HomeMy WebLinkAboutSoutheast Washington Aging and Long Term Care - Adult Day Care and Respite AgreementALTCCOG 2018-14
PERFORMANCE AGREEMENT NO. 2018 COY (ADCRESPITE)
ADMINISTRATION OF AGREEMENT
THIS AGREEMENT is entered into by and between Southeast Washington Aging and Long Term Care
Council of Governments hereinafter denominated "SE WA ALTC COG", whose address is P.O. Box 8349, Yakima,
Washington 98908, and The City of Yakima, Day Break Adult Day Care, whose address is 101 N. 65th Avenue,
Yakima, Washington 98908, hereinafter denominated the "Contractor", whose duly authorized representatives are
named in documents on file at the Southeast Washington Aging and Long Term Care Council of Govemments
Administrative office.
The parties agree that this contract agreement becomes effective at the time of execution by the Southeast
Washington Aging and Long Term Care Council of Governments Director and/or Governing Board.
THE PURPOSE of this Agreement is to provide for the delivery of Adult Day Care and Respite services in
accordance with the terms and conditions set forth in the provisions as listed below:
ADDITIONAL TERMS of this Agreement are set out in and governed by ALTC Basic Agreement January
2016 (Basic Agreement No: 20161anBasic-11 COY). In the event the Basic Agreement is revised, this Agreement shall
conform to the revisions.
Period of Agreement:
January 1, 2018 to December 31, 2018
CONTRACTOR SIGNATURES
City of Yakima -
Date: Li ?Ci 17
net Cr%2$,na,rLori J. Brown,iri for
SE Washington Aging and Long Term Care
Council of Governments
Approved As To Legal Form:
Daniel Clark, WSBA #35901
Yakima County Senior Deputy Prosecuting Attorney
And Civil Legal Counsel for SE WA ALTC COG
CrrY CONTRACT NO:
�? O/-7-' 7p
RESOLUTION NO: 19 /a
Date: t/ V /0/0 l r
Adult Day Services
Respite
Total
Total Funding Allocation
$5,400
$13,500
$18,900
Period of Agreement:
January 1, 2018 to December 31, 2018
CONTRACTOR SIGNATURES
City of Yakima -
Date: Li ?Ci 17
net Cr%2$,na,rLori J. Brown,iri for
SE Washington Aging and Long Term Care
Council of Governments
Approved As To Legal Form:
Daniel Clark, WSBA #35901
Yakima County Senior Deputy Prosecuting Attorney
And Civil Legal Counsel for SE WA ALTC COG
CrrY CONTRACT NO:
�? O/-7-' 7p
RESOLUTION NO: 19 /a
Date: t/ V /0/0 l r
ALTCCOG 2018-14
STANDARD TERMS AND PAYMENT PROVISIONS
CITY OF YAKIMA
MULTIPLE SERVICE PROVIDER
SPECIFIC PROVISIONS
I. SERVICE SPECIFICATIONS
The Contractor agrees that services provided within the terms of this Agreement shall meet the following
specifications:
A. Efforts will be made to assure access of service to the target population, to include at least the
following:
1. Accessible office or site location;
2. Home visits or home delivery of services (if applicable);
3. Multicultural, bilingual persons to assist multicultural, bilingual clients in receiving services;
4. Publicity of program through public service announcements, brochures, etc;
5. Meeting with other service providers/agencies to explain services the Contractor provides
and how referral can be made;
6. Ability to serve individuals with disabilities.
B. Services shall be delivered in accordance with the information submitted in Request for Proposal.
II. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES
The Contractor agrees that:
A. Levels of service to be provided shall be as described in the Statements of Work for Adult Day
Services and Respite services attached to this Agreement. Failure to meet the service levels as
defined in the Program Attachments may result in a renegotiation of the service levels provided
under the terms of this Agreement.
B. SE WA ALTC COG may unilaterally reduce the Agreement budget within thirty (30) days of the close
of the quarter by the amount of the projected quarterly expenditures left unspent at the end of that
quarter. SE WA ALTC COG shall submit to the Contractor notification of intent to recapture unspent
funds and a modification to the budget reflecting the adjusted changes in the Agreement.
III. ADMINISTRATIVE AGREEMENTS:
A. ACCESS BY DSHS: The Contractor shall provide access at all reasonable times for DSHS to monitor
and/or evaluate the provision of services under this Agreement in recognition of the responsibility of
DSHS of the effective statewide operation of this program. Nothing herein contained shall be
interpreted to imply a privy to a contract between DSHS and the Contractor or to diminish in any
manner the responsibility and authority of the Contractor in administering this Agreement.
B. ACCESS BY SE WA ALTC COG: The Contractor shall provide access at all reasonable times for SE WA
ALTC COG to monitor and/or evaluate the provisions of services under this Agreement. SE WA
ALTC COG may, with prior permission from the participant and knowledge of the Contractor,
interview a certain percentage of participants to ascertain their experiences with the program.
C. Records and Reports: The Contractor agrees to:
Cil
2
ALTCCOG 2018-14
1. Maintain program records and reports, including statistical information, and to make such
records available for inspection by the SE WA ALTC COG in order for the SE WA ALTC COG
to be assured that contracted activities remain consistent with the terms of this Agreement
and the currently approved SE WA ALTC COG Area Plan which shall be kept on file at the SE
WA ALTC COG office. The Contractor further agrees to provide such information as
requested by the SE WA ALTC COG within the time limitations established by the SE WA
ALTC COG.
2. Submit the monthly report showing service level provided by the tenth day of each month
following the month during which the services were provided;
3. End of year invoices will be accepted until February 28th following the contract period
unless otherwise noted in the contract. Any invoices received after February 28th will not
be processed for payment.
4. Submit the Quarterly financial report upon request to SE WA ALTC COG by the end of the
month following the end of each quarter;
5. Complete and submit such additional reports as are required by SE WA ALTC COG within
the specified time frames, providing the Contractor is given a written request for the reports
thirty (30) days prior to the due date.
D. CONTRACTORS MEETING: The Contractor agrees to have a representative attend the SE WA ALTC
COG contractors' meeting and the Long Term Care Planning Committee meetings.
E. PROGRAM PUBLICATION: The Contractor agrees that:
1. The program shall be publicized on a regular basis, with all publicity and printed material
identifying the SE WA ATLC COG as a funding agency;
2. All material distributed with regards to publicizing the program contain a statement assuring
non-discrimination. Following is the wording suggested:
The City of Yakima does not discriminate in providing services on the grounds of race,
creed, color, religion, national origin, gender, age, marital status, or the presence of
any sensory, mental, or physical disability.
3. Materials publicizing the program must be printed in other appropriate languages in
counties that have a specific minority 60+ population of three (3%) percent or more of the
general 60+ population.
F. ADDITIONAL REMUNERATION PROHIBITED: Neither the Contractor nor any of its officers,
employees, agents or representatives, shall solicit, impose any fees, or accept any remuneration
whatsoever from clients, friends, relatives, or representatives of any clients for services performed
for that client under this Agreement other than the client matching monies or donations (see Section
I).
In the event that this provision is violated, SE WA ALTC COG shall have the right to assert a claim
against the Contractor on its own behalf and/or on behalf of the client.
G. MAINTENANCE OF FUNDING SOURCES: The Contractor agrees that:
1. SE WA ALTC COG funds are not used to replace funds from any other existing program
funding;
2. It will continue or initiate efforts to obtain support from private sources and other public
organizations for this service;
3
AL7'CCOG 2018-14
3. It will utilize new funding sources for this service if they become available through SE WA
ALTC COG and it will make any changes necessary to meet the requirements of the new
funding sources.
H. FEES AND DONATIONS: The Contractor agrees that:
1. It will assure that older persons have the opportunity to contribute to all or part of the cost
of the service, but service will not be denied if participant cannot or does not wish to
contribute;
2. It shall utilize client donations to meet project expenses before using State or Federal
funds;
3. It shall provide that the methods of receiving fees, donations and contributions from
individuals shall be handled in such a manner so as not to publicly differentiate among
individuals;
4. All project income derived from the provision of services described herein or incorporated by
reference herein or derived or generated through program fund-raising activities or profits
earned from fixed rate service shall stay with the project and shall be used to provide
increased levels or improved quality of service to the target population.
The state requires that rates charged to others cannot be less than the program charges
the state for the same services (usual and customary fee). The unit rate charged to SE WA
ALTC COG must equal or exceed the rate billed the state for the same service or the state
must be charged the lower rate.
MONITORING/ASSESSMENT PROCEDURES: The Contractor agrees to:
1. Monitor both its fiscal and program status monthly and assess its performance on program
objectives and activities covered under this Agreement on an ongoing basis.
2. Monitor and assess on an ongoing basis the performance of any subcontracting agencies, and
insure that funds made available are expended only in accordance with the specific provisions
of this Agreement.
3. Recognize that SE WA ALTC COG will monitor and assess the activities and progress of all
programs covered under this Agreement on an ongoing basis. Said monitoring and
assessment will be accomplished through, but not limited to, review of program and financial
reports, on-site visits (service delivery and administrative sites), conference with program
administrators and staff, and visits by members of the SE WA ALTC COG staff and SE WA
ALTC COG. Monitoring may include assessing performance based on information submitted in
the Request for Proposal (RFP). Prior notice of all such visits will be provided.
4. Authorize and/or participate in any program or fiscal evaluations or studies conducted by SE
WA ALTC COG or DSHS. Prior notice will be provided as well as final reports of evaluations
or studies.
5. Conduct a self-evaluation of the program annually. The self-evaluation shall include a
survey of at least 10% of clients utilizing the service. The Contractor shall take steps to
correct deficiencies found during the internal monitoring. Monitoring reports shalt be made
available to SE WA ALTC COG upon request.
J. GRIEVANCE PROCEDURE AND HEARINGS
The Contractor shall establish a system through which clients of services under this
approved Agreement may present grievances as outlined in the Basic Agreement, Section
XXIV.
4
ALTCCOG 2018-14
K. SECURITY OF DATA
1. The Contractor shall take reasonable precautions to secure against unauthorized physical
and electronic access to data, which shall be protected in a manner that prevents
unauthorized persons, including the general public, from retrieving data by means of
computer, remote terminal, or other means. The Contractor shall take due care to
protect said Data from unauthorized physical and electronic access. The data will be
stored on computers with security systems that require individual user IDs and hardened
passwords.
Only persons who have signed the Washington State Notice of Nondisclosure
confidentiality form covering this data share agreement will be able to access the data
that SE WA ALTC COG shares with the Contractor under this agreement.
2. The Contractor shall remove data received under this agreement from computer
equipment after it's been used for its stated purposes by using a "WIPE" utility for
purging the Data from electronic storage media, degaussing the media, or physically
destroying the media in such a way that Data cannot be recovered. Media includes, but
is not limited to, the following:
a. Personal computer-based hard drives;
b. Floppy disks;
c. Magnetic tapes (reels or cartridges);
d. Compact Disks (CDs), including CDs from cameras;
e. DVDs;
f. Zip disks;
g. Portable RAM (Compact Flash, etc.);
h. Mainframe or mini mass storage (disk platters, arrays, etc.);
i. Storage Area Networks (SAN); and,
j. Network Attached Storage (NAS).
3. The Contractor shall ensure disks and/or documents generated in printed form from the
electronic file are properly returned, destroyed or shredded when no longer needed.
Unauthorized individuals cannot have access to client information. Data destroyed shall
include all copies of any data sets in possession after the data has been used for the
purpose specified herein or within 30 days of the date of termination, and certify such
destruction to SE WA ALTC COG. SE WA ALTC COG shall be responsible for destroying
the returned documents to ensure confidentiality is maintained. The Data provided by SE
WA ALTC COG will remain the property of SE WA ALTC COG and will be promptly
destroyed when The Contractor and its subcontractors have completed the work for
which the information was required, as fully described herein.
4. The Contractor shall protect information according to state and federal laws including the
following incorporated by reference:
a. Privacy Act 1974 5 USC subsection 552a;
b. Chapter 40.14 RCW Preservation and Destruction of Public Records;
c. Chapter 74.04 RCW General Provisions — Administration;
d. Chapter 42.56.230 RCW Certain Personal & Other Records Exempt
e. 45 CFR 205.50 provides for Safeguarding information for the Financial assistance
Programs and identifies limitations to disclosure of said information; and,
f. Public Law 99-508 (18 USC section 2510et. Seq. Electronic Communications
Privacy Act of 1986) Part A of Title IV of the Social Security Act authorizes
5
ALTCCOG 2018-14
disclosure of client information and provides for safeguards, which restrict the
use or disclosure of information concerning applicants or recipients to purposes
directly connected with administration of the program.
A. SPECIAL TERMS AND CONDITIONS
1. Access and Disclosure information. The Contractor agrees to follow the DSHS IT
Security Policy Manual (Section 4.2.3.1, S1) that covers unique user IDs and security
elements of constructing safe passwords and protecting them from unauthorized
disclosure.
The Contractor shall not disclose the contents of any Client records, files, papers and
communications except as necessary for the administration of programs to provide
services to clients as required by law.
a. Clients shall only be permitted to access their own data.
b. The Contractor shall not use or disclose any information concerning any DSHS client
for any purpose not directly connected with the administration of the Contractors
responsibilities under this Agreement except by prior written consent of the DSHS
Client, his/her attorney, parent or guardian.
2. Dissemination to staff. Prior to making information available to new staff and annually
thereafter, the Contractor shall ensure that staff accessing the Personal Information or
PHI under this Agreement are trained in HIPPA use and disclosure of PHI requirements
and understand:
a. Confidentiality of Client Data.
i. Client data is confidential and is protected by various state and federal laws.
The basis for this protection is the individual's right to privacy as outlined in the
HIPPA Privacy Rule — 45 CFR 160 to 45 CFR 164.
ii. Personal Information means demographic and financial information about a
particular individual that is obtained through one or more sources (such as
name, address, SSN, and phone numbers).
b. Use of Client Data.
i. Client data may be used only for purpose of these contracted services, directly
related to providing services to the client or for the operation of aging and
long-term care programs.
ii. Any personal use of client information is strictly prohibited.
iii. Access to data must be limited to those staff whose duties specifically require
access to such data in the performance of their assigned duties.
c. Disclosure of Information.
i. Client information may be provided to the client, client's authorized guardian,
or a client authorized 3rd party per WAC 388-01, and the Long Term Care
Manual.
ii. Client information may be disclosed to other individuals or agencies only for
purposes of administering DSHS programs.
iii. Questions related to disclosure are to be directed to the Home and
Community Programs Public Disclosure Coordinator.
6
ALTCCOG 2018-14
iv. Any Disclosure of information contrary to this section is unauthorized and is
subject to penalties identified in law.
3. The Contractor shall perform the services as set forth below and in accordance with Data
Security Requirements of DSHS and Southeast Washington Aging and Long Term Care:
a. Authority to Access Data. RCW 74.39A.090 mandates that DSHS contract with
Area Agencies on Aging (AAA's) to provide case management services to
individuals receiving Title XIX personal care services and to reassess and
reauthorize these individuals for Title XIX personal care services or other home
and community services as defined by this statute. In order to effectively
administer these DSHS services, the Contractor must have access to client data,
and to certain DSHS information systems.
b. Systems Access and Method of Access. The Contractor may access or may
request permission to access the following:
i. The Social Assistance Management System (SAMS), until it sunsets, and
successor system, Community Living Connections (CLC) for managing and
recording service provision and utilization, demographic, resource directory,
and consumer website information.
ii. The Washington Connection benefit portal for the purpose of helping citizens
complete an online application for federal, state and local benefits, services
and assistance.
c. The Contractor shall limit access to client data to the Contractor and any
subcontractor staff whose duties specifically require access to such data in the
performance of their assigned duties. Contractor or subcontractor staff shall not
access any individual client data for personal purposes. Clients shall only be
permitted to access their own data.
d. The Contractor shall ensure each employee signs the Contractor Agreement on
Nondisclosure of Confidential Information form provided by DSHS and SE WA
ALTC to acknowledge the data access requirements prior to DSHS granting
access. Access will be given only to data necessary to the performance of this
Agreement. The Contractor shall retain the original Nondisclosure form on file.
The Contractor shall have the form available for DSHS or SE WA ALTC review
upon request.
The Contractor must provide an annual written reminder of the Nondisclosure
requirements to all employees with access to the data to remind them of the
limitations, use or publishing of data. The Contractor shall retain documentation
of such reminder on file for monitoring purposes.
e. The Contractor or its service provider may disclose information to each other or
to DSHS for purposes directly connected with the administration of their
programs. This includes, but is not limited to, determining eligibility, providing
services, and participation in an audit. The Contractor and its service providers
shall disclose information for research, statistical, monitoring and evaluation
purposes conducted by appropriate federal agencies and DSHS.
DSHS must authorize in writing the disclosure of this information to any other
party not identified in this section.
f. The Contractors staff shall not link the data with personal data or individually
identifiable data from any other source nor re -disclose the data unless specifically
authorized in this Agreement or by the prior written consent of DSHS.
7
ALTCCOG 2018-14
9.
The Contractor shall notify each system Administrator within five business days
when a User leaves employment or otherwise no longer requires system access.
Upon notification, the system Administrator will deactivate the User ID and
terminate access to the applicable application(s). The Contractor shall confirm
the need for continued access for each User of the ACD on a quarterly basis.
h. The Contractor shall ensure that only registered system Users access and use the
systems in this Agreement, use only their own User ID and password to access
the systems and do not allow employees who are not registered to borrow a User
ID or password to access any systems.
Access to systems may be continuously tracked and monitored. DSHS reserves
the right at any time to conduct audits of systems access and use, and to
investigate possible violations of this Agreement and/or violations of federal and
state laws and regulations governing access to protected health information.
The Contractor shall access these systems through the State Government
Network (SGN), the Inter -Governmental Network (IGN), SecureAccess
Washington (SAW), or through a DSHS approved method of secure access.
The Contractor agrees to follow the DSHS IT Security Policy Manual (Section
4.2.3.1, Si) that covers unique user IDs and security elements of constructing
safe passwords and protecting them from unauthorized disclosure.
B. DATA SECURITY REQUIREMENTS
1. Definitions. The words and phrases listed below, as used in this section, shall each have
the following definitions:
a. "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.
b. "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.
2. Data Transport. When transporting DSHS Confidential Information electronically,
including via email, the Data will be protected by:
a. Transporting the Data with the (State Governmental Network) SGN or
Contractors internal network, or;
b. Encrypting any Data that will be in transit outside the SGN or Contractors internal
network. This includes transit over the public Internet.
3. 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. Data stored on local workstation hard disks. Access to the
Data will be restricted to Authorized User(s) by requiring logon to the local
workstation using a Unique User ID and Hardened Password or other
authentication mechanisms which provide equal or greater security, such as
biometrics or smart cards.
b. Network server disks. Data stored on hard disks mounted on network servers
and made available through shared folders. Access to the Data will be restricted
to Authorized Users through the use of access control lists which will grant access
only after the Authorized User has authenticated to the network using a Unique
8
ALTCCOG 2018-14
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 Secured Area and otherwise meet
the requirements listed in the above paragraph. Destruction of the Data as
outlined in this document, may be deferred until the disks are retired, replaced,
or otherwise taken out of the Secured 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 a Secure Area. When
not in use of the contracted purpose, such discs must be locked in a drawer,
cabinet or other container to which only Authorized Users have the key,
combination or mechanism required to access the contents of the container.
Workstations which access DSHS Data on optical discs must be located in an area
which is accessible only to authorized personnel, with access controlled through
use of a key, card key, combination lock, or comparable mechanism.
d. Optical discs (CDs or DVDs) in drives or jukeboxes attached to servers.
Data provided by DSHS on optical discs 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 Secured Area which is only accessible to authorized personnel. When not in
use, such records must be stored in a locked container, such as a file cabinet,
locking drawer, or safe, to which only authorized persons have access.
f. Remote Access. Access to and use of the Data over the State Governmental
Network (SGN) will be controlled by DSHS staff who will issue authentication
credentials (e.g. a Unique User ID and Hardened Password) to Authorized Users
on Contractor staff. Contractor will 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.
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
with the terms and conditions of the Contract. If so authorized, the Data
shall be given the following protections:
g.
1. Encrypt the Data with a key length of at least 128 bits
ii. Control access to devices with a Unique User ID and Hardened Password
or stronger authentication method such as a physical token or biometrics.
9
ALTCCOG 2018-14
iii. 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.
(2) Physically Secure the portable device(s) and/or media by
i. Keeping them in locked storage when not in use
ii. Using check-in/check-out procedures when they are shared
iii. Taking frequent inventories
h. Data Stored for backup purposes.
(1) DSHS data may be stored on portable media as part of a Contractors
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 this document and
DSHS IT Policy.
(2) DSHS Data may be stored on non-portable media (e.g. Storage Area
Network drives, virtual media, etc.) as part of a Contractors existing,
documented back up process for business continuity or disaster recovery
purpose. 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 the time in accordance with this
document and DSHS IT Policy.
C. DATA SEGREGATION
a. DSHS Data must be segregated or otherwise distinguishable from non-DSHS
data. This is to ensure that when no longer needed by the Contractor, all DSHS
Data can be identified for return or destruction. It also aids in determining
whether DSHS Data has or may have been compromised in the event of a
security breach. As such, one or more of the following methods will be used for
data segregation.
b. DSHS Data will be kept on media (e.g. hard disk, optical disc, tape, etc.) which
will contain no non-DSHS data. And/or,
c. DSHS Data will be stored in a logical container on electronic media, such as a
partition or folder dedicated to DSHS Data. And/or,
d. DSHS Data will be stored in a database which will contain no non-DSHS data.
And/or,
e. DSHS Data will be stored in a database and will be distinguishable from non-DSHS
data by the value of a specific field or fields within database records.
f. When stored as physical paper documents, DSHS Data will be physically
segregated from non-DSHS data in a drawer, folder, or other container.
g. 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.
10
ALTCCOG 2018-14
Data Stored on:
Will be destroyed by:
Using a "wipe" utility which will overwrite the Data
at least three (3) times using either random or
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
Information
Recycling through a contracted firm provided the
contract with the recycler assures that the
confidentiality of Data will be protected.
Paper documents containing Confidential
Information requiring special handling (e.g.
protected health information)
On-site shredding, pulping, or incineration
Incineration, shredding, or completely defacing the
readable surface with a coarse abrasive
Degaussing, incineration or crosscut shredding
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 action to mitigate the risk of loss
and comply with any notification or other requirements imposed by law or DSHS.
L. Emergency Preparedness
Contractor will develop an emergency plan that includes the administrative office, local offices
and clients that defines what procedures should be followed when a disaster occurs. The plan
will outline what process is to be followed to provide the necessary services for a client when
normal services may be disrupted. The plan must include a list of those who are at most risk and
updated frequently. This plan must be submitted to SE WA ALTC COG for review.
The plan should include the following:
a. Contractor must designate a staff person to oversee planning tasks and
determine how emergency management is carried out in the local jurisdiction(s);
b. Contractor must communicate and establish working relationships with local
emergency operations leadership such as SE WA ALTC COG emergency
management, fire department, law enforcement, etc.;
c. Participate in plan development, drills, exercises and other preparedness
activities. Request of local emergency operations leadership to notify your
agency to be included in ongoing exercises and other preparedness activities;
d. Identify other partners such as the American Red Cross, Salvation Army who are
active in disaster situations
e. Contractor must have a plan for serving currently authorized clients during
periods when normal services may be disrupted. This may include earthquakes,
floods, snowstorms, etc. Reasonable efforts to contact all clients beginning with
those who have been determined to be most at risk must be made.
f. Through the duration of the disaster the contractor shall continue to contact
clients at least weekly who have declined services to offer services and identify
significant changes in condition.
Once the emergency policy has been developed, SE WA ALTC COG should be provided a copy for
review and approval.
11
ALTCCOG 2018-14
M. MANDATED REPORTING:
All employees of the contractor are mandatory reporters of abuse and neglect of vulnerable
adults and children as required under RCW 74.34.035 and RCW 26.44.030. The contractor must
immediately report all suspected incidents to the appropriate protective services and shall not
impede or interfere with any DSHS or law enforcement investigation. Employees shall not be
discouraged from reporting suspected incidents by any other contractor or employee. Suspected
incidents that must be reported are defined in RCW 26.44.020 and 74.34.035 and include:
1. Physical abuse
2. Sexual abuse
3. Mental/emotional abuse
4. Neglect by others
5. Self-neglect
6. Exploitation including financial
7. Abandonment
N. CRIMINAL HISTORY/BACKGROUND CHECKS
The Contractor agrees to undergo a criminal history background check conducted by SE WA ALTC
COG every two years, and as required by RCW 43.20A.710. RCW 43.43.830 through 43.43.842,
and WAC 388-06.
If the Contractor has employees or volunteers who will have unsupervised access to Clients in the
course of performing the work under this Contract, the Contractor must conduct and maintain
documentation of criminal history background checks being completed every two years on those
employees or volunteers.
PAYMENT PROVISIONS
I CONSIDERATION
Payment shall be based on claims for reimbursement as reported on the SE WA ALTC COG invoice and
support documentation and shall be contingent upon the receipt of all required financial and program reports
by the respectively assigned due dates.
SE WA ALTC COG shall not be held responsible for any financial loss suffered by the Contractor as a result of
performance of services as outlined in this Agreement in the mutually agreed budget, service delivery
standards, units of service and payment standards.
II GENERAL PAYMENTS CONDITIONS
The Contractor agrees to the following standards in satisfactorily performing the terms and conditions of this
Agreement:
A. No payment shall be made for any contracted activity rendered by the Contractor which is not
identified within the terms and conditions of this Agreement and set forth within a category of the
budget.
B. Contractor shall submit to SE WA ALTC COG a written request for approval of budget revision when:
1. The revision would change the scope or objectives of any contracted activity category or;
2. Additional revenue is received for contracted activities within the terms of this Agreement.
C. Payments shall be based on SE WA ALTC COG'S receipt of all fiscal and programmatic reports
required by this Agreement to substantiate claims for reimbursement. SE WA ALTC COG expressly
reserves the right to withhold payment in whole or in part when:
12
ALTCCOG 2018-14
1. The Contractor fails to submit all required documentation, or
2. In SE WA ALTC COG's judgment, additional information is required to substantiate the basis
upon which claims for reimbursement are made, provided the request for such additional
information is consistent with the requirements of this Agreement; or
3. Claims for reimbursement are inconsistent with the terms and conditions of this Agreement.
D. Program Income: Gross income received by the contractor and/or subcontractors directly generated
by federal funds or a federal grant supported activity or earned as the result of the grant and/or
federal contract.
1. Program income may include, but is not limited to, income from: fees for services
performed, proceeds from the sale, lease or rent of assets which were acquired using
federal funds, contributions/donations from clients, honorariums, consultant fees, training
fees, and the like, earned by staff when time spent earning such honorarium or fee was
charged to federal funds, and revenue generated from sale of fabricated items.
2. Use program income in accordance with the Department of Health and Human Services
Administration of Grants, 45CFR, Part 74. Costs borne by the program income must be
used to satisfy cost sharing requirements.
SE WA ALTC COG agrees to promptly notify the Contractor of any proposed reduction in funding by State,
Federal, or other officials. The Contractor agrees that upon receipt of such notice it shall take appropriate
and reasonable action to reduce its spending in the affected funding area so that expenditures do not
exceed the funding level which would result if said proposed reduction became effective.
III BILLING PROCEDURES
A. Contractor shall submit written daims for reimbursement of contracted activities provided on the appropriate
forms. All payments will be based on contracted activities provided unless otherwise approved in writing by
SE WA ALTC COG.
B. SE WA ALTC COG agrees to make payment for contracted activities provided as approved by SE WA ALTC
COG with warrants within thirty (30) working days. This is contingent upon the availability of funds and
receipt of the Contractor's claims for reimbursement by SE WA ALTC COG by the tenth day of each
month following the month during which the services were provided.
No payment shall be made in the month services are rendered unless otherwise approved by SE WA ALTC
COG.
C. End of year invoices will be accepted until February 28th following the contract period unless
otherwise noted in the contract. Any invoices received after February 28th will not be
processed for payment.
13
ALTCCOG 2018-14
Exhibit A
STATEMENT OF WORK
2O18ADULT DAY CARE
CITY OF YAKIMA
I APPLICABLE LAWS AND REGULATIONS
The Contractor agrees that services contemplated or delivered within the terms of this Agreement and funds
administered in the delivery of the specified services shall be provided in accordance with all applicable
Federal, State, and local laws and regulations,
A. CFR Title 45, Subtitle A, Part 74, (Administration of Grants)
B. Older Americans Act (P.L. 109-365)
C. WAC 388-106-1100 through 1120 (Senior Citizens Service Act)
D. WAC 388-71-0701 through 0776 (Adult Day Services)
II. PROJECT DEFINITION
An adult day services program is a community-based program designed to meet the needs of adults with
impairments through individual plans of care. This type of structured, comprehensive, nonresidential
program provides a variety of health, social, and related support services in a protective setting. By
supporting families and caregivers, an adult day services program enables the person to live in the
community. An adult day services program assesses the needs of the persons served and offers services to
meet those needs. The persons served attend on a planned basis. Nothing in this generic description of
adult day services may be construed to modify the specific services or eligibility requirements referenced in
the definition of adult day care and adult day health.
Adult Day Care (ADC) is a supervised daytime program providing core services as defined under WAC
388-71-0704. Core services are appropriate for adults with medical or disabling conditions that do not
require the intervention of services of a registered nurse or licensed rehabilitative therapist acting under
the under the supervision of the client's physician.
The ADC center must offer and provide on-site the following core services as listed in WAC 388-106-0800.
A. Personal Care Services as defined in WAC 388-106-0010, or its successor;
B. Social services on a consultation basis;
C. Routine health monitoring with consultation from a registered nurse that a consulting nurse acting
within the scope of practice can provide with or without a physician's order;
D. General therapeutic activities that an unlicensed person can provide or that a licensed person can
provide with or without a physician's order. These services are planned and provided as an integral
part of the clients plan of care and are based on the clients abilities, interests and goals;
E. General health education that an unlicensed person can provide or that a licensed person can
provide with or without a physician's order;
F. A nutritional meal and snacks provided each four-hour period at regular times comparable to
normal meal times, including modified diet if needed and within the scope of the program, as
provided under WAC 388-71-0770;
G. Supervision and/or protection for clients who require supervision or protection for their safety;
H. Assistance with arranging transportation to and from the program;
I. First aid and provisions for obtaining or providing care in an emergency.
ALTCCOG 2018-14
III PARTICIPANTS
The Contractor agrees that:
A. The Adult Day Services program Target population is individuals as referenced in the Adult Day
Health Program Standards.
B. There will be written assessment procedures utilized by the Contractor to determine if clients meet
the program target population criteria.
C. To the degree feasible, Contractor shall ensure that preference is given to those individuals aged 60
and over who meet the vulnerability criteria listed below with further preference given to low-
income, limited English proficiency and minority individuals and to those with the greatest economic
and social need.
A person is considered vulnerable if s/he:
1. Is unable to perform one or more of the activities of daily living below without assistance
due to physical, cognitive, emotional, psychological or social impairment:
• Eating
• Toileting
• Personal hygiene & grooming
• Bathing
• Cooking
• Dressing or undressing
• Housework
• Walking
• Managing medical treatments (prescribed exercises, change of dressing, injections,
etc)
• Manage medications (what to take, when to take it, how to store it properly, etc.)
• Telephoning
• Transfer (getting in and out of bed/wheelchair)
• Transportation
• Managing money (budgeting, check writing, etc.)
• Preparing Meals
2. Has behavioral or mental health problems that could result in premature institutionalization,
is unable to perform activities on daily activities listed above, or is unable to provide for
her/her own health and safety primarily due to cognitive, behavioral, psychological, or
emotional conditions which inhibit decisions making and threaten the ability to remain
independent.
3. Lacks an informal support system: The person has no family, friends, neighbors or others
who are willing and able to perform the services needed or whose informal support system
needs to be temporarily or permanently supplemented.
IV SERVICE SPECIFICATIONS
A. Eligibility Determination
The purpose of eligibility determination is to assess whether an applicant meets the financial and
program eligibility criteria for adult day care.
Financial Eligibility: Income below 40 percent of the state median income for free services; sliding -
fee scale applies if income is between 40 percent and 100 percent of state median income.
2
ALTCCOG 2018-14
Program Eligibility: The applicant must be 60 years of age or older, both willing and able to
participate in the adult day care program on a regular scheduled basis and both willing and able to
use adult day care services to achieve treatment goals.
1. Adult day center staff are responsible for determining the financial and program eligibility of
an applicant for ADC services using the Senior Citizens Services Application.
2. Eligibility must be determined:
a. prior to the provision of adult day services and within thirty (30) days after the
applicant has requested service. Eligible applicants may be provided services as of
the date of application.
b. each January when the client's gross monthly income at the time of eligibility
determination is derived exclusively from pensions, Social Security benefits (SSA),
Supplemental Security Income (SSI), or a combination thereof.
3. A Participant Intake Form (PIF) or other client tracking information shall be completed on
each client served and submitted with the monthly Service Level Report as required to SE
WA ALTC COG. Additionally a PIF must be completed each January for participants
continuing into the New Year.
B. Reduction/Termination of Services
The Discharge Plan Form must be completed when a client becomes ineligible for adult day health
services or when services are reduced or terminated for any reason.
1. Adult day center staff are responsible for determining whether services provided to a client
should be reduced or terminated.
2. Reasons for reduction of services:
a. Client requests a reduction;
b. In the professional judgment of adult day center staff, the client no longer requires
the number of service days now being provided or is not both willing and able to
effectively utilize the number of service days now being provided to achieve
treatment goals. Whenever possible, service reductions should be accomplished
through mutual negotiation with the client and the client's family and/or others in
his/her informal support system and the client's physician;
c. Funding cutbacks require reduction.
3. Reasons for termination of services:
a. Client requests termination;
b. In the professional judgment of ADC center staff, the client no longer requires ADC
services, ADC services no longer meet the client's needs, or the client is not both
willing and able to effectively utilize the adult day health program to achieve
treatment goals. Whenever possible, service termination should be accomplished
through mutual negotiation with the client and with the involvement of dient's
family and/or others in his/her informal support system and the client's physician;
c. Funding cutbacks require termination.
C. The adult day center must be located in geographic areas, which contain major concentrations or
high proportions of target group older persons.
3
ALTCCOG 2018-14
C. Payment Provisions
The respite care program shall ensure:
1. That a record of all units of service used by a caregiver, as reported by the Contractor, is
maintained.
2. That funds received from participants shall be reported to SE WA ALTC COG by the
agencies collecting them. SE WA ALTC COG shall report funds collected from participants to
DSHS as part of monthly invoicing. These funds shall only be used within the respite care
program.
3. The Contractor shall not be paid for more service hours than authorized by the SE WA ALTC
COG case manager.
4. Funds from participants and caregivers not meeting all of the eligibility criteria shall be
accounted for at the Contractor level.
VIII STAFFING STANDARDS
A. Service Delivery
1. There shall be written procedures for recruiting, screening, training, supervising, and
monitoring in-home and out -of -home respite care workers.
2. It is the responsibility of the Contractor to provide training to workers. SE WA ALTC COG
will monitor to insure training standards are met.
3. Sufficient staff shall be available to ensure that all authorized requests for service can be
met in a timely manner.
IX. PAYMENT CONSIDERATION
As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with
the Budget Provisions of this Agreement, SE WA ALTC COG agrees to pay the Contractor a sum not to exceed
$13,500 from available funds as submitted on the 2017 Contract Budget Summary. This total sum shall be
available during the period January 1, 2017 through December 31, 2017. These funds shall be used to
provide Respite Care services. Payment to the Contractor for this Agreement shall be based on $14.20 per
hour less client match as computed on the Senior Citizen Services sliding fee schedule.
3
ALTCCOG 2018-14
2. If the participants income is between 40 and 99 percent of the State Median Income, he or
she will be charged a percentage of the cost of respite care. This amount shall be calculated
using the sliding fee schedule.
3. If the participants income is 100 percent or more of the State Median Income, he or she will
pay the full cost of the service.
4. The cost of respite care shall be determined by the number of hours or days of respite care
service authorized and used, and the rate of the service, as negotiated between the respite
care program and Contractor.
5. The caregiver shall not be means -tested nor be required to pay for the care received. If a
caregiver does not meet all of the eligibility requirements but requests respite care, the full
cost of respite care services shall be charged.
V PROGRAM ADMINISTRATION
A. For Traditional Respite, an in-home assessment shall be conducted by SE WA ALTC COG case
manager in the participants home using the Tailored Caregiver Assessment and Referral (TCARE)
tool. The same assessment and scheduling procedures shall apply to all respite care participants
and caregivers regardless of share in the cost of respite care.
Upon completion of the assessment, a Respite Information Form for Providers shall be generated by
the TCARE tool and sent to the Contractor. It shall include information on the care receiver's
Activities of Daily Living and Instrumental Activities of Daily Living as well as the care receiver's
memory and decision—making status and health-related issues. Contact information for both the
care receiver and caregiver will be included. It shall be the responsibility of the Contractor to
discuss with the caregiver the details of the plan of care.
B. Short Term Respite shall be authorized by an SE WA ALTC COG case manager for family caregivers
who have not undergone a full TCARE assessment or who do not qualify for Traditional Respite
services, enabling them to attend caregiver educational offerings. Because TCARE assessments
have not been completed for these caregivers, the TCARE Information for Respite Care Service
Providers form cannot be generated. The Contractor shall meet with these family caregivers to
obtain the information about the care receiver necessary to develop Respite care instructions for
agency care providers.
C. All authorizations for service shall be made through the SE WA ALTC COG case manager. SE WA
ALTC COG case managers shall encourage caregivers to schedule episodes of respite care in
advance. If respite care episodes cannot be provided when requested, a waiting list shall be used.
D. Maximum Hours
The SE WA ALTC COG case manager shall determine the dollars available during any one month
and authorize hours to the Contractor accordingly. The Contractor shall not deliver more service
hours than authorized by the SE WA ALTC COG case manager.
VI SERVICE AREA
Services shall be provided throughout those areas of Yakima County that are not a part of the Yakama Nation.
Persons, who live within the boundaries of the Yakama Nation, will be the responsibility of the Yakama Nation
Area Agency on Aging.
VII UNITS OF SERVICE
A. Definition: A unit Respite service shall consist of one (1) hour of service.
B. Anticipated Service Level by Contract: 951
2
ALTCCOG 1018-14
Exhibit B
STATEMENT OF WORK
2018 RESPITE
CITY OF YAKIMA
I APPLICABLE LAWS AND REGULATIONS
The Contractor agrees that services contemplated or delivered within the terms of this Agreement and funds
administered in the delivery of the specified services shall be provided in accordance with all applicable
Federal, State, and local laws and regulations, in particular the following:
A. WAC 388-106-1200 through 1230 (Respite Services)
B. WAC 388-71-0701 through 0774 (Adult Day Services)
C. Title III E of the Older American's Act (P. L. 109-365) Section 371-374 (National Family Caregiver
Support Program)
D. RCW 74.41.010 — 74.41.090 (State Family Caregiver Support Program)
II PROJECT DEFINITION
The purpose of Traditional Respite care is to provide relief for families or other caregivers of disabled adults.
Both in-home and out -of -home Traditional Respite care is available and is provided on an hourly and daily
basis, including 24-hour care for several consecutive days. Respite care workers provide supervision,
companionship and personal care services usually provided by the primary caregiver of the disabled adult.
Services appropriate to the needs of individuals with dementia are also provided. Medically related services,
i.e. administration of medication or injections; are provided by a licensed health practitioner.
The purpose of Short Term Respite care is to provide the in-home care necessary to enable unpaid
caregivers who do not qualify for Traditional Respite to attend family caregiver educational classes and
seminars.
III TARGET POPULATION
State Respite — To be eligible to receive respite care, a caregiver shall meet the target population criteria
for respite services as referenced in the Respite Program Standards under Eligibility Requirements for
Caregivers.
State Family Caregiver Support Program (SFCSP) — To be eligible to receive caregiver support, an
unpaid caregiver may be any age, but must have primary responsibility for the care of an adult 18 years of
age and older with a functional disability.
National Family Caregiver Support Program (NFCSP) — To be eligible to receive caregiver support, an
unpaid caregiver may be any age, but must be providing care to a recipient age 60 and above. Priorities
shall be given to unpaid older individuals with the greatest social and economic needs.
A sliding fee scale is used for Respite care and the Family Caregiver Support programs.
IV FINANCIAL PARTICIPATION
DSHS requires eligible participants to pay part of the cost of the respite care services received. A SE WA
ALTC COG case manager shall administer a sliding -fee schedule (the same as the Senior Citizens Services
Act (SCSA) fee schedule), which shall be updated annually, to determine the participant's share of the cost
of respite care services.
A. In determining the amount the participant shall pay, the following shall apply:
1. There shall be no charge to the participant if his or her income is at or below 40 percent of
the State Median Income.
1
ALTCCOG 2018-14
D. Transportation to and from the center must be available.
E. The adult day center must operate at least three (3) days a week and designate at least four (4)
consecutive hours a day when it provides a structured program.
F. The adult day center must meet the minimum staffing requirements.
G. The adult day center should have a written plan for evaluating whenever the program is meeting
the day health standards and the needs of the participants.
H. Participants shall be referred to other services as needed.
I. Services shall be provided throughout those areas of Yakima County that are not a part of the
Yakama Nation. Persons, who live within the boundaries of the Yakama Nation, will be the
responsibility of the Yakama Nation Area Agency on Aging.
V. UNITS OF SERVICE
A. Definition: A unit of Adult Day Care services shall consist of one (1) hour of Adult Day Care service,
not including transportation time.
B. Anticipated Service Level by Contract: 540
VI PAYMENT CONSIDERATION
As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with
the Budget Provisions of this Agreement, the SE WA ALTC COG agrees to pay the Contractor for client Adult
Day Care Core services a sum not to exceed $5,400 as submitted on the 2018 Contract Budget Summary.
The contracted amount shall be available during the period January 1, 2018 through December 31, 2018.
Payment to the Contractor for this Agreement shall be based on $10.00 per hour, less client match as
computed on the Senior Citizen Services sliding fee schedule.
4