and the federal programs under which they were received, by Catalog of Federal Domestic Assistance (CFDA) title and number, award number and year, name of the federal agency, and name of the pass-through entity; (2) Maintain internal controls that provide reasonable assurance that the Contractor is managing federal awards in compliance with laws, regulations, and provisions of contracts or grant agreements that could have a material effect on each of its federal programs; (3) Prepare appropriate financial statements, including a schedule of expenditures of federal awards; (4) Incorporate OMB Circular A-133 audit requirements into all agreements between the Contractor and its Subcontractors who are subrecipients; (5) Comply with any future amendments to OMB Circular A-133 and any successor or replacement Circular or regulation; (6) Comply with the applicable requirements of OMB Circular A-87 and any future amendments to OMB Circular A-87, and any successor or replacement Circular or regulation; and (7) Comply with the Omnibus Crime Control and Safe streets Act of 1968, Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title II of the Americans with Disabilities Act of 1990, Title IX of the Education Amendments of 1972, The Age Discrimination Act of 1975, and The Department of Justice Non-Discrimination Regulations, 28 C.F.R. Part 42, Subparts C.D.E. and G, and 28 C.F.R. Part 35 and 39. (Go to www.oip.usdoi.aov/ocr/ for additional information and access to the aforementioned Federal laws and regulations.) b. Single Audit Act Compliance. If the Contractor is a subrecipient and expends $500,000 or more in federal awards from any and/or all sources in any fiscal year, the Contractor shall procure and pay for a single audit or a program-specific audit for that fiscal year. Upon completion of each audit, the Contractor shall: (1) Submit to the DSHS contact person the data collection form and reporting package specified in OMB Circular A-133, reports required by the program-specific audit guide (if applicable), and a copy of any management letters issued by the auditor; (2) Follow-up and develop corrective action for all audit findings; in accordance with OMB Circular A-133, prepare a"Summary Schedule of Prior Audit Findings." c. Overpayments. If it is determined by DSHS, or during the course of a required audit, that the Contractor has been paid unallowable costs under this or any Program Agreement, DSHS may require the Contractor to reimburse DSHS in accordance with OMB Circular A-87. 21. Termination. a. Default. If for any cause, either party fails to fulfill its obligations under this Agreement in a timely and proper manner, or if either party violates any of the terms and conditions contained in this Agreement, then the aggrieved party will give the other party written notice of such failure or violation. The responsible party will be given 15 working days to correct the violation or failure. If the failure or violation is not corrected, this Agreement may be terminated immediately by written notice from the aggrieved party to the other party. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 7 b. Convenience. Either party may terminate this Interlocal Agreement for any other reason by providing 30 calendar days' written notice to the other party. : c. Payment for Performance. If this Interlocal Agreement is terminated for any reason, DSHS shall only pay for perFormance rendered or costs incurred in accordance with the terms of this Agreement and prior to the effective date of termination. 22. Treatment of Client Property. Unless otherwise provided, the Contractor shall ensure that any adult client receiving services from the Contractor has unrestricted access to the clienYs personal property. The Contractor shall not interfere with any adult client's ownership, possession, or use of the clienYs property. The Contractor shall provide clients under age eighteen (18) with reasonable access to their personal property that is appropriate to the clienYs age, development, and needs. Upon termination of the Contract, the Contractor shall immediately release to the client and/or the client's guardian or custodian all of the client's personal property. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 8 Special Terms and Conditions Definitions. The words and phrases listed below, as used in this Contract, shall each have the following definitions: a. "Assistance" means help provide to a client for the purpose of aiding him/her in the performance of tasks. b. "Authorized" means approved by a DDD case manager/social worker as evidenced by receipt of an SSPS Social Services notice. c. "Case Resource Manager" means the DSHS or DDD worker assigned to a client and who authorized the services performed under this Contract. d. "Client" means a person whom DSHS has determined financially and programmatically eligible to receive services and for whom specific services have been authorized. e. "Community Settings" means a place such as community center, senior center, park and recreation, summer programs, or adult day care. f. "DDD" means the Division of Developmental Disabilities within the DSHS Aging and Disabilities Service Administration. g. "Physical Assistance" means the provision of hands-on assistance on the performance of daily tasks or activities. h. "Primary Caregiver(s)" or "Caregiver" means the parents, legal guardians or other persons who have or assume primary responsibility for the necessary care of the client. i. "Protective Supervision" means supervision to ensure the safety and well being of a client, exclusive of those responsibilities which should be assumed by a legal guardian. Respite Care" means intermittent relief for persons providing care for developmentally disabled individuals on either an emergency or planned basis. k. "SSPS" means the Social Service Payment System, the service authorization and payment system used by DSHS. I. "Service Plan" means an individual support plan (ISP) which is a written plan for long term care service delivery. The ISP identifies ways to meet the Client's needs with the most appropriate services. m. "Transportation Services" means the process of transporting a client from one location to another. n. "Unusual Incidents" means a change in circumstances or events that concern a client's safety or well being. These may include, but are not limited to the following examples: an increased frequency, intensity, or duration of any medical conditions;, adverse reactions to medication, severe behavioral incidents that are unlike the client's ordinary behavior, severe injury, running away, physical or verbal abuse to themselves or others, etc. 2. Purpose. The purpose of respite care is to provide intermittent relief for persons providing care for DDD clients, on either an emergency or planned basis, to assist a client to remain in the least restrictive DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (415-09) Page 9 environment. Care shall be provided in the residence of the clienYs family/relative, in the licensed residence/facility of the Contractor, or in a Community Setting. 3. Contractor Qualifications. a. The Contractor shall be licensed, registered, and certified as is required by law. b. Community settings providing respite care must meet the regulations governing their business or activity. c. The Contractor agrees to undergo a criminal history background check conducted by DSHS, as required by RCW 43.20A.710. If the Contractor has employees or volunteers who will h�ve unsupervised access to Clients in the course of performing the work under this Contract, the Contractor will conduct criminal history background checks on those employees. 4. Statement of Work. The Contractor shall provide the services and staff, and otherwise do all things necessary for or incidental to the performance of work, as set forth below: a. Upon receipt of and in accordance with the provisions of a written service authorization form issued by DSHS the Contractor shalL• (1) Provide physical assistance, support and protective supervision to the client in daily routine activities and to prevent injury to him or herself and to others; (2) Obtain information about the client's identified needs and care requirements from the parent(s) or primary caregiver(s) and ensure that the client's needs are met while providing services; (3) Contact the clienYs parent or primary caregiver(s) if the Contractor has not heard from them within seven (7) days of the Contractor's receipt of the service authorization to make arrangements for specific dates and times of care; (4) Make arrangement with the primary provider of assistance for emergency medical treatment should this become a necessity (5) Maintain copies of all Social Service Payment System (SSPS) authorizations to provide services; and (6) Complete and maintain copies of the work verification records for all services provided. These records shall be kept on file by the Contractor for the duration of this Contract and thereafter for a period of 6 years and will be available to DSHS upon request for purposes of audit, monitoring and/or service verification. b. In addition to the above, the contractor may also provide as authorized the following: (1) Provide the client transportation to and from community resources and agencies; (2) Provide written progress reports as requested by a DDD Case Resource Manager or per other DDD procedures; and c. Community Settings shall provide care that assists the clienYs participation in a safe manner. (See section 4.e.(3).(a) through (f) below). d. Contractor shall not require client, clienYs guardian and/or clienYs legal representative to enter into DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 10 any agreement releasing or limiting contractor's legal liability for injuries arising out of premises operation, acts of independent contractors, products corr�pletion, or personal injuries sustained due to contractor's negligence in connection with providing services under this contract unless contractor, at the same time, requires client, clienYs guardian and/or clienYs legal representative to release the State of Washington and all of its agencies, agents, contractors, servants and employees from liability for any acts of contractor causing injuries arising out of premises operation, acts of independent contractors, products completion, or personal injuries sustained due to contractor's negligence in connection with providing services under this contract. e. Further Requirements for Agency and Licensed Facilities: (1) The Contractor shall not provide care if there is no vacant bed in the licensed home or the provision of care exceeds the number of licensed beds in the home. (2) The Contractor shall ensure that they or their care providers possess the following minimum qualifications (a) Be twenty-one (21) years of age or older; (b) Possess the following minimum standards of knowledge and experience: General knowledge of acceptable standards of performance, including the necessity to perform dependably, report punctually, maintain flexibility, and to demonstrate kindliness and caring to the client; and ii. Knowledge of when and how to contact the client's representative and the clienYs case manager. (c) Adequate skills to read, either directly or through an interpreter, understand, and implement the services authorized in the plan; (d) Adequate communication skills to convey and understand, either directly or through an interpreter, information required to implement the clienYs written service plan(s) and verbal instructions; and (e) Adequate skills to maintain provider records of services performed and payments received. (3) The Contractor shall ensure that the care providers are able to: (a) Understand specific directions for providing the care that an individual client requires; (b) Provide services within the scope of practice for their profession/skill level; (c) Observe the client for change in health status, including weakness, confusion, and loss of appetite; (d) Identify problem situations and take appropriate action; (e) Respond to emergencies without direct supervision; and (f) Accept the elient's individual differences and preferences when performing routine tasks. f. Cooperate with DSHS in the evaluation of their performance under the terms of this Contract including the following: DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 11 (1) Follow-up contact with clients, their families, guardians or primary caregivers regarding their satisfaction with the services provided; ' (2) Investigation and documentation of all complaints about the service provided; and (3) Periodic monitoring of service documentation records, verification of provider qualifications, and of billing and payment data in SSPS. 5. Consideration. Total consideration payable to Contractor for satisfactory performance of the work under this Contract shall be based on the following: a. The fee for service shall not exceed the rate listed in Exhibit A— Rate Schedule. b. DSHS will only reimburse the Contractor for the number of hours authorized and provided per client. c. In case of a legislatively mandated vendor rate change, the rates will be adjusted accordingly and will be incorporated into this Contract on the date the rate(s) become effective. DSHS will provide written notification of rate increases to the Contractor. 6. Billing and Payment. a. DSHS shall issue invoices generated by SSPS to the Contractor. b. The Contractor shall indicate on each invoice received from DSHS whether the serviees were delivered. c. The Contractor shall submit the invoices for payment as directed on the invoice or by using Invoice Express. d. The Contractor shall contact the DSHS staff who authorized the services if there is any problem with the SSPS invoice. � e. DSHS shall use the completed SSPS invoice to generate payment to the Contractor. f. DSHS shall not pay the Contractor for cancelled or missed appointments, nor for scheduled hours of service when clients are not seen or served by the Contractor. g. In the event that the Client has fewer waiver resources available than the rate set in Exhibit A, the client or their family may choose to receive the services and pay the difference of the authorized amount and the Exhibit A set rate. The authorization will reflect this difference, if any. The Contractor accepts the DSHS payment amount, together with any Client participation amount, as sole and complete payment fqr the services provided under this Contract. The Contractor agrees to be responsible for collection of the ClienYs participation amount (if any) from the Client in the month in which services are provided. h. DSHS will only reimburse the Contractor for authorized services provided to clients in accordance with this Contract's Statement of Work and the client's Service Plan. If DSHS pays the Contractor for any other services, the amount paid shall be considered an overpayment and must be returned to the Department. i. If DSHS pays the Contractor for services authorized but not provided by the Contractor the amount paid shall be considered to be an overpayment. If this Contract is terminated for any reason, DSHS shall pay for only those services authorized and DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (415-09) Page 12 provided through the date of termination. 7,' Duty to Report Suspected Abuse. In addition to the preceding Services, the Contractor shall report, in accordance with state law, all instances of suspected Client abuse immediately to the Department at the current state abuse hotline (1-800-562-6078). 8. Duty to Report Unusual Incidents. The Contractor shall submit written information of any unusual incident to the DDD Resource Manager or the DSHS contact listed on page 1 of this Contract within seventy-two (72) hours. 9. Duty to Report Death of Clients. The Contractor shall report all deaths of DSHS clients receiving services from the Contractor within twenty-four (24) hours to the DDD Resource Manager or the DSHS contact listed on page 1 of this contract. 10. Drug Free Workplace. The Contractor, and the Contractor's employees and sub-contractors, shall abstain from the use of alcohol and illegal drugs in the workplace and in the performance of their duties. 11. Insurance. For purposes of this Agreement: a. DSHS certifies that it is self-insured under the State's self-insurance liability program, as provided by RCW 4.92.130, and shall pay for losses for which it is found liable. b. The Contractor certifies, by checking the appropriate box below, initialing to the left of the box selected, and signing this Agreement, that: � The Contractor is self-insured or insured through a risk pool and shall pay for losses for which it is found liable; or ❑ The Contractor maintains the types and amounts of insurance identified below and shall, prior to the execution of this Agreement by DSHS, provide certificates of insurance to that effect to the DSHS contact on page one of this Agreement. Commercial General Liabilitv Insurance fCGL) — to include coverage for bodily injury, property damage, and contractual liability, with the following minimum limits: Each Occurrence - $1,000,000; General Aggregate -$2,000,000. The policy shall include liability arising out of premises, operations, independent contractors, products-completed operations, personal injury, advertising injury, and liability assumed under an insured contract. The State of Washington, DSHS, its elected and appointed officials, agents, and employees shall be named as additional insureds. OSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 13 Exhibit A Rate Table ' : Provider�� � �� R�#e Pa�rmerr� � �, �. e �ay,��nt��ode� � Calcutatiun Out-of home in a licensed $10.03 hr facility: Not to exceed 8 hours 7362 — Agency ■ Daycare/Childcare Daily =$80.24 in a 24 hour period. respite (IFS) ■ Child foster home, [8 hrs x$10.03] � ■ AFH 7811 (VPS state- ■ ARC only) Prior approval required to authorize 8178, 8278, 8378, more than 8 hours 8377 Child group home $17.38hr Not to exceed 8 hours 7362 — Agency in a 24 hour period respite (IFS) Staffed residential home Prior approval 8177, 8277, 8377 required to authorize 8777 more than 8 hours Home care agency: $17.38hr Pay for each hour 7362 — Agency in clienYs home respite (IFS) 8177, 8277, 8377, 8777 Camp and other community $17.38hr Number of Hours = settings providing respite Cost of service = 8177, 8277, 8377, $17.38. 8777 Round up to the nearest hour. Notes: ■ Respite and personal care cannot be paid at the same time for the same service. Respite services include any personal care and supervision that is needed. ■ SSPS authorizations will be authorized at an hourly rate. ■ Community Settings will be reimbursed at the Contractor's published fee for services provided. A copy of the Contractor's Published Service and Fee Schedule can be located at the following web site . A printed copy of the Contractor's Published Service and Fee Schedule shall be maintained in the Contractor's Contract file for each year services are provided by this Contract. ■ Respite services must be tracked separately from personal care services. DSHS Central Contract Services 1735LP Agency Respite Care Interlocal (4-15-09) Page 14