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R-2012-136 2013-2017 Adult Daycare and Respite Service Program and Foot Care Services Program Agreements FUNDING 5 YR
RESOLUTION NO. R- 2012 -136 A RESOLUTION authorizing the City Manager to execute agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for the delivery of the Adult Day Care and Respite Services Program and the Foot Care Services Program for Senior Citizens at the Harman Center, and depending upon funding, authorizing the City Manager to execute any subsequent amendments or reoccurring agreements for the following five years (2017), upon approval as to form by the City Attorney WHEREAS, the City of Yakima desires that an Adult Day Care Program and Respite Services be available at the Harman Center; and WHEREAS, the City of Yakima desires that Foot Care Program a Services be available at the Harman Center; and WHEREAS, Yakima County, through its Office of Aging and Long Term Care (ALTC), is willing to provide funding to the City for these services in accordance with the attached agreement; and WHEREAS, the City Council deems it to be in the best interest of the City of Yakima to enter agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), in accordance with the terms of the attached agreements, now, therefore, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA: The City Council authorizes the City Manager to execute agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for the delivery of Adult Day Care and Respite Services and also delivery of the Foot Care Services Program at the Harman Center, and depending upon funding, authorizes the City Manager to execute any subsequent amendments or reoccurring agreements that are substantially in the form of the agreement approved pursuant to this resolution, for the following five years (2017), upon approval as to form by the City Attorney. . ADOPTED BY THE CITY COUNCIL this 6th day of November, 2012. ATTEST: r Tee, City C FS , F � f v I S Micah Cawle , Mayor PERFORMANCE AGREEMENT NO. 2013 COY ADMINISTRATION OF AGREEMENT THIS AGREEMENT is entered into this 33�' day of C 2012 between Yakima County, hereinafter denominated the "County ", through the Office of Aging and Long Term Care whose address is P.O. Box 8349, Yakima, Washington 98908, hereinafter denominated the "Department ", and City of Yakima Day Break Adult Day Care, 101 N. 65"' Ave., Yakima, Washington 98908, hereinafter denominated the "Contractor ", whose duly authorized representatives are named in documents on file at the Office of Aging and Long Term Care. 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 Basic Agreement No. ALTC -10. In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PAYMENT CATEGORY AMOUNTS Adult Day Care $8,000 Respite $5,000 TOTAL FUNDINGALLOCATION 0- PERIOD OFAGREEMENT January 1, 2013 — December 31, 2013 CONTRACTOR SIGNATURES Tony O'Rourke,ity Manager City of Yakima Date: IM a M MO.). I Z Enffl City Clerk City Contract Resolution Nc Date: 11 J M .._ ,t P Lori J. Brovtoi, Director SE Washington Aging and Long Term Care Date: D !�— Contract Authorization Performance Agreement No. 2013 COY (Adult Day Care and Respite Services) %%OF YAIQy l�i�ii J�e� (T. Attest: Tiera L. Girard Clerk of the Board Approved as to Form: �/1ey Deputy Prosecuting Attorney vj'�B1A- 't�; 5 � 01 BOARD OF YAKIMA COUNTY COMMISSIONERS Aowlr J. Rto Elliott, Chairman ;X) i uchey, Commissioner o tituti g the Board of County Commissioners for a County, Washington BOCC702 -2012 October 30, 2012 2013 ALTCi CONTACT CITY OF Yl;KKN ADULT [SAY CARE FZEF'ITE ADMINISTRATION OF AGREEMENT (signature page) STANDARD TERMS AND PAYMENT PROVISIONS FOR MULTIPLE SERVICE PROVIDERS SPECIFIC PROVISIONS I. SERVICE SPECIFICATIONS II ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATE III. ADMINISTRATIVE AGREEMENTS PAYMENT PROVISIONS I. CONSIDERATION II. GENERAL PAYMENT CONDITIONS III. BILLING PROCEDURES EXHIBIT A ADULT DAY CARE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. PARTICIPANTS IV. SERVICE SPECIFICATIONS V. UNITS OF SERVICE VI. PAYMENT CONSIDERATIONS EXHIBIT B RESPITE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. TARGET POPULATION IV. FINANCIAL PARTICIPATION V. PROGRAM ADMINISTRATION VI. SERVICE AREA VII. UNITS OF SERVICE VIII. STAFFING STANDARDS IX. PAYMENT CONSIDERATIONS EXHIBIT C BUDGET 3 ST�NDDAf�L� TEh� -15 ,�Na PAYMENT PROD V1410O N5 FOO f� �- 1ULTIPLE SEF�VICE PfZOOVIDD ER5 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 State of Washington Aging and Adult Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. II. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for Adult Day Care and Respite Care to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding levels provided under the terms of this Agreement. B. The County 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. The County 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 the County: The Contractor shall provide access at all reasonable times for the County to monitor and /or evaluate the provisions of services under this Agreement. The County 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. B. Records and Reports: The Contractor agrees to: 4 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by the County in order for the County to be assured that contracted activities remain consistent with the terms of this Agreement and the currently approved SE /ALTC Area Plan which shall be kept on file at the ALTC office. The Contractor further agrees to provide such information as requested by the County within the time limitations established by the County. 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. A quarterly report must be submitted to ALTC by the end of the month following the end of each quarter. 3. Complete and submit such additional reports as are required by the County within the specified time frames, providing the Contractor is given a written request for the reports thirty (30) days prior to the due date. C. Inventory: The Contractor agrees to: 1. Submit to the County vendor invoice(s) at the same time with the monthly billing before County reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year physical inventory, using forms provided by the County, of all equipment purchased under this Agreement. D. Contractors Meetina: The Contractor agrees to have a representative attend the Office of Aging and. Long Term Care Contractors and 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 Southeast Washington Office of Aging and Long Term Care 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: 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) 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 5 is violated, the County shall have the right to assert a claim against the Contractor on its own behalf and /or on behalf of the client. G. Private Pa v: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that the County is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. H. Maintenance of Funding Sources: The Contractor agrees that: 1. The County 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. It will utilize new funding sources for this service if they become available through the County and it will make any changes necessary to meet the requirements of the new funding sources. I. 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 the county must equal or exceed the rate billed the state for the same service or the state must be charged the lower rate. J. 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. 6 3. Recognize that the County 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 Office of Aging and Long Term Care (ALTC) staff and ALTC Advisory Council. 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 the County 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 shall be made available to the County upon request. K. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 ("HIPAA'�, and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not -use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of The County's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to The County 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 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. L. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. C. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. Client information may be provided to the client, client's authorized guardian, or a client- authorized V party per WAC 388 -01, and the Long Term Care Manual. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. C. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. M. SECURITY OF DATA 0 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 The County 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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; 0 d. Chapter 42.56.210 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 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. N. The Contractor shall indemnify and hold harmless Yakima County for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. 0. The Contractor will partner with ALTC's oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. P. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be" brought in the Superior Court for the State of Washington in Yakima County, Washington. PAYMENT PROVISIONS I CONSIDERATION Payment shall be based on claims for reimbursement as reported on the Office of Aging and Long Term Care invoice and support documentation and shall be contingent upon the receipt of all required financial and program reports by the respectively assigned due dates. The County 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. The Contractor shall submit to the County a written request for approval of budget revision when: 1. The revision would change the scope or objectives of any contracted activity category; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 10 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of the County budgeted amount for administration or service delivery. C. Payments shall be based on the County's receipt of all fiscal and programmatic reports required by this Agreement to substantiate claims for reimbursement. The County expressly reserves the right to withhold payment in whole or in part when: 1. The Contractor fails to submit all required documentation, or 2. In the County'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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of County contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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. 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, Sec. 25. Costs borne by the program income must be used to satisfy cost sharing requirements. The County 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. E. Termination of Contract 11 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, the County may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds ALTC relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, ALTC may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the County. B. The County agrees to make payment for contracted activities provided as approved by the Auditor of Yakima County with County warrants within thirty (30) working days. This is contingent upon the availability of funds and receipt of the Contractor's claims for reimbursement by the County 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 the County. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last County working day of the month. 12 IE�XHIE�IT A 11DULT n�Y CAF E �T-TEf1ENT OO F WOO W CITY OO F IWO1KIMA 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 (PL 109 -365) C. WAC 388 - 106 -1100 through 1120 (Senior Citizens Service Act) D. WAC 388 - 106 -0300 (COPES Services) E. WAC 388 -71 -0702 through 0776 (Adult Day Care) 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 Services is a supervised daytime program providing core services as defined under WAC 388 -106 -0800 subsection (2), Core services are appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. The adult day care 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 -71 -0215, 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; 1 III i 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 client's plan of care and are based on the client's 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. PARTICIPANTS The Contractor agrees that: A. The target population for the day care program is individuals who are appropriate for care services as referenced in the Adult Day Care WAC 388- 71 -0704. B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by the Office of Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low- income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Office of Aging and Long Term Care (ALTC) funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be targeted for 2013 'are as follows: Target Group Percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% The Contractor must report on clients served in these categories. IV SERVICE SPECIFICATIONS A. Eli_ ibility 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. 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 day care services to achieve treatment goals. 1. Adult day care center staff are responsible for determining the financial and program eligibility of an applicant for day care services. 2. Eligibility must be determined prior to the provision of adult day care services and within thirty (30) days after the applicant has requested service. Eligible applicants may be provided services as of the date of application. 3. A Participant Intake Form (PIF) or other client tracking information shall be completed on each client served and submitted as required to the Office of Aging and Long Term Care. B. Eligibility Re- determination The purpose of the eligibility re- determination is to assess whether an adult day care client continues to meet financial and program eligibility criteria. 1. Adult day care center staff are responsible for re- determining eligibility. A new Senior Citizens Services Application must be completed to document whether the client was found to be eligible or ineligible. 2. Eligibility must be determined: a. Within thirty (30) days after the adult day care center has received information that a change has occurred in the client's circumstances that may make the client ineligible; b. At six -month intervals if change occurs; C. At twelve -month intervals 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. C. Reduction/Termination of Services The Discharge Plan Form must be completed when a client becomes ineligible for adult day care services or when services are reduced or terminated for any reason. 1. Adult day care 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 care 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 day care center staff, the client no longer requires adult day care services, adult day care services no longer meet the client's needs or the client is not both willing and able to effectively utilize the adult day care program to achieve treatment goals. Whenever possible, service termination should be accomplished through mutual negotiation with the client and with the involvement of client's family and /or others in his /her informal support system and the client's physician; C. Funding cutbacks require termination. 4. A client who disagrees with a decision of adult day care staff to reduce,-or terminate services has ninety (90) days after receipt of the Discharge Plan Form to request a fair hearing. Services may not be reduced or terminated until the fair hearing decision is rendered if the request for a hearing is received prior to the effective date for reduction or termination. D. The day care center must be located in geographic areas which contain major concentrations or high proportions of target group older persons. E. Transportation to and from the center must be available. 4 F. The day care 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. G. The day care center must meet the minimum staffing requirements for a center, which operates five (5) days a week and has an average daily attendance of less than twenty (20) participants. H. The day care' „center should have a written plan for evaluating whether the program is meeting the day care standards and the needs of the participants. I. Participants shall be referred to other services as needed. J. 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. K. Services shall be provided throughout Yakima County. V. UNITS OF SERVICE A. Definition: A unit of Adult Day Care service shall consist of one (1) hour of Adult Day Care service, not including transportation time. B. There will be 4 unduplicated individuals served by this Agreement. C. Anticipated Service Level by Quarter: Month Hours January - March 200 April - June 200 July - September 200 October - December 200 Total 800 D. Anticipated Expenditure Rate by Quarter for client services: Month Rate January - March $2,000 April - June $2,000 July - September $2,000 October - December $2,000 Total $.9 9 VI PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor for client Adult Day Care Core services a sum not to exceed $8,000 as submitted on the 2013 Contract Budget Summary. The contracted amount shall be available during the period January 1, 2013 through December 31, 2013. 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. The payment for COPES services will be in addition to the contracted amount. The COPES payment will be based on claims for reimbursement as reported on the COPES services billing. This includes clients now authorized, number of units of service and the actual number of units provided. The COPES unit rate will be $9.81 per hour or $39.25 per day and revised, if applicable, to reflect the unit rate established by DSHS. Services are reimbursed on an hourly basis up to four hours per day. Any service provided over four hours per day shall be reimbursed at the daily rate. In addition, COPES transportation rate to Day Break is $3.00 per day if utilizing the Dial -A -Ride program. 0 'EXHIE3IT f FZESPITE STATEMENT (�F NSA WRK CITY OO F 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 -0702 through 388 -71 -0776 (Adult Day Services) C. Title III E of the Older American's Act (PL 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 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 illnesses 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 55 and above or disabled. 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. 1 IV FINANCIAL PARTICIPATION DSHS requires eligible participants to pay part of the cost of the respite care services received. A 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. 2. If the participant's 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 participant's 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 an ALTC TCARE - certified case manager in the participant's 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 ALTC TCARE - certified 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 home care agency shall meet with these family caregivers to obtain the information about the care receiver necessary to develop Respite care instructions for agency care providers. 2 C. All authorizations for service shall be made through the case manager. Case managers shall encourage caregivers to schedule respite care in advance. If respite care cannot be provided when requested, a waiting list shall be used. D. Maximum Hours The Respite 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 Ware case manager. E. Levels of Care Provided The level of care refers to the activities that will be performed for a participant during a given respite care episode. The Respite case manager shall determine, during the in -home assessment, the level of care needed. The program shall provide for any one of or a combination of the following levels of care for the participant: Level 1: Help with activities that require no special training; e.g., companion- ship, supervision, meal preparation. Level 2: Help with activities of daily living for which special training is required, but a licensed health practitioner is not required. It includes personal care, lifting, turning and transferring. Level 3: A licensed health practitioner (LPN or RN) must perform these tasks. VI SERVICE AREA Services shall be provided throughout Yakima County. VII UNITS OF SERVICE A. Definition: A unit of Respite service shall consist of one (1) hour of service. B. Level of Care: Relates to activities that will be performed for a participant during a given respite visit. Levels of care allowable for this contract are Levels I and II. C. There will be 4 unduplicated individuals served by this Agreement. 3 D. Anticipated Service Level by Quarter: Month Units January - March 88 April - June 88 July - September 88 October - December 1 88 Total 1 352 E. , Anticipated Expenditure Rate by Quarter: Month Total January - March $1,250 April - June $1,250 July - September $1,250 October - December $1,250 Total Is 5,000 F. 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 ALTC by the agencies collecting them. ALTC 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 case manager. 4. Funds from participants and caregivers not meeting all of the eligibility criteria shall be accounted for at the Contractor level. G. Rates Each program shall negotiate for an hourly and daily rate with the Contractor whenever possible. Rates of payment to respite care Contracting Agencies shall not exceed, and may be less than, rates paid by DSHS to Contracting Agencies for the same level of care. DSHS shall notify AAA's of the current maximum allowable rates. 1. If a Contractor has only an hourly rate, this rate shall be paid for each hour of respite care used, including 24 consecutive hours of respite care. 2. If a Contractor has only a daily rate, the rate shall be paid for 24 consecutive hours or less of respite care used. 2 3. If a Contractor has an hourly and daily rate, the hourly rate shall be paid for each hour of respite care when less than 24 hours of service is provided. The total amount paid at the hourly rate shall not exceed the Contractor's daily rate for that level of care. The daily rate shall be paid for 24 consecutive hours of respite care. The daily rate shall also be used for less than 24 consecutive hours of respite IF by using the daily rate the cost of the episode of respite care is less than using the hourly rate for the same amount of hours. 4. DSHS shall pay Medicaid certified nursing homes and developmentally disabled facilities providing respite care services the Medicaid rate approved for that facility. The rate paid to non - Medicaid certified nursing homes providing respite care services may not exceed the average Medicaid rate in that county. It shall be unlawful for any nursing home which has a Medicaid contract with DSHS to charge any amounts in excess of the Medicaid rate from the date of eligibility for services covered, except for any supplementation permitted by DSHS pursuant to RCW 18.51.070. The participant shall pay for services not included in the Medicaid rate. 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. ALTC 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 CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $5,000 from available funds as submitted on the 2013 Contract Budget Summary. This total sum shall be available during the period January 1, 2013 through December 31, 2013. These funds shall be used to provide Respite Care services. Payment to the Contractor for this Agreement shall be based on $144.20 per hour less client match as computed on the Senior Citizen Services sliding fee schedule. Term Respite,care shall be: voiced.separatelyfrom ?voice.- is,td;be:labe %d -as Short ,Term,Resvitej 5 c FUNDING SOURCE Title III -B (CFDA #93.044) SCSA Total AMOUNT '1: $1,092 $5,000 4 unduplicated individuals, 622 units of service, @ $9.81 per hour (less client match as computed on the Senior Citizen Services slide fee schedule) An additional 112 units were budgeted because of client participation. COPES rate for Level I is $9.81 per hour gp to four hours per day or $39.25 for over four hours per day. RESPITE FUNDING SOURCE AMOUNT Title III -E (CDFA #93.52) $1,081 State Family Caregiver $2,419 Total $3,500 4 unduplicated individuals, 390 units of service, @ $9.81 per hour (less client match as computed on the Senior Citizen Services sliding fee schedule) An additional 33 units were budgeted because of client participation. PERFORMANCE AGREEMENT NO. 2013 CITY OF YAKIMA ADMINISTRATION OF AGREEMENT THIS AGREEMENT is entered into this 3tPl- day of 2012, by and between Yakima County, hereinafter denominated the "County ", through the Office of Aging and Long Term Care whose address is P.O. Box 8349, Yakima, Washington 98908, hereinafter denominated the "Department ", and City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901, hereinafter denominated the "_Contractor ", whose duly authorized representatives are named in documents on file at the Office of Aging and Long Term Care. THE PURPOSE of this Agreement is to provide for the delivery of Foot Care 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's "Basic Agreement No. ALTO -12." In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. The City of Yakima shall be an additional party to the Basic Agreement and shall have all of the rights and privileges of Yakima County Southeast Washington Aging and Long Term Care contained in said Basic Agreement. PROGRAM AMOUNTS Foot Care Title III -B CFDA #93.044 Title III -D CFDA #93.043 SCSA TOTAL FUNDING ALLOCATION $42,000 PERIOD OF AGREEMENT January 1, 2013 - December 31, 2013 Tony-QAour`1e, City Manager City of Yakima Date: Attest: CONTRACT SIGNATURES City Clerk 7 City Contract No. c1a- is Resolutiqn No. /"�- - Date: t I &- /-/ 5r-- �3L- I, Onrx-� Lori J. Bro n, Director SE Washington Aging and Long Term Care Date: til : , .;7 1 Contract Authorization Performance Agreement No. 2013 City of Yakima, (Foot Care Services) OF r�� � v -.- \Cj _ -L Z _0:" Attest: Tiera L. Girard Clerk of the Board Approved as to Form: i y- , 9 Deputy Prosecuting Attorney BOARD OF YAKIMA COUNTY COMMISSIONERS / 0- J. RatA Elliott, Chairman Michael D. Leita, Commissioner —wnj K n . B uchey, Commissioner sti utin the Board of County Commissioners r Ya i County, Washington BOCC703 -2012 October 30, 2012 STANDARD TERMS AND PAYMENT PROVISXONS SPECIFIC PROVISIONS 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. CFR Title 45, Chapter XIII, Subchapter C, Part 1321 (Older Americans Act) C. WAC 388 - 106 -1100 through 1120 (Senior Citizens Services Act) D. Older American Act (PL 109 -365) II PROJECT DEFINITION Geriatric Preventative Foot Care services are intended to provide early detection of existing and potential foot problems as well as alleviate dry skin problems, and maintenance of healthy nails. Services include foot inspection and palpation, foot soaks, nail trimming, and instructions in foot health maintenance. Referrals for follow -up treatment are made to local physicians and podiatrists. III PARTICIPANTS The Contractor agrees that: A. The target population for geriatric preventative foot care services are the individuals age 60 and over who: 1. Need one or more of the program services to avoid additional health problems or assist with activities of daily living, thereby reducing the need for other services; AND 2. Are not eligible for or have exhausted other sources of payment for similar services (Medicare, Medicaid, insurance) or similar services are not available. As stated in the Geriatric Preventative Foot Care Program Standards. All persons served should be members of the target population. To the degree feasible, persons served should meet the vulnerability criteria. B. There will be written assessment procedures utilized by the Contractor to determine if the program target population criteria are met by the clients served. C. The indicators used by the Office of Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: 3 IV Low - income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Living alone ALTC funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be attained for 2013 are as follows: Target Group percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% Living alone 40% The Contractor must report on clients served in these categories. D. Local medical professionals will be available to provide consultation services and act in an advisory capacity. E. Clinics will be held monthly at each designated facility that will include, but not be limited to, low- income housing facilities and senior centers. F. Participants shall be referred to the Information and Assistance /Case Management Program as needed. G. 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. H. Services shall be provided throughout Yakima County. 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. Multicultural, bilingual persons to assist multicultural, bilingual clients in receiving services; 3. Publicity of program through public service announcements, brochures, etc. 4. Meeting with other service providers /agencies to explain services the Contractor provides and how referral can be made; 5. Ability to serve individuals with disabilities. 4 B. Services shall be delivered in accordance with the State of Washington Aging and Disabilities Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. V. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for City of Yakima to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding levels provided under the terms of this Agreement. B. The County 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. The County 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. VI. ADMINISTRATIVE AGREEMENTS: A. Access by the County: The Contractor shall provide access at all reasonable times for the County to monitor and /or evaluate the provisions of services under this Agreement. The County 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. B. Records and Reports: The Contractor agrees to: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by the County in order for the County to be assured that contracted activities remain consistent with the terms of this Agreement and the currently approved SE /ALTC Area Plan which shall be kept on file at the ALTC office. The Contractor further agrees to provide such information as requested by the County within the time limitations established by the County; 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. A quarterly report must be submitted by the end of the month following the end of each quarter. 3. Complete and submit such additional reports as are required by the County within the specified time frames, providing the Contractor is given a written request for the reports thirty (30) days prior to the due date. C. Inventory: The Contractor agrees to: 5 1. Submit to the County vendor invoice(s) at the same time with the monthly billing before County reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year physical inventory, using forms provided by the County, of all equipment purchased under this Agreement. D. Contractors Meeting: The Contractor agrees to have a representative attend meetings of the Office of Aging and Long Term Care Contractors and Long Term Care Planning Committee. 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 Southeast Washington Office of Aging and Long Term Care 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) 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, the County shall have the right to assert a claim against the Contractor on its own behalf and /or on behalf of the client. G. Private Pa v: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that the County is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. H. Maintenance of Funding Sources: The Contractor agrees that: 1. The County funds are not used to replace funds from any other existing program funding; 3. It will continue or initiate efforts to obtain support from private sources and other public organizations for this service; 11 3. It will utilize new funding sources for this service if they become available through the County and it will make any changes necessary to meet the requirements of the new funding sources. I. 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 the county must equal or exceed the rate billed the state for the same service or the state must be charged the lower rate. J. 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 the County 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 Office of Aging and Long Term Care (ALTC) staff and ALTC Advisory Council. 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 the County 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 shall be made available to the County upon request. K. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 ( "HIPAA'�, and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of The County's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to The County 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 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. L. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. C. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. 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. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. C. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. M. 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 9 data share agreement will be able to access the data that The County 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 so that unauthorized individuals cannot access 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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 42.56.210 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 10 Security Act authorizes 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. N. The Contractor shall indemnify and hold harmless Yakima County for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. 0. The Contractor will partner with ALTC's oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. P. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington PAYMENT PR®VTS..TOiVS I CONSIDERATION Payment shall be based on, claims for reimbursement as reported on the Office of Aging and Long Term Care invoice and support documentation and shall be contingent upon the receipt of all required financial and program reports by the respectively assigned due dates. The County 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. The Contractor shall submit to the County a written request for approval of budget revision when: 1. The revision would change the scope or objectives of any contracted activity category; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 11 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of the County budgeted amount for administration or service delivery. C. Payments shall be based on the County's receipt of all fiscal and programmatic reports required by this Agreement to substantiate claims for reimbursement. The County expressly reserves the right to withhold payment in whole or in part when: 1. The Contractor fails to submit all required documentation, or 2. In the County'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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of County contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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, Sec. 25. Costs borne by the program income must be used to satisfy cost sharing requirements. The County 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. 12 E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, the County may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds ALTC relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, ALTC may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the County. B. The County agrees to make payment for contracted activities provided as approved by the Auditor of Yakima County with County warrants within thirty (30) working days. This is contingent upon the availability of funds and receipt of the Contractor's claims for reimbursement by the County 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 the County. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last County working day of the month. IV. UNITS OF SERVICE A. Definition: A unit of Geriatric Preventative Foot Care service shall consist of one (1) foot care treatment. B. There will be 653 unduplicated individuals served by this Agreement (547 participants shall reside in the upper valley and 106 shall reside in the lower valley). C. Anticipated Service Level by Quarter: Month UV Units LV Units Total January - March 658 89 747 April - June 658 89 747 July - September, 658 90 748 October - Decemberl 6581 891 747 Total 321 357 2,989 13 Anticipated Service Levels include 737 additional units in the upper valley funded by donations and 72 units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV Rate LV Rate Total January - March $9,000 $1,500 $10,500 April - June $9,000 $1,500 $10,500 July - September $9,000 $1,500 $10,500 October - December $9,000 $1,500 $10,500 Total $36,000 $6,000 $42,000 PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $42,000 from available funds as submitted on the 2013 Contract Budget Summary. This total sum shall be available during the period January 1, 2013 through December 31, 2013. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before ALTC funds. 14 • r � BUSINESS OF THE CITY COUNCIL YAKIMA, WASHINGTON AGENDA STATEMENT rr,� Item No. "/ For Meeting of: November 6. 2012 -J ITEM TITLE: Resolution authorizing agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC) for the Adult Day Care and Respite Services Program and the Foot Care Services Program at the Harman Center. SUBMITTED BY: Chris Waarvick, Director of Public Works Ken Wilkinson, Parks and Recreation Manager CONTACT Ken Wilkinson, Parks and Recreation Manager, 575 -6020 PERSON /TELEPHONE: SUMMARY EXPLANATION: Submitted for City Council consideration is a resolution authorizing agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for two programs at the Harman Center, the Adult Day Care and Respite Services Program and also the Foot Care Services program. The Adult Day Care Respite Services program is a community- based, supervised daytime program providing a variety of services designed to meet the needs of adults with impairments through individual plans of care. The Foot Care Services Program provides basic preventative foot care for senior citizens. Both programs began in 1990 and have been very well received. For 2013, the Adult Day Care and Respite Services Program will be allocated $13,000. The ALTC Foot Care Services program will be allocated $42,000. Resolution X Ordinance Contract: X Contract Term: January 1, 2013 - December 31, 2013 Insurance Required? "No Funding ALTC Grant Source: Other Agreements (specify) Mail to: SE WA ALTC, P O Box 8349, Yakima, WA 98908 Amount: Adult Daycare /Respite - $13,000; Expiration Date: 12/31/2013 FootCare- $42,000 Phone: 965 -0105 APPROVED FOR • SUBMITTAL: City Manager STAFF RECOMMENDATION: Staff respectfully requests adoption of the resolution authorizing execution of agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for the delivery of Adult Day Care and Respite Services Program services and also delivery of the Foot Care Services program at the Harman Center, and depending upon funding, authorizing the City Manager to execute any subsequent amendments or reoccurring agreements that are substantially in the form of the agreement approved pursuant to this resolution, to provide these services for the following five years (2017), upon approval as to form by the City Attorney. BOARD /COMMISSION RECOMMENDATION: ATTACHMENTS: Click to download ❑ Resolution ❑ Adult Daycare Table of Contents ❑ Adult Daycare Performance Aqrmt ❑ Adult Daycare Exhibit A ❑ Adult Daycare Exhibit B Respite ❑ Adult Daycare Specific Provisions ❑ Foot Care Performance Aqrmt ❑ Foot Care Payment Provisions • 0 AGREEMENT NO. MOD. NO. FUNDING SOURCE AGREEMENT PERIOD 2013 City of Yakima TITLE III -B, Title III -D Foot Care 01 & SCSA 1/01/13- 12/31/13 THIS AGREEMENT MODIFICATION to Agreement No. 2013 City of Yakima Foot Care is entered into this y�'r day of . c 1u ne. , 2013. This Modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The purpose of this modification is to amend as follows: 1) Decrease the contract from $42,000 to $30,240. The funding sources are: Title III -B (CFDA #93.044), Title III -D (CFDA #93.043) and Senior Citizens Services Act (state); Z) Revise the PAYMENT PROVISIONS Section IV. UNITS OF SERVICE, Part B., Part C. Anticipated Service Level by Quarter and Part D. Anticipated Expenditure Rate by Quarter; 3) Revise Section V. PAYMENT CONSIDERATIONS; The parties agree that this contract modification becomes effective at the time of execution of the Yakima County Board of County Commissioners. Contractor Signatures Date: IP1 It -� c Lori J. Br n, Director SE Washington Aging and Long Term Care Date: V. a 2013 AGREEMENT MODIFICATION #1 FOOT CARE STATEMENT OF WORK CITY OF YAKIMA UNITS OF SERVICE C. Anticipated Service Level by Quarter: (first quarter shows actual units of service) Anticipated Service Levels include 561 additional units for the Upper Valley and 96 additional units for the Lower Valley funded by donations. D. Anticipated Expenditure Rate by Quarter: (first quarter shows actual expenditures) Upper Lower Upper Lower Month Valley Valley Total Valley Valley Total January - March 658 89 747 590 95 685 April - June 658 89 747 445 69 514 July - September 658 90 748 445 69 514 October - December 658 89 747 445 69 514 Total 2,632 357 2,989 1,925 302 2,227 Anticipated Service Levels include 561 additional units for the Upper Valley and 96 additional units for the Lower Valley funded by donations. D. Anticipated Expenditure Rate by Quarter: (first quarter shows actual expenditures) PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $30,240 from available funds. This total sum shall be available during the period January 1, 2013 through December 31, 2013. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before ALTC funds. 2 Upper Lower Upper Lower Month Valle Valley Total Valley Valley Total January - March $9,000 $1,500 $10,500 $7,942 $1,357 $9,299 April - June $9,000 $1,500 $10,500 $5,992 $988 $6,980 July - September $9,000 $1,500 $10,500 $5,993 $988 $6,981 October - December $9,000 $1,50 0 10 500 $5,993 987 $6,980 Total $36,000 $6,000 $42,000 $25,920 $4,320 $30,240 PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $30,240 from available funds. This total sum shall be available during the period January 1, 2013 through December 31, 2013. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before ALTC funds. 2 C o n t ra c t A u t h o r i z a t i o n Agreement No: 2013 City of Yakima Foot Care, Mod No 01 \\���jIII111lrr���/ \ \ \�O6F V ..... oQ WAS�:iy�'�'.�? IL : �, 9„ o "Lj PO ggp�dcl(Ilq� IItO �\\\\`\ Attest: Tiera irard, Clerk of the Bb-#d Mandy Burkett Deputy Clerk of the Board Approved As To Form: 4'4'q'W- Deputy Prose uting Attorney WSBA# ?4t Board of Yakima County Commissioners Michael D. Leita, Chairman , Commissioner I bbd Elliott, Commissioner Constituting the Board of County Commissioners for Yakima County, Washington BOCC278 -2013 June 4, 2013 AGREEMENT NO. MOD. NO. FUNDING SOURCE 2013 City of Yakima Adult Day Care & TITLE III -B, Title III -E, 1/01/13 - 12/31/13 Respite 01 SFCSP & SCSA THIS AGREEMENT MODIFICATION jo Agreement No. 2013 City of Yakima Adult Day Care & Respite is entered into this Stlirt day of , 2013. This Modification shall consist of those points enumerated b6TIow and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The purpose of this modification is to: 1) Increase the contract to $12,000 for Respite. The total contract amount increases from $13,000 to $20,000. EXHIBIT B 2) Revise EXHIBIT B, RESPITE STATEMENT OF WORK, Section VII. UNITS OF SERVICE, Part D. Anticipated Service Level by Quarter and Part E. Anticipated Expenditure Rate by Quarter. 3) Revise Section IX. PAYMENT CONSIDERATIONS. 4) Revise EXHIBIT C, BUDGET. Contractor Signatures OF "KIM YAKIMA COUNTY, Southeast Washington Office Of Aging And Long Term Care 5'Roafke, City Manager Lori Brown, irector Date: S 5 Date: Q 0 ,'s K�p,KIMq A t: ___N 4 City Clerk City Contract No /? - Resolution No. Date t o'� Page 1 Contract Authorization Agreement No: 2013 City of Yakima Adult Day Care & Respite, Mod No 01 \`\0111►►►►►lll�,/ .....A . S' e,. v , Attest: Tiera L. Girard, Clerk of the Board Approved As To Form: i OQ,(tp Deputy Prosecuting Attorney WSBA# �;S UJ Board of Yakima County Commissioners Michael D. Leita, Chairman — wj V I ouchey, Commissioner J. a d Elliott, Commissioner CoAstituting the Board of County Commissioners for Yakima County, Washington BOCC397 -2013 July 30, 2013 Page 2 2013 AGREEMENT MODIFICATION #1 CITY OF YAKIMA EXHIBIT B RESPITE STATEMENT OF WORK VII. UNITS OF SERVICE D. Anticipated Service Level by Quarter: Month Hours Original Modified January - March 88 211 April - June 88 212 July - September 88 211 October - December 88 211 Total 352 845 E. Anticipated Expenditure Rate by Quarter: Month Original Modified January - March $1,250 $3,000 April - June $1,250 $3,000 July - September $1,250 $3,000 October - December $1,250 $3,000 Total $5,000 $12,000 IX. PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $12,000 from available funds. This total sum shall be available during the period January 1, 2013 through December 31, 2013. These funds shall be used to provide Respite Care services. Payment to the Contractor for this unit rate price Agreement shall be based on the unit rate of $14.20 per hour, less client match as computed on the Senior Citizen Services sliding fee schedule. Page 3 EXHIBIT C BUDGET CITY OF YAKIMA ADULT DAY CARE - RESPITE ,JANUARY 1, 2013 - December 31, 2013 ADULT DAY CARE FUNDING SOURCE Title III -B (CFDA #93.044) SCSA Total AMOUNT $8,000 4 unduplicated individuals, 800 units of service, @ $10.00 per hour (less client match as computed on the Senior Citizen Services slide fee schedule). COPES rate for Level I is $9.81 per hour up to four hours per day or $39.25 for over four hours per day. RESPITE FUNDING SOURCE AMOUNT Title III -E (CDFA #93.52) State Family Caregiver Total $12,000 4 unduplicated individuals, 845 units of service, @ $14.20 per hour (less client match as computed on the Senior Citizen Services sliding fee schedule). Page .4 RESOLUTION NO. R- 2012 -136 A RESOLUTION authorizing the City Manager to execute agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for the delivery of the Adult Day Care and Respite Services Program and the Foot Care Services Program for Senior Citizens at the Harman Center, and depending upon funding, authorizing the City Manager to execute any subsequent amendments or reoccurring agreements for the following five years (2017), upon approval as to form by the City Attorney WHEREAS, the City of Yakima desires that an Adult Day Care Program and Respite Services be available at the Harman Center; and WHEREAS, the City of Yakima desires that Foot Care Program a Services be available at the Harman Center; and WHEREAS, Yakima County, through its Office of Aging and Long Term Care (ALTC), is willing to provide funding to the City for these services in accordance with the attached agreement; and WHEREAS, the City Council deems it to be in the best interest of the City of Yakima to enter agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), in accordance with the terms of the attached agreements, now, therefore, BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF YAKIMA: The City Council authorizes the City Manager to execute agreements with Yakima County, through the Office of Aging and Long Term Care (ALTC), for the delivery of Adult Day Care and Respite Services and also delivery of the Foot Care Services Program at the Harman Center, and depending upon funding, authorizes the City Manager to execute any subsequent amendments or reoccurring agreements that are substantially in the form of the agreement approved pursuant to this resolution, for the following five years (2017), upon approval as to form by the City Attorney. . ADOPTED BY THE CITY COUNCIL this 6th day of November, 2012. ATTEST: r Tee, City C FS , F � f v I S Micah Cawle , Mayor 1 I PERFORM NCE AGREEMENT NO. 2014 CITY OF YAKIMA ADMINISTRATION OF AGREEMENT 0 THIS AGREEMENT is entered into this of 4 , 2013, by and between Yakima County, hereinafter denominated the "County ", through the Southeast Washington Office of Aging and Long Term Care whose address is P.O. Box 8349, Yakima, Washington 98908, hereinafter denominated "ALTC ", and City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901, hereinafter denominated the "Contractor ", whose duly authorized representatives are named in documents on file at the Office of Aging and Long Term Care. THE PURPOSE of this Agreement is to provide for the delivery of Foot Care 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's Basic Agreement No. ALTC -12. In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. The City of Yakima shall be an additional party to the Basic Agreement and shall have all of the rights and privileges of Yakima County Southeast Washington Aging and Long Term Care contained in said Basic Agreement. PROGRAM AMOUNTS Foot Care Title III -B CFDA #93.044 SCSA TOTAL FUNDING ALLOCATION $24,828 PERIOD OF AGREEMENT January 1, 2014 - December 31, 2014 CONTRACTOR SIGNATURES • Tony O' urk - ity Manager Lori J. Broom, Director City of Yakima , SE Washington Aging and Long Term Care Date: 0.-P_O ✓ Y)1,✓ Vct ► ?CI Date: it / 7 /,? a / 3 1 A im : City Clerk - ► - tt,. �►� City Contract No /3 - -Z 3`7 � - \r Resolution No.r_ 7Oj.. - g • o z , D o S Date: aae-- 19 2..4 17 1 1k r 1 W �"" \ ∎∎ 1 Contract Authorization Performance Agreement No. 2014 City of Yakima (Foot Care Services) BOARD OF YAKIMA COUNTY COMMISSIONERS n o a Michael D. Leita, Chairman CIS :�' dA..gAex K:f ► J.: • .. - ey, Commissioner Attest: Tiera L. Girard Clerk of the Board Excused BOCC573 -2013 November 19, 2013 J. Rand Elliott, Commissioner Approved as to Form: Constituting the Board of County Commissioners I for Yakima County, Washington /Ili, Deputy Prosecuting Attorney WSBA# Sgt 1 2 STANDAF D TERMS MS ANDD PAYMERT PG°3OOMIISIIONS SP[ CIIFIIC PI;33OO MIISII ©ISIS 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. CFR Title 45, Chapter XIII, Subchapter C, Part 1321 (Older Americans Act) C. WAC 388 -106 -1100 through 1120 (Senior Citizens Services Act) D. Older Americans Act (PL 109 -365) II PROJECT DEFINITION Geriatric Preventative Foot Care services are intended to provide early detection of existing and potential foot problems as well as alleviate dry skin problems, and maintenance of healthy nails. Services include foot inspection and palpation, foot soaks, nail trimming, and instructions in foot health maintenance. Referrals for follow -up treatment are made to local physicians and podiatrists. III PARTICIPANTS The Contractor agrees that: A. The target population for geriatric preventative foot care services are the individuals age 60 and over who: 1. Need one or more of the program services to avoid additional health problems or assist with activities of daily living, thereby reducing the need for other services; AND 2. Are not eligible for or have exhausted other sources of payment for similar services (Medicare, Medicaid, insurance) or similar services are not available. As stated in the Geriatric Preventative Foot Care Program Standards. All persons served should be members of the target population. To the degree feasible, persons served should meet the vulnerability criteria. B. There will be written assessment procedures utilized by the Contractor to determine if the program target population criteria are met by the clients served. C. The indicators used by the Office of Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: 3 Low - income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Living alone ALTC funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be attained for 2014 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% Living alone 40% The Contractor must report on clients served in these categories. D. Local medical professionals will be available to provide consultation services and act in an advisory capacity. E. Clinics will be held monthly at each designated facility that will include, but not be limited to, low- income housing facilities and senior centers. F. Participants shall be referred to the Information and Assistance /Case Management Program as needed. G. 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. H. 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. IV. 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. Multicultural, bilingual persons to assist multicultural, bilingual clients in receiving services; 3. Publicity of program through public service announcements, brochures, etc. 4. Meeting with other service providers /agencies to explain services the Contractor provides and how referral can be made; 5. Ability to serve individuals with disabilities. 4 B. Services shall be delivered in accordance with the State of Washington Aging and Disabilities Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. V. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for City of Yakima to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding levels provided under the terms of this Agreement. B. The County 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. The County 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. VI. ADMINISTRATIVE AGREEMENTS: A. Yakima County may potentially cease as the sponsoring governmental entity for Southeast Washington Aging and Long Term Care. The parties agree that in the event that Yakima County ceases as sponsoring governmental entity, the County shall have the contractual right to unilaterally assign, without consent or recourse by the Contractor, the rights and terms under this contract possessed by the County to a newly created Council of Government (COG) entity which may be created in the future to handle services on behalf of the County. Such assignment by the County shall not impact any terms or conditions of this contract and the parties expressly agree that the effective date of the transfer shall be made by the Yakima County Board of County Commissioners. B. Access by the Count: The Contractor shall provide access at all reasonable times for the County to monitor and /or evaluate the provisions of services under this Agreement. The County 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: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by the County in order for the County to be assured that contracted activities remain consistent with the terms of this Agreement and the currently approved SE /ALTC Area Plan which shall be kept on file at the ALTC office. The Contractor further agrees to provide such information as requested by the County within the time limitations established by the County; 5 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. A quarterly report must be submitted by the end of the month following the end of each quarter. 3. Complete and submit such additional reports as are required by the County 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. Inventory: The Contractor agrees to: 1. Submit to the County vendor invoice(s) at the same time with the monthly billing before County reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year physical inventory, using forms provided by the County, of all equipment purchased under this Agreement. E. Contractors Meeting: The Contractor agrees to have a representative attend meetings of the Office of Aging and Long Term Care Contractors and Long Term Care Planning Committee. F. Program Publication: The Contractor agrees that: 1. The program shall be publicized on a regular basis, with all publicity and printed material identifying the Southeast Washington Office of Aging and Long Term Care 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) percent or more of the general 60+ population. G. 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, the County shall have the right to assert a claim against the Contractor on its own behalf and /or on behalf of the client. H. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that 6 the County is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. I. Maintenance of Funding Sources: The Contractor agrees that: 1. The County funds are not used to replace funds from any other existing program funding; 3. It will continue or initiate efforts to obtain support from private sources and other public organizations for this service; 3. It will utilize new funding sources for this service if they become available through the County and it will make any changes necessary to meet the requirements of the new funding sources. J. 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 the county must equal or exceed the rate billed the state for the same service or the state must be charged the lower rate. K. 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 the County will monitor and assess the activities and progress of all programs covered under this Agreement on an ongoing basis. 7 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 Office of Aging and Long Term Care (ALTC) staff and ALTC Advisory Council. 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 the County 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 shall be made available to the County upon request. L. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 ("HIPAA'), and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of The County's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to The County 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 shall disclose information for research, statistical, monitoring and evaluation purposes conducted by appropriate federal agencies and DSHS. DSHS must authorize in writing 8 the disclosure of this information to any other party not identified in this section. M. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. 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. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. 9 N. 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 The County 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 so that unauthorized individuals cannot access 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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: io 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 42.56.210 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 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. 0. The Contractor shall indemnify and hold harmless Yakima County for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. P. The Contractor will partner with ALTC's oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. Q. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington PAYMENT SENT PROVISIOI S' CONSIDERATION Payment shall be based on claims for reimbursement as reported on the Office of Aging and Long Term Care invoice and support documentation and shall be contingent upon the receipt of all required financial and program reports by the respectively assigned due dates. The County 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: 11 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. The Contractor shall submit to the County a written request for approval of budget revision when: 1. The revision would change the scope or objectives of any contracted activity category; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of the County budgeted amount for administration or service delivery. C. Payments shall be based on the County's receipt of all fiscal and programmatic reports required by this Agreement to substantiate claims for reimbursement. The County expressly reserves the right to withhold payment in whole or in part when: 1. The Contractor fails to submit all required documentation, or 2. In the County'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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of County contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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, 12 • 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, Sec. 25. Costs borne by the program income must be used to satisfy cost sharing requirements. The County 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. E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, the County may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds ALTC relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, ALTC may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the County. B. The County agrees to make payment for contracted activities provided as approved by the Auditor of Yakima County with County warrants within thirty (30) working days. This is contingent upon the availability of funds and receipt of the Contractor's claims for reimbursement by the County 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 the County. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last County working day of the month. IV. UNITS OF SERVICE A. Definition: A unit of Geriatric Preventative Foot Care service shall consist of one (1) foot care treatment. 13 • B. There will be 257 unduplicated individuals served by this Agreement (216 participants shall reside in the upper valley and 41 shall reside in the lower valley). C. Anticipated Service Level by Quarter: Month UV Units LV Units Total January - March 394 63 457 April - June 394 63 457 July - September 394 63 457 October - December 394 64 458 Total 1,576 253 1,829 Anticipated Service Levels include 456 additional units in the upper valley funded by donations and 84 units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV Rate LV Rate Total January - March $5,319 $888 $6,207 April - June $5,319 $888 $6,207 July - September $5,319 $888 $6,207 October - December $5,319 $888 $6,207 Total $21,276 $3,552 $24,828 V. PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $24,828 from available funds as submitted on the 2014 Contract Budget Summary. This total sum shall be available during the period January 1, 2014 through December 31, 2014. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before ALTC funds. 14 PERFORMANCE AGREEMENT NO. 2014 COY ADMINISTRATION OF AGREEMENT THIS AGREEMENT is entered into this / ? day of 2013 between Yakima County, hereinafter denominated the "County ", through the Southeast Washington Office of Aging and Long Term Care whose address is P.O. Box 8349, Yakima, Washington 98908, hereinafter denominated the "ALTO ", and City of Yakima Day Break Adult Day Care, 101 N. 65 Ave., Yakima, Washington 98908, hereinafter denominated the "Contractor ", whose duly authorized representatives are named in documents on file at the Office of Aging and Long Term Care. 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 Basic Agreement No. ALTC - 12. In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PAYMENT CATEGORY AMOUNTS Adult Day Care $ 5,400 Respite $10,000 TOTAL FUNDING ALLOCATION $15,400 PERIOD OF AGREEMENT January 1, 2014 - December 31, 2014 CONTRACTOR SIGNATURES A AI . _ 1/1 C) , i To " our T., City Manager Lori J. Brolein, Director City of Yakima SE Washington Aging and Long Term Care Date: (G ) ' �3 Date: (( — ag — a0/ Att t - l uiumel - -:. -,- City Clerk ' ' ' : , ` vs o " City Contract No.� /3 -238 a ! ? 1 \,r ! ; Resolution No. i ?i / — / ? (,, o, s 'i. ' q Date: u-a.c_ 194 �! `4 t... . 1 Contract Authorization Performance Agreement No. 2014 COY (City of Yakima - Adult Day Care and Respite Services) BOARD OF YAKIMA COUNTY COMMISSIONERS , I o Q ^,: �� ; Q _ Michael D. Lei a, Chairman . : • ch ey , Commissioner err Attest: Tiera L. Girard Clerk of the Board - - BOCC572 - 2013 Excused November 19, 2013 J. Rand Elliott, Commissioner Approved as to Form: Constituting the Board of County Commissioners for Yakima County, Washington GI r' r Deputy Prosecuting Attorney WSBA# sga 2 2014 ALTC CONTRACT CIITy OF MAMA ADULT DAY CARL RC SPIITE TABLE OF CO ITERITS ADMINISTRATION OF AGREEMENT (signature page) STANDARD TERMS AND PAYMENT PROVISIONS FOR MULTIPLE SERVICE PROVIDERS SPECIFIC PROVISIONS I. SERVICE SPECIFICATIONS II ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATE III. ADMINISTRATIVE AGREEMENTS PAYMENT PROVISIONS I. CONSIDERATION II. GENERAL PAYMENT CONDITIONS III. BILLING PROCEDURES EXHIBIT A ADULT DAY CARE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. PARTICIPANTS IV. SERVICE SPECIFICATIONS V. UNITS OF SERVICE VI. PAYMENT CONSIDERATIONS EXHIBIT B RESPITE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. TARGET POPULATION IV. FINANCIAL PARTICIPATION V. PROGRAM ADMINISTRATION VI. SERVICE AREA VII. UNITS OF SERVICE VIII. STAFFING STANDARDS IX. PAYMENT CONSIDERATIONS EXHIBIT C BUDGET 3 STANIDD Ab3DD TERMS AND PAYMENT PROVESIIOO RIS FOR MULTIPLE C SERVICE PROVIDERS ERS SPECIFIC PROVISIONS 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 State of Washington Aging and Adult Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. II. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for Adult Day Care and Respite Care to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding levels provided under the terms of this Agreement. B. The County 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. The County 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. 4 III. ADMINISTRATIVE AGREEMENTS: A. Yakima County may potentially cease as the sponsoring governmental entity for Southeast Washington Aging and Long Term Care. The parties agree that in the event that Yakima County ceases as sponsoring governmental entity, the County shall have the contractual right to unilaterally assign, without consent or recourse by the Contractor, the rights and terms under this contract possessed by the County to a newly created Council of Government (COG) entity which may be created in the future to handle services on behalf of the County. Such assignment by the County shall not impact any terms or conditions of this contract and the parties expressly agree that the effective date of the transfer shall be made by the Yakima County Board of County Commissioners. B. Access by the County: The Contractor shall provide access at all reasonable times for the County to monitor and /or evaluate the provisions of services under this Agreement. The County 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: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by the County in order for the County to be assured that contracted activities remain consistent with the terms of this Agreement and the currently approved SE /ALTC Area Plan which shall be kept on file at the ALTC office. The Contractor further agrees to provide such information as requested by the County within the time limitations established by the County. 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. A quarterly report must be submitted to ALTC by the end of the month following the end of each quarter. 3. Complete and submit such additional reports as are required by the County 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. Inventory: The Contractor agrees to: 1. Submit to the County vendor invoice(s) at the same time with the monthly billing before County reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year physical inventory, using forms provided by the County, of all equipment purchased under this Agreement. 5 E. Contractors Meeting: The Contractor agrees to have a representative attend the Office of Aging and Long Term Care Contractors and Long Term Care Planning Committee meetings. F. Program Publication: The Contractor agrees that: 1. The program shall be publicized on a regular basis, with all publicity and printed material identifying the Southeast Washington Office of Aging and Long Term Care 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: 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) percent or more of the general 60+ population. G. 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, the County shall have the right to assert a claim against the Contractor on its own behalf and /or on behalf of the client. H. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that the County is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. Maintenance of Funding Sources: The Contractor agrees that: 1. The County 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. It will utilize new funding sources for this service if they become available through the County and it will make any changes necessary to meet the requirements of the new funding sources.H: \2014 CONTRACTS \2014 Contracts \City Of Yakima, Adult Day Care \2014 STP COY (adc resp).doc 3. Fees and Donations: The Contractor agrees that: 6 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 the county must equal or exceed the rate billed the state for the same service or the state must be charged the lower rate. K. 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 the County 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 Office of Aging and Long Term Care (ALTC) staff and ALTC Advisory Council. 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 the County 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 shall be made available to the County upon request. L. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 ("HIPAA'), and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of The County's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to The County 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 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. M. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 8 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. Client information may be provided to the client, client's authorized guardian, or a client- authorized 3 party per WAC 388 -01, and the Long Term Care Manual. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. N. 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 The County 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: 9 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); 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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 42.56.210 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 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. 0. The Contractor shall indemnify and hold harmless Yakima County for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. 10 P. The Contractor will partner with ALTC's oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. Q. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. PAYMENT PROVISIONS CONSIDERATION Payment shall be based on claims for reimbursement as reported on the Office of Aging and Long Term Care invoice and support documentation and shall be contingent upon the receipt of all required financial and program reports by the respectively assigned due dates. The County 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. The Contractor shall submit to the County a written request for approval of budget revision when: 1. The revision would change the scope or objectives of any contracted activity category; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of the County budgeted amount for administration or service delivery. C. Payments shall be based on the County's receipt of all fiscal and programmatic reports required by this Agreement to substantiate claims for reimbursement. The County expressly reserves the right to withhold payment in whole or in part when: 11 1. The Contractor fails to submit all required documentation, or 2. In the County'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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of County contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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, Sec. 25. Costs borne by the program income must be used to satisfy cost sharing requirements. The County 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. E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, the County may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 12 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds ALTC relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional " or modified conditions are placed on such funding, ALTC may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the County. B. The County agrees to make payment for contracted activities provided as approved by the Auditor of Yakima County with County warrants within thirty (30) working days. This is contingent upon the availability of funds and receipt of the Contractor's claims for reimbursement by the County 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 the County. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last County working day of the month. 13 ENHE1 ]IT A ADULT DAY CARE STATIEHIEMnT OCR'WORK CETYOFYAKIMA 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 (PL 109 -365) C. WAC 388 - 106 -1100 through 1120 (Senior Citizens Service Act) D. WAC 388 - 106 -0300 (COPES Services) E. WAC 388 -71 -0702 through 0776 (Adult Day Care) 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 Services is a supervised daytime program providing core services as defined under WAC 388- 106 -0800 subsection (2). Core services are appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. The adult day care 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 -71 -0215, 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 client's plan of care and are based on the client's abilities, interests and goals; 1 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. III PARTICIPANTS The Contractor agrees that: A. The target population for the day care program is individuals who are appropriate for care services as referenced in the Adult Day Care WAC 388- 71 -0704. B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by the Office of Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low - income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Office of Aging and Long Term Care (ALTC) funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be targeted for 2014 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% The Contractor must report on clients served in these categories. 2 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. 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 day care services to achieve treatment goals. 1. Adult day care center staff are responsible for determining the financial and program eligibility of an applicant for day care services. 2. Eligibility must be determined prior to the provision of adult day care services and within thirty (30) days after the applicant has requested service. Eligible applicants may be provided services as of the date of application. 3. A Participant Intake Form (PIF) or other client tracking information shall be completed on each client served and submitted as required to the Office of Aging and Long Term Care. B. Eligibility Re- determination The purpose of the eligibility re- determination is to assess whether an adult day care client continues to meet financial and program eligibility criteria. 1. Adult day care center staff are responsible for re- determining eligibility. A new Senior Citizens Services Application must be completed to document whether the client was found to be eligible or ineligible. 2. Eligibility must be determined: a. Within thirty (30) days after the adult day care center has received information that a change has occurred in the client's circumstances that may make the client ineligible; b. At six -month intervals if change occurs; c. At twelve -month intervals 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 C. Reduction/Termination of Services The Discharge Plan Form must be completed when a client becomes ineligible for adult day care services or when services are reduced or terminated for any reason. 1. Adult day care 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 care 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 day care center staff, the client no longer requires adult day care services, adult day care services no longer meet the client's needs or the client is not both willing and able to effectively utilize the adult day care program to achieve treatment goals. Whenever possible, service termination should be accomplished through mutual negotiation with the client and with the involvement of client's family and /or others in his /her informal support system and the client's physician; c. Funding cutbacks require termination. 4. A client who disagrees with a decision of adult day care staff to reduce or terminate services has ninety (90) days after receipt of the Discharge Plan Form to request a fair hearing. Services may not be reduced or terminated until the fair hearing decision is rendered if the request for a hearing is received prior to the effective date for reduction or termination. 4 D. The day care center must be located in geographic areas which contain major concentrations or high proportions of target group older persons. E. Transportation to and from the center must be available. F. The day care 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. G. The day care center must meet the minimum staffing requirements for a center, which operates five (5) days a week and has an average daily attendance of less than twenty (20) participants. H. The day care center should have a written plan for evaluating whether the program is meeting the day care standards and the needs of the participants. I. Participants shall be referred to other services as needed. J. 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. K. 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 service shall consist of one (1) hour of Adult Day Care service, not including transportation time. B. There will be 4 unduplicated individuals served by this Agreement. C. Anticipated Service Level by Quarter: Month Hours January - March 135 April - June 135 July - September 135 October - December 135 Total 540 D. Anticipated Expenditure Rate by Quarter for client services: Month Rate January - March $1,350 April - June $1,350 July - September $1,350 October - December $1,350 Total $5,400 5 VI PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor for client Adult Day Care Core services a sum not to exceed $5,400 as submitted on the 2014 Contract Budget Summary. The contracted amount shall be available during the period January 1, 2014 through December 31, 2014. 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. The payment for COPES services will be in addition to the contracted amount. The COPES payment will be based on claims for reimbursement as reported on the COPES services billing. This includes clients now authorized, number of units of service and the actual number of units provided. The COPES unit rate will be $9.81 per hour or $39.25 per day and revised, if applicable, to reflect the unit rate established by DSHS. Services are reimbursed on an hourly basis up to four hours per day. Any service provided over four hours per day shall be reimbursed at the daily rate. In addition, COPES transportation rate to Day Break is $3.00 per day if utilizing the Dial -A -Ride program. 6 C NII13IIT l RE SPII=C STATEMENT f` T OO F 'WORK CIITY OF YAKIIMI 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 -0702 through 388 -71 -0776 (Adult Day Services) C. Title III E of the Older American's Act (PL 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 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 illnesses 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 55 and above or disabled. 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. 1 • IV FINANCIAL PARTICIPATION DSHS requires eligible participants to pay part of the cost of the respite care services received. A 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. 2. If the participant's 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 participant's 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 an ALTC TCARE - certified case manager in the participant's 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 ALTC TCARE - certified 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 home care agency shall meet with these family caregivers to obtain the information about the care receiver necessary to develop Respite care instructions for agency care providers. 2 • C. All authorizations for service shall be made through the case manager. Case managers shall encourage caregivers to schedule respite care in advance. If respite care cannot be provided when requested, a waiting list shall be used. D. Maximum Hours The Respite 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 TCare case manager. E. Levels of Care Provided The level of care refers to the activities that will be performed for a participant during a given respite care episode. The Respite case manager shall determine, during the in -home assessment, the level of care needed. The program shall provide for any one of or a combination of the following levels of care for the participant: Level 1: Help with activities that require no special training; e.g., companion- ship, supervision, meal preparation. Level 2: Help with activities of daily living for which special training is required, but a licensed health practitioner is not required. It includes personal care, lifting, turning and transferring. Level 3: A licensed health practitioner (LPN or RN) must perform these tasks. 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 of Respite service shall consist of one (1) hour of service. B. Level of Care: Relates to activities that will be performed for a participant during a given respite visit. Levels of care allowable for this contract are Levels I and II. C. There will be 4 unduplicated individuals served by this Agreement. 3 D. Anticipated Service Level by Quarter: Month Units January - March 176 April - June 176 July - September 176 October - December 176 Total 704 E. Anticipated Expenditure Rate by Quarter: Month Tot ! January - March $2,500 April - June $2,500 July - September $2,500 October - December $2,500 Total $10,0001 F. 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 ALTC by the agencies collecting them. ALTC 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 case manager. 4. Funds from participants and caregivers not meeting all of the eligibility criteria shall be accounted for at the Contractor level. G. Rates Each program shall negotiate for an hourly and daily rate with the Contractor whenever possible. Rates of payment to respite care Contracting Agencies shall not exceed, and may be less than, rates paid by DSHS to Contracting Agencies for the same level of care. DSHS shall notify AAA's of the current maximum allowable rates. 1. If a Contractor has only an hourly rate, this rate shall be paid for each hour of respite care used, including 24 consecutive hours of respite care. 2. If a Contractor has only a daily rate, the rate shall be paid for 24 consecutive hours or less of respite care used. 4 3. If a Contractor has an hourly and daily rate, the hourly rate shall be paid for each hour of respite care when less than 24 hours of service is provided. The total amount paid at the hourly rate shall not exceed the Contractor's daily rate for that level of care. The daily rate shall be paid for 24 consecutive hours of respite care. The daily rate shall also be used for less than 24 consecutive hours of respite IF by using the daily rate the cost of the episode of respite care is less than using the hourly rate for the same amount of hours. 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. ALTC 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 CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $10,000 from available funds as submitted on the 2014 Contract Budget Summary. This total sum shall be available during the period January 1, 2014 through December 31, 2014. These funds shall be used to provide Respite Care services. Payment to the Contractor for this Agreement shall be based on $14.20 per hour less client match as computed on the Senior Citizen Services sliding fee schedule. Short Term Respite care shall be invoiced separately from Traditional Respite Care. The invoice is to be labeled as Short Term Respite. 5 GEOEIU IIT C BUDGET CITY OF YAf IIlr�ilA ADULT DAY CARE RESKTE JANUARY fl 2M4 e DECEMBER MBER 321, 2014 ADULT DAY CARE FUNDING SOURCE AMOUNT Title III -B (CFDA #93.044) SCSA To$aD $5,400 4 unduplicated individuals, 540 units of service, @ $10.00 per hour (less client match as computed on the Senior Citizen Services slide fee schedule). COPES rate for Level I is $9.81 per hour up to four hours per day or $39.25 for over four hours per day. RESPIITC FUNDING SOURCE AMOUNT Title III -E (CFDA #93.52) State Family Caregiver Tot D $10,11 4 unduplicated individuals, 704 units of service, @ $14.20 per hour (less client match as computed on the Senior Citizen Services sliding fee schedule). 1 BASIC AGREEMENT: SE WA ALTC -2015 between SOUTHEAST WASHINGTON AGING AND LONG TERM CARE COUNCIL OF GOVERNMENTS and THE CITY OF YAKIMA Table of Contents PURPOSE 1 II AUTHORITY OF THE DIRECTOR 1 III EXTENT OF AGREEMENT 1 IV PERIOD OF AGREEMENT 1 V COMPLIANCE WITH LAWS 1 VI ORDER OF PRECEDENCE 1 VII RELATIONSHIP OF THE PARTIES 2 VIII DEFINITIONS 2 IX SAFEGUARDING OF INFORMATION 2 X TREATMENT OF ASSETS 3 XI LICENSING AND PROGRAM STANDARDS 4 XII ° STANDARDS FOR FISCAL ACCOUNTABILITY 4 XIII, INSPECTION 4 XIV HOLD HARMLESS 5 XV ° AUDIT REQUIREMENTS 5 XVI', INSURANCE AND BONDING 7 XVII NONDISCRIMINATION 7 XVIII INCIDENT REPORTING 8 XIX ASSIGNMENT AND SUBCONTRACTING 9 XX " SEVERABILITY 9 XXI, MODIFICATION 9 XXII SUSPENSION, TERMINATION AND CLOSE -OUT 9 XXIII INDIVIDUAL RIGHTS AND HIPAA 10 XXIV GRIEVANCE PROCEDURES 10 XXV DEBARMENT AND EXCLUSION 11 XXVI CONFLICT OF INTEREST 11 XXVII CONVENANT AGAINST CONTINGENT FEES 11 XXVIII LOBBYING 11 XXIX PROHIBITION OF POLITICAL ACTIVITES 12 XXX DISPUTES 12 XXXI DRUG -FREE WORKPLACE 12 XXXII REIMBURSEMENT LIMITS 12 XXVIII VENUE 13 XXXIV CONDITION PRECEDENT 13 CONTRACTAUTHORIZATION 13 COY THIS BASIC AGREEMENT is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments hereinafter called "Southeast Washington Aging and Long Term Care," whose address is P.O. Box 8349 Yakima, Washington 98908, and The City of Yakima hereinafter called "the Contractor" whose address is 129 North Second Street, Yakima, Washington, 98901. I PURPOSE The purpose of this document is to establish a Basic Agreement containing General Terms that shall be incorporated by reference into any Contract executed between Southeast Washington Aging and Long Term Care and the Contractor. II AUTHORITY OF THE DIRECTOR OF SOUTHEAST WASHINGTON AGING AND LONG TERM CARE Southeast Washington Aging & Long Term Care hereby appoints and the Contractor hereby accepts the Director of Southeast Washington Aging and Long Term Care or a designee, as the Southeast Washington Aging and Long Term Care's representative for the purpose of administering the provisions of this Basic Agreement and subsequent Contracts, including Southeast Washington Aging and Long Term Care's right to inspect facilities and records, to receive and act on reports and documents, to request and receive additional information from the Contractor, to approve budget revisions and payment changes, to approve fee schedules for services, to assess the general performance of the Contractor, to determine if contracted services are being delivered in accordance with Federal, State, and local laws and regulations, to approve subcontracts, and to suspend this Basic Agreement or any Contract. All actions taken by the Director shall be subject to approval by the Southeast Washington Aging and Long Term Care. Southeast Washington Aging and Long Term Care reserves the right to terminate this Basic Agreement or any Contract and to commence civil action for its enforcement. III EXTENT OF AGREEMENT The Basic Agreement and Contract(s) contain all the terms agreed upon by the parties. No other understandings, written or oral, regarding the subject matter of this Basic Agreement or any Contract shall bind the parties. IV PERIOD OF AGREEMENT l The terms of this Basic Agreement shall commence upon the date of execution and shall remain in full force and effect until specifically modified or terminated by mutual assent of the parties regardless of the modification or termination in whole or in part of any Contract. This Basic Agreement supersedes any prior Basic Agreement executed between Southeast Washington Aging and Long Term Care and the Contractor. V COMPLIANCE WITH LAWS The Contractor, in performance of this Basic Agreement and any Contract, shall comply with all applicable Federal, State, and local laws and regulations including HIPAA. VI ORDER OF PRECEDENCE Unless otherwise provided in a Contract, any inconsistency in the Basic Agreement or a Contract shall be resolved by giving precedence in the following order: A. Applicable Federal and State laws and Regulations; B. The terms and conditions of a Contract; Page 1 of 13 COY C. The terms and conditions of the Basic Agreement; D. Any other provisions incorporated in writing into the Basic Agreement or Contract. VII RELATIONSHIP OF THE PARTIES The parties agree that the Contractor is an independent contractor and not an agent or employee of Southeast Washington Aging and Long Term Care. Agents, employees, or representatives of the Contractor shall neither claim to be nor present themselves as employees, agents, or representatives of Southeast Washington Aging and Long Term Care for any purpose. Employees of the Contractor are not entitled t6 any benefits Southeast Washington Aging and Long Term Care provides for its employees. VIII DEFINITIONS Terms used throughout this Basic Agreement shall have meanings as defined in the Washington Administrative Code (WAC). Additionally, the following words shall have the meanings as indicated: Aging and Long Term Care — Southeast Washington Aging and Long Term Care. Basic Agreement - This Agreement, which identifies the Contractor and the general terms that apply when and if Southeast Washington Aging and Long Term Care and the Contractor execute a Contract. The terms' of the Basic Agreement are applicable to a Contract. Client - An individual applying for or receiving goods, services or benefits under a Contract. The terms Consumer, Customer, and Participant are synonymous. Contract, - A document consisting of terms specific to contracted services, including Specific Provisions, Payment Provisions, and a Budget. Contracted Services - Those services to be provided by the Contractor under the terms of a Contract. Contractor - The individual or entity entering into this Basic Agreement with Southeast Washington Aging and Long Term Care. If a Contract is subsequently executed, the Contractor will deliver contracted services. Contractor includes authorized representatives and subcontractors retained to deliver contracted services. The term Business Associate is synonymous. Director = The Director of the Southeast Washington Aging and Long Term Care or designee. Ir HIPAA —" Health Insurance Portability and Accountability Act of 1996, 45 CFR 160, 164, privacy and security standards for Private Health Information. PHI — Private Health Information means individually identifiable information relating to the past, present or future physical or mental health or condition of an individual, provision of health care to an individual, or the past, present or future payment for health care provided to an individual. Subcontract - An agreement between the Contractor and a subcontractor, or between a subcontractor and another subcontractor, for the delivery of contracted services. The term subcontract does not include the purchase of supplies or support services that do not directly affect the client's health or welfare. The term subcontract means subcontract in any tier. Subcontractor - An individual or other entity delivering contracted services under a separate agreement with the Contractor or another subcontractor. The individual or entity is bound by the same HIPAA restriction and conditions as the county and contractor. The term "subcontractor" means subcontractor in any tier. IX SAFEGUARDING OF INFORMATION The use or disclosure by the Contractor of confidential information and PHI concerning a client is prohibited without the written consent /authorization of the client, their designee, or responsible parent or guardian if the client is incompetent or a minor, or as otherwise provided by law, except: Page 2 of 13 COY A. The Director or the Contractor may disclose information to each other, the State of Washington, or the Federal government for purposes directly connected with the administration of this Basic Agreement or any Contract. Such information includes determining eligibility, delivering services, and participating in an audit. B. The Director or the Contractor may disclose information to appropriate Federal agencies and the State of Washington for research, monitoring, statistical, and evaluation purposes. C. The Director and the Contractor may disclose PHI to each other for data aggregation services, treatment, payment or health care operations. D. The contractor agrees to develop and use appropriate procedural, physical, and electronic safeguards to prevent misuse of PHI. The contractor must limit any use or disclosure to the minimum amount necessary to accomplish the intended purpose. X TREATMENT OF ASSETS Real and personal property shall not be purchased under this Basic Agreement or any Contract without prior written approval from the Director. An inventory of such property shall be completed annually and submitted to the Director A. Definitions: 1. Nonexpendable Personal Property means tangible personal property having a useful life of more than one year and an acquisition cost of $5,000.00 or more per unit, unless defined otherwise by Contract. 2. Personal Property means property of any kind except real property. 3. Acquisition Cost means the amount expended for property, excluding interest and the book value (acquisition cost less depreciation) of any trade -in. 4. Useful Life of property means that useful service life as based on the U. S. Department of Treasury, Internal Revenue Service, policies on depreciation for tax purposes, unless the Contractor can document to the written satisfaction of the Director some different period. B. Title to all property furnished by Southeast Washington Aging and Long Term Care with County, State, or Federal funds shall remain with Southeast Washington Aging and Long Term Care, the State of Washington, or the Federal Government as their respective interests may appear. C. Title to all nonexpendable personal property purchased by the Contractor, the cost of which the Contractor is entitled to be reimbursed as a direct item of cost under a Contract, shall pass to and vest in Southeast Washington Aging and Long Term Care or State of Washington, or Federal Government as their respective interests may appear, upon delivery of such property. D. Nonexpendable personal property purchased by the Contractor under the terms of any Contract in which title is vested in Southeast Washington Aging and Long Term Care, State, or Federal Government shall not be rented, loaned, or otherwise passed to any person, partnership, corporation, association or organization without the prior written approval of the Southeast Washington Aging and Long Term Care, State, or Federal Government. E. Nonexpendable personal property furnished to or purchased by the Contractor, which is vested in Southeast Washington Aging and Long Term Care, State, or Federal Government, shall be used only for the delivery of contracted services. F. As a condition precedent to reimbursement for the purchase of nonexpendable personal property, title to which shall vest in Southeast Washington Aging and Long Term Care, State, or Federal Government, the Contractor agrees to ;execute such security agreements and other documents as shall be necessary for Southeast Washington Aging and Long Term Care, State, or Federal Page 3 of 13 COY Government to protect their respective interests in such property in accordance with the Uniform Commercial Code - Secured Transactions as codified in Article 9, Title 62A, RCW. G. The Contractor shall be responsible: 1. For loss or damage to property of Southeast Washington Aging and Long Term Care, State, or Federal Government that results from negligence, willful misconduct, or lack of good faith on the part of the Contractor; 2. To maintain and administer property in accordance with sound management practices; and 3. To ensure that the property shall be returned to Southeast Washington Aging and Long Term Care, State, or Federal Government in condition as good as when acquired, reasonable wear and tear expected. H. Upon the loss or destruction of or damage to Southeast Washington Aging and Long Term Care, State, or Federal Government property, the Contractor shall notify the Director thereof and shall take all reasonable steps to protect that property from further damage. I. The Contractor shall surrender to the Director all property of Southeast Washington Aging and Long Term Care, State, or Federal Government within 30 days after settlement upon rescission, termination, or completion of this Basic Agreement or the Contract(s) for which the property was purchased, unless otherwise mutually agreed between the Contractor and the Director. J. The Director may, at his or her discretion, abandon in place property in which title is vested in Southeast Washington Aging and Long Term Care, State, or. Federal Government under the terms of this Basic Agreement insofar as permitted by law, rule, or regulation, and thereupon all rights and obligations of Southeast Washington Aging and Long Term Care, State, or Federal Government regarding such abandoned property shall cease. XI LICENSING AND PROGRAM STANDARDS The Contractor shall comply with all applicable Federal, State, and local laws and regulations for licensing, certification and operation of facilities and programs, and accreditation and licensing of individuals, and other standards or criteria as described in this Basic Agreement or any Contract to assure quality of services. XII STANDARDS FOR FISCAL ACCOUNTABILITY A. The Contractor's fiscal management system shall: 1. Provide accurate, current, and complete disclosure of the financial status of each Contract; 2. Identify the source and application of all funds received for contracted services, distinguish costs of contracted services delivered under the terms of the Contract from all other costs and provide for accounting separation of all funds received; and 3. Report all revenue and expenditures to the Director in a manner consistent with generally accepted accounting principles. B. The Contractor agrees to maintain written accounting procedures. C. The Contractor agrees to: 1. Maintain records and documents that accurately reflect all direct and indirect costs related to the delivery of contracted services; and 2. Retain all fiscal and program records and other material relevant to a Contract according to the federal or state program guidelines. Fiscal records must be retained until all audits are resolved. Page 4 of 13 COY XIH INSPECTION A. The Contractor shall give access to its facilities and records to any authorized officer, employee or agent of Southeast Washington Aging and Long Term Care, the State of Washington or the Federal Government at all reasonable times. Authorized persons shall have the right to examine the Contractor's performance, financial records, and HIPAA documentation and perform other activities to determine the Contractor's compliance with the terms of this Basic Agreement, any Contract, and HIPAA. The Director shall give the Contractor reasonable notice of monitoring, auditing, observation and other visits by its officers and employees to the Contractor's place of business. B. The Director may require the Contractor to make reasonable changes in the contracted services and HIPAA practices, as completed or to be completed, if the contracted services fail to conform to the standards and specifications set forth in the Contract. C. The Contractor shall notify the Director immediately of inspections, audits, accreditations, or program reviews related to the delivery of contracted services. The Contractor agrees to provide the Director copies of written reports of inspections, audits, accreditations or program reviews within 72 hours. XIV HOLD HARMLESS A. Indemnification, Defense, and Hold Harmless: To the fullest extent permitted by law including RCW 4.24.115, the Contractor shall indemnify, defend, and save harmless Southeast Washington Aging and Long Term Care and its officers, employees, agents, and volunteers from all claims, suits, or actions brought for injuries to, or death of, any persons, or damages arising from or relating to the Contractor's performance of this Agreement or in consequence of any negligence or breach of contract related to the Contractor's performance of this Agreement caused in whole or in part by any act or omission by the Contractor or the agents or employees of the Contractor related to performance of this Agreement. B. Contractor's Waiver of Employer's Immunity under Title 51 RCW: Contractor intends that its obligations to indemnify, defend, and hold harmless set forth above in section 15 shall operate with full effect regardless of any provision to the contrary in Title 51 RCW, Washington's Industrial Insurance Act. Accordingly, the Contractor specifically assumes all potential liability for actions brought by employees of the Contractor against Southeast Washington Aging and Long Term Care and its officers, employees, agents, and volunteers, and, solely for the purpose of enforcing the Contractor's obligations to indemnify, defend, and hold harmless set forth above in section 15, the Contractor specifically waives any immunity granted under the state industrial insurance law, Title 51 RCW. The parties have mutually negotiated this waiver. The Contractor shall similarly require that any subcontractor it retains in connection with its performance of this Agreement shall comply with the terms of this paragraph, waive any immunity granted under Title 51 RCW, and assume all liability for actions brought by employees of the subcontractor. XV AUDIT REQUIREMENTS A. Definitions Single Audit means an audit that will encompass the entirety of the financial operations of the Contractor and shall determine and report whether: I. The financial statements of the Contractor present fairly its financial position and the results of its financial operations in accordance with generally accepted accounting principles, and whether the Contractor has complied with laws and regulations that may have a material effect upon the financial statements; Page 5 of 13 COY 2. The Contractor has internal control systems to provide reasonable assurance that it is managing Federal financial assistance programs in compliance with applicable laws and regulations; and 3. The Contractor has complied with laws and regulations that may have a material effect upon each major Federal assistance program. In testing compliance for this section the auditor must select and test a representative number of transactions from each major Federal assistance program. Program- Specific Audit means an audit of one Federal program in accordance with Federal laws, regulations, or audit guides relative to that particular program. When a Contractor expends Federal Financial Assistance under only one Federal program and the Federal program's laws, regulations, or grant agreements do not require a financial statement audit of the Contractor, the Contractor may elect to have a program - specific audit. Subrecipient means any person or government department, agency, or establishment that receives federal financial assistance to carry out or administer a program but not an individual who is a beneficiary of such a program. Distinguishing characteristics of a subrecipient include such items as responsibility to meet compliance requirements, performance measured against meeting the objectives of a program, responsibility for programmatic decision making, and determining eligibility for assistance. Vendor means an entity responsible for providing goods or services that are required for the conduct of a Federal program. Distinguishing characteristics of a vendor include such items as providing the goods or services within normal business operations, operating for a profit, providing similar goods or services to many different purchasers, operating in a competitive environment, and not having responsibility for adherence to program compliance requirements. Federal Financial Assistance means assistance provided by a Federal agency in the form of grants, contracts, cooperative agreements, loans, loan guarantees, property, interest subsidies, insurance, food commodities, direct appropriations, and other assistance. It does not include direct Federal cash assistance to individuals. It includes awards received directly from Federal agencies or indirectly through other units of state and local governments. B. The Contractor, if a subrecipient of Federal Financial Assistance and expends (from all sources) $750,000 or more a year in Federal Financial Assistance, shall purchase annually a single or program - specific audit conducted for that year by a government auditor or public accountant who meets the standards for independence specified in the Government Auditing Standards. The Contractor agrees to: 1. Adhere to the Office of Management and Budget (OMB) Circular A -133 and other relevant Federal and State Requirements; 2. Provide access to independent auditors to its financial records; and 3. Maintain accounting records that will enable identification of all federal funds received and expended by the OMB Catalog of Federal Domestic Assistance number. C. The Contractor, if a subrecipient of Federal Financial Assistance and expends (from all sources) less than $750,000 per year in Federal awards is exempt from Federal audit requirements for that year, but records must be available for review or audit by appropriate officials of the Federal Agency, pass- through entity and the General Accounting Office (GAO). D. The Contractor, if a vendor, is exempt from Federal audit requirements but records must be available for review by appropriate officials of the Federal agency, pass- through entity, and the General Accounting Office. The Contractor agrees to: Page 6 of 13 COY 1. Ensure that transactions are in compliance with laws, regulations, and the provisions of the Contract or grant agreements; 2. Maintain accounting records that will enable identification of all federal funds received and expended; and 3. Provide access to its financial records by appropriate officials of Southeast Washington Aging and Long Term Care, State, Federal Government or their authorized representative to determine program compliance. E. The Contractor shall ensure that the audit report, with management letter, is submitted to the Director within nine months after the end of the audit period but no later than 30 -days after its receipt. XVI INSURANCE AND BONDING A. Southeast Washington Aging and Long Term Care certifies that it is insured as a member of Enduris, and can pay for losses for which it is found liable. B. The Contractor shall maintain occurrence based comprehensive general liability insurance and automobile liability insurance with minimum limits of $1,000,000 per occurrence and $2,000,000 aggregate, as well as Workers Compensation Contingent Employers Liability with minimum limits of $1,000,000 each accident or disease for each employee. Such insurance shall provide that Southeast Washington Aging and Long Term Care, its officers, employees, agents and volunteers are II Primary Additional Insured's under such insurance. The coverage provided under such insurance for such Primary Additional Insured's shall be primary and not contributory to any other coverage that may be available to such Primary Additional Insured's. Prior to commencement of any' under this Agreement, the Contractor shall, provide proof of such insurance including all Cerificates of Insurance and endorsements pertaining to such insurance, and if requested, any policy pertaining to insurance required under this Agreement. C. The Contractor agrees to maintain, without interruption during the term of a Contract, a Fidelity Bond in a minimum amount of $50,000, unless specified otherwise in the contract, which covers all individuals responsible for the administration of funds provided within the terms of a Contract. Certification of bonding shall be submitted to the Director within thirty days after execution of a Contract. D. The Contractor shall notify the Director immediately if either insurance or bonding coverage is terminated during the term of a Contract or is reduced below contractual requirements. XVH NONDISCRIMINATION A. The Contractor shall develop or adopt a nondiscrimination plan consistent with the Washington State Law Against Discrimination (RCW 49.60). B. The Contractor agrees that it shall not discriminate against any person on the grounds of race, creed, color, religion, national origin, sex, sexual orientation, age, marital status, political affiliation or belief, or the presence of any sensory, mental or physical handicap in violation of the Washington State Law Against Discrimination (RCW Chapter 49.60) or the Americans with Disabilities Act (42 USC 12101 et seq). In the event the Contractor violates this provision, ALTC may terminate this Agreement immediately and bar the Contractor from performing any services for ALTC in the future. The Contractor shall not: 1. Deny an individual contracted services or benefits; 2. Provide contracted services or benefits to an individual that are different, or are provided in a different manner, from those provided to others; Page 7 of 13 COY II 3. Subject an individual to segregation or separate treatment in any manner related to the receipt of contracted services or benefits; or 4. Deny an individual an opportunity to participate in any program or afford an opportunity to do so that is different from that afforded others. C. Theo Contractor shall not use criteria or methods of administration that have the effect of subjecting individuals to discrimination because of race, creed, color, religion, national origin, sex, sexual orientation, age, marital status, political affiliation or belief, or the presence of any sensory, mental or physical handicap or have the effect of defeating or substantially impairing the delivery of contracted services to the class of individuals mentioned above through the selection of: 1. The types of contracted services or other benefits to be provided; 2. , The class of individuals to whom, or the situation in which, such contracted services or other benefits shall be provided; or 3. The class of individuals to be afforded an opportunity to receive contracted services or other benefits; In accordance of the Washington State Law Against Discrimination (RCW Chapter 49.60) or the Americans with Disabilities Act (42 USC 12101 et seq). In the event the Contractor violates this provision, Southeast Washington Aging and Long Term Care may terminate this Agreement immediately and bar the Contractor from performing any services for ALTC in the future. D. TheliContractor shall comply with all Federal and State nondiscrimination rules, including: 1. The Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination against qualified individuals with disabilities and requires reasonable accommodations to the known physical or mental limitations of an otherwise qualified individual. 2. Title VI of the Civil Rights Act of 1964 as amended. 3. Section 504 of the Rehabilitation Act 1973 as amended. 4. The Age Discrimination Act of 1975 as amended. 5. The Washington State Law Against Discrimination, RCW 49.60. E. The Contractor shall have a written procedure for resolving complaints that allege a violation of Federal laws against discrimination. A copy shall be made available to clients and applicants for contracted services. Such procedures should include time frames for Contractor response or action. Persons wishing to file a complaint shall be advised in writing of their right to file their complaint wit 180 days of the alleged act of discrimination directly with the Washington State Human Rights Commission, the U.S. Equal Employment Opportunity Commission, the U.S. Department of Health and Human Services Office for Civil Rights, or the U.S. Department of Labor Office of Contract Compliance. F. The Contractor shall require subcontractors to fully comply with the provisions of this section, Including sanctions for noncompliance. XVIII INCIDENT REPORTING The Contractor agrees to report any extraordinary incident to the Director, in writing, within three working days of the occurrence of an incident. A reportable incident is one that occurs or arises under this Basic Agreement or any Contract, and that involves: A. A death or injury, requiring inpatient hospital care, of a client or person under the care, supervision, or control of the Contractor at the time of the incident; Page 8 of 13 COY B. An act of violence or serious crime in which the victim or the perpetrator is a client or person employed by or under the care, supervision, or control of the Contractor at the time of the incident; C. An incident of such public concern that the Director or the Southeast Washington Aging and Long Term Care Council of Governments Governing Board may have a need to know; or D. A loss of funding so great as to jeopardize the Contractor's ability to fulfill the terms of this Basic Agreement or any Contract. E. Any unauthorized uses /disclosures of which it becomes aware, and shall take all reasonable steps to mitigate the potentially harmful effects of such breach. XIX ASSIGNMENT AND SUBCONTRACTING The Contractor shall not assign or subcontract any portion of contracted services unless the written subcontract has been reviewed and approved by the Director prior to the start of the subcontract. All contracted services that are not delivered directly by the Contractor must be delivered according to the terms of this Basic Agreement and the Contract. XX SEVERABILITY If any provision of this Basic Agreement shall be held invalid, the invalidity shall not affect the other provisions of the Agreement. To that end, the provisions of this Basic Agreement are severable. XXI MODIFICATION No modification or waiver of any clause or condition of this Basic Agreement is binding upon either party unless such modification or waiver is in writing and executed by both parties. XXII SUSPENSION, TERMINATION AND CLOSEOUT If the Contractor fails to comply with the terms of this Basic Agreement, any Contract or HIPAA, the Director may pursue such remedies as are legally available including the suspension or termination of this Basic Agreement or the Contract in whole or in part in the manner specified herein. A. Suspension - If the Contractor fails to comply or is unable to substantiate full compliance with the terms of this Basic Agreement or any Contract, the Director may suspend this Basic Agreement or the Contract in whole or in part pending corrective action or investigation, effective no less than seven days following written notification to the Contractor. The suspension shall remain in force until the Contractor complies to the satisfaction of the Director and is able to substantiate its full compliance with the terms of this Basic Agreement and the Contract. No obligation incurred by the Contractor during the period of suspension shall be allowable under this Basic Agreement except: 1. Reasonable, proper, and otherwise allowable costs that the Contractor could not avoid during the period of suspension; and 2. Discretionary costs that the Contractor incurred during the period of suspension if the II Contractor is able to substantiate complete compliance with the terms of this Basic Agreement and the Contract. B. Termination for Cause - The Director may, by written notice, terminate this Basic Agreement or any Contract in whole or in part for substantial breach by the Contractor of duties under this Basic Agreement, any Contract or HIPAA. In such an event, the Contractor shall be liable for reasonable damages, including the reasonable cost of procuring similar services actually procured by the Director to fully execute the Contractor's duties under this Basic Agreement and the Contract(s). Page 9 of 13 COY II C. Termination for Other Grounds - This Basic Agreement or any Contract may be terminated in whole or in part by: I. Either party, upon thirty days advance written request, in which case the two parties shall devise by mutual agreement the conditions of termination including the effective date and in case of termination in part, the portion to be terminated. 2. The Director, immediately upon written notice, if funding is withdrawn or reduced to the extent that the continuation is not in the best interest of Southeast Washington Aging and Long Term Care. D. Closeout - Upon expiration or termination of a Contract, in whole or in part, the following provisions shall apply: 1. Southeast Washington Aging and Long Term Care shall pay to the Contractor all allowable reimbursable costs not covered by previous payment upon submittal of a final invoice, subject only to the right reserved to the parties in the event of a dispute as provided in subparagraph "3" below. 2. The Contractor shall pay to Southeast Washington Aging and Long Term Care moneys received from Southeast Washington Aging and Long Term Care in excess of allowable costs, subject only to the right reserved to the parties in the event of a dispute as provided in subparagraph "3" below. 3. In the event the Director and the Contractor are unable to agree upon amounts due as provided in subparagraphs "1" or "2" above, either party shall have the right to withhold the disputed amount from final payment pending a final audit, and then pay such amounts as the audit determines are payable. 4. The Contractor shall submit all required financial and performance reports and claims for payment within thirty days after the end of the contract unless a different period is set by Southeast Washington Aging and Long Term Care. 5. At the option of the Director, the contractor shall return or destroy all PHI created or received from or on behalf of Southeast Washington Aging and Long Term Care and provide appropriate documentation evidencing procedure. The contractor agrees that it will not retain any copies of PHI except as required by law. If return or destruction of all PHI, and all copies of PHI, is not feasible, contractor agrees to extend the protections of this Contract to such information for as long as it is maintained. E. Notices shall be delivered by U.S. mail to the address stated in the first paragraph of this Agreement or such other address provided by the Contractor in writing to the Director. XXIII INDIVIDUAL RIGHTS AND HIPAA The contractor shall make all PHI and related information in its possession available: A. To the individual or his /her personal representative or to Southeast Washington Aging and Long Term Care, for inspection and copying. B. To the individual or his /her personal representative or to the county to fulfill any obligation to account for disclosures of PHI. C. To Southeast Washington Aging and Long Term Care to fulfill any obligation to amend PHI and related information and shall incorporate any amendments or related statements into the information the contractor holds and notify any subcontractors or agents of amendments. Page 10 of 13 COY XXIV GRIEVANCE PROCEDURES The Contractor shall have a written procedure for resolving grievances. A copy shall be made available to clients and applicants for contracted services. Such procedures should include time frames for filing a grievance and provide opportunities for informal and formal resolution. For grievances arising from the delivery of contracted services, the grievance procedures must include the right of the grievant to appeal to the Director. Applicants and clients shall be advised of the grievance procedures and their right to due process if they feel they have been wrongfully denied or terminated from services. XXV DEBARMENT AND EXCLUSION A. The Contractor shall and does certify it is not debarred, suspended, ineligible or voluntarily excluded from participation in Federal assistance programs. The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. The Contractor shall provide immediate written notice to the Director if at any time the Contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. C. The Contractor shall not knowingly assign or subcontract any portion of contracted services to a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation. XXVI CONFLICT OF INTEREST The Director may, by written notice to the Contractor, terminate this Basic Agreement in whole or in part if it is found after due notice and hearing that any of the following laws have been violated in obtaining or amending this Basic Agreement or any Contract or in making determinations with respect to this Basic Agreement or any Contract: A. RCW 42.20, Misconduct of Public Officers; B. RCW 42.23, Code of Ethics for Municipal Officers- Contract Interests. C. RCW 42.52, Ethics in Public Service Southeast Washington Aging and Long Term Care shall not be liable for payment for services rendered under any, Contract to the extent this Basic Agreement or the Contract was entered into in violation of this clause. XXVII COVENANT AGAINST CONTINGENT FEES The Contractor shall assure that no person or agency has been employed or retained on a contingent fee for the purpose of seeking or obtaining a Contract. This does not apply to legitimate employees or an established commercial or selling agency maintained by the Contractor for the purpose of securing business. In the event of breach of this clause by the Contractor, the Director may: A. Annul this Basic Agreement or the Contract in whole or in part without any liability; or B. Deduct, or similarly recover from the consideration of the Contract, the amount of the contingent fee. XXVIII LOBBYING A. Federal requirements (U.S.C. Title 31, §1352): 1. No Federal appropriated funds may be paid, by or on behalf of the Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress Page 11 of 13 COY in connection with the making of any Federal grant, the entering into of any cooperative agreement and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement. If non - Federal funds are used, the Contractor shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. The Contractor, if a recipient of a grant or cooperative agreement over $100,000, shall and does certify that it did and will comply with these Federal requirements. The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. State requirements (RCW 42.17.020 (27); RCW 42.17.190; RCW 34.05): No public funds may be used directly or indirectly to attempt to influence the passage or defeat of any legislation by the legislature of the State of Washington, or the adoption or rejection of any rule, standard, rate, or other legislative enactment of any State agency under the State Administrative Procedure Act. Provided, This does not prevent the Contractor from communicating with a member of the legislature on the request of that member or requesting legislative action or appropriations through appropriate channels. XXIX PROHIBITION OF POLITICAL ACTIVITIES No funds, material, property or contracted services provided under the terms of this Basic Agreement or any Contract shall be used for partisan political activity or to further the election or defeat of any candidate for public office. XXX DISPUTES Any dispute arising under this Basic Agreement or any Contract, including a disputed complaint or grievance resolution, shall, unless otherwise provided in this Basic Agreement or the Contract, be submitted in writing to the Director for settlement under Southeast Washington Aging and Long Term Care's Dispute Resolution Procedures. XXXI DRUG -FREE WORKPLACE A. The Contractor shall and does certify it provides a drug -free workplace in compliance with the Drug -Free Workplace Act (Public Law 100 -690 Title V, Subtitle D). The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. The Contractor shall publish a statement notifying employees of prohibitions against use, manufacture, distribution or possession of controlled substances in the workplace and specific actions that will be taken in the event of non - compliance. Employees shall be notified that, as a condition of employment, they must abide by the terms of the statement and notify the employer in writing of any conviction for a criminal drug statute occurring in the workplace within five calendar days after such conviction. This statement shall at a minimum be distributed to all employees engaged in the delivery of contracted services. C. The Contractor shall establish an on -going drug -free awareness program to inform employees about: 1. The dangers of drug abuse in the workplace; 2. The contractor's policy of maintaining a drug -free workplace; 3. The availability of drug counseling, rehabilitation, and employee assistance programs; and 4. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. Page 12 of 13 COY XXXII REIMBURSEMENT LIMITS The sum of payments to the Contractor for a contracted service shall not exceed the contracted unit rate or the contracted amount whichever is greater. In the event payments to the Contractor exceed this limit, the overpayment shall be returned to Southeast Washington Aging and Long Term Care or deducted from the next Claim for Payment submitted by the Contractor. XXXIII VENUE This Basic Agreement and all Contracts shall be governed by the laws of the State of Washington. Any action, suit, or judicial proceeding for the enforcement of this Basic Agreement or any Contract shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. XXXIV CONDITION PRECEDENT This Basic Agreement shall not be binding until signature is authorized by Resolution of Southeast Washington Aging and Long Term Care Council of Government Governing Board. Contract Authorization Southeast Washington Aging and The City of Yakima Long Term Care Lori Brown, Dire t r ' : 'Rou e, City Manager i on t 162_ ` n o ' Print Name and Title U /Op(' m it/ Date: Date: Page 13 of 13 COY CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG -FREE WORKPLACE REQUIREMENTS Signature of this form provides for compliance with certification requirements under the "New Restrictions on Lobbying," "Government -wide Debarment and Suspension (Nonprocurement) and Government -wide Requirements for Drug -Free Workplace (Grants)., The certifications shall be treated as a material representation of fact upon which reliance was placed when this basic agreement was entered into. 1. LOBBYING I As required by Section 1352, Title 31, of the U.S. Code for persons entering into a grant or cooperative agreement (including subawards) over $10 ,000, the contractor certifies that: A) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant orilcooperative agreement; B) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; C) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly. 2. DEBARMENT,SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by the certification requirements under the regulations implementing Executive Order 12549, Debarment and Suspension, the contractor certifies that it and its principals. A) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in covered transactions by any Federal department or agency; B) Have not withinna three -year period preceding this Agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, !;State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and C) Are not presently indicted for or otherwise criminally or civilly charged by a Government entity (Federal, State, or local) with commission of any offenses enumerated in paragraph (B) of this certification. Where the contractor is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. 3. DRUG -FREE WORKPLACE As required by the drug-Free Workplace Act of 1988 (Pub.L. 100 -690, Title V, Subtitle D) and implemented through additions to the Debarment and Suspension regulations, published in the Federal Register on January 31, 1989, and May 25, 1990: A) The Contractor certifies that it will or will continue to provide a drug -free workplace by: 1) Publishing a statement notifying employees that the unlawful manufacture., distribution, dispensing, possession, or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition; Page 1 of 2 COY 2) Establishing an ongoing drug -free awareness program to inform employees about: a) The dangers of drug abuse in the workplace; b) The contractor's policy of maintaining a drug -free workplace; c) Any available drug counseling, rehabilitation, and employee assistance programs; and d) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; 3) Making it arequirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph (1); 4) Notifying the employee in the statement required by paragraph (1) that, as a condition of employment under the contract, the employee will: a) Abide by the terms of the statement; and b) Notify the employer in writing of his or her conviction for a violation of a criminal drug statue occurring in the workplace not later than five calendar days after such conviction; 5) Notifying the County, in writing, within ten calendar days after receiving notice under subparagraph (2)(b) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose contract activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected contract; 6) Taking one jof the following actions, within 30 calendar days of receiving notice under subparagraph (4)(b), with respect to any employee who is so convicted: a) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended, or b) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local health, law enforcement, or other appropriate agency; 7) Making a good faith effort to continue to maintain a drug- free workplace through implementation of paragraphs (1),(2),(3),(4),(5), and (6). B) Insert in the space provided below the site(s) for the performance of work done in connection with the specific contract: Place of Performance: (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified here. As the duly authorized representative of the Contractor, I hereby certify that the Contractor will comply with the above certifications. Contrac I � 1 ke„ Prins-. Namt and Ti tl; of horized'Representa 've 0 10(4 . ure and ►ate Page 2 of 2 COY AGREEMENT NO. Mod No. AGREEMENT PERIOD FUNDING SOURCE 2014 COY, 01 Title III -B, Title III —E, 1/01/14 — 12/31/14 (Adult Day Care SFCSP,, and SCSA and Respite) THIS AGREEMENT MODIFICATION to Performance Agreement No. 2014 COY is entered into by Yakima County Southeast Washington Office of Aging and Long Term Care, whose address is PO Box 8349, Yakima, Washington 98908, and City of Yakima Day Break Adult Day Care, whose address is 101 N. 65 Avenue, Yakima, WA 98908. This Modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The purpose of this agreement modification is to: 1) MAXIMUM CONTRACT AMOUNT Increase the contract amount for Respite from $10,000 to $13,300. The total contract amount increases from $15,400 to $18,700. 2) EXHIBIT B Revise EXHIBIT B, RESPITE STATEMENT OF WORK: Section VII. UNITS OF SERVICE, Part D. Anticipated Service Level by Quarter, and Part E. Anticipated Expenditure Rate by Quarter. Section IX. PAYMENT CONSIDERATIONS 3) EXHIBIT C Revise EXHIBIT C, BUDGET, RESPITE The parties signing below warrant they have read and understand this Agreement and have authority to enter into this Agreement. The parties agree that this contract modification becomes effective at the time of execution by the Yakima County Board of County Commissioners. Page 1 of 4 • NTRACTOR SIGNATURES r Tony . ou , ke, City Manager Lori 3. Bro , ' Di er ctor City of Yaki SE Washington Aging and Long Term Care Date: t 1 y Date: l k) / cz /17 Jou t: City Clerk c' A ,N", City Contract No. - - . v Resolution No. X2- -- �! ' 'a Date: -01 . . -tip Page 2 of 4 MODIFICATION #1 EXHIBIT B RESPITE STATEMENT OF WORK CITY OF YAKIMA VII. UNITS OF SERVICE D. Anticipated Service Level by Quarter: Month Hours Ori in I Modified January - March :176 234 April - June :176 234 July - September 176 234 October - December 176 234 T ©ttal 704 _36" E. Anticipated Expenditure Rate by Quarter: Month Original Modified ed January - March $2,500 $3,325 April - June $2,500 $3,325 July - September $2,500 $3,325 October - December $2,500 $3,325 Tote° $10,000 $13,300 IX. PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement and in accordance with the Budget Provisions of this Agreement, the County agrees to pay the Contractor a sum not to exceed $13,300 from available funds. This total sum shall be available during the period January 1, 2014 through December 31, 2014. These funds shall be used to provide Respite Care services. Payment to the Contractor for this unit rate price Agreement shall be based on the unit rate of $14.20 per hour, less client match as computed on the Senior Citizen Services sliding fee schedule. Page 3 of 4 MODIFICATION #1 EXHIBIT C BUDGET CITY OF YAKIMA ADULT DAY CARE FUNDING SOURCE AMOUNT Title III -B (CFDA #93.044) SCSA Total $5,400 4 unduplicated individuals, 540 units of service, @ $10.00 per hour (less client match as computed on the Senior Citizen Services slide fee schedule). COPES rate for Level I is $9.81 per hour up to four hours per day or $39.25 for over four hours per day. RESPIITi'E State Family Caregiver Total $13,300 4 unduplicated individuals, 936 units of service, @ $14.20 per hour (less client match as computed on the Senior Citizen Services sliding fee schedule). Page 4 of 4 Contract Authorization Agreement No. 2014 COY (City of Yakima - Adult Day Care and Respite Services) BOARD OF YAKIMA COUNTY COMMISSIONERS ‘‘oF`(AKIMgCo,/ 1 c co. Q c�> _ V 4 ouchey,-Chairman z 0 ./1/ 4j111% \ • J.. " nd. -Elliott, Commissioner Attest: Tiera L. Girard - - Clerk of the Board — .- BOCC402 -20 September 23, 2014 Excused • Approved as to Form: Michael D. Leita Commissioner Constituting the of County Commissioners 9,74 y p Q for Yakima County, Washington W � Deputy Prosecuting Attorney WSBA# 35 5 ALTCCOG 8 -2015 PERFORMANCE AGREEMENT [NO. 2015 CITY OF YAKIIMA (f © ©tcare) ADMINISTRATION OF AGREEMENT THIS AGREEMENT is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments, hereinafter denominated the "SE WA ALTC COG ", whose address is P.O. Box 8349, Yakima, Washington 98908, and the City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901, 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 Governments Administrative office. THE PURPOSE of this Agreement is to provide for the delivery of Foot Care 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's Basic Agreement No. ALTC -15. In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. The City of Yakima shalil be an additional party to the Basic Agreement and shall have all of the rights and privileges contained in said Basic Agreement. PROGRAM AMOUNTS Foot Care Title III -B CFDA #93.044 SCSA TOTAL FUNDING ALLOCATION $24,828 PERIOD OF AGREEMENT January 1, 2015 — December 31, 2015 1 ONTRACTOR SIGNATURES ) - • Tonyy Rou e, City Manager Lora : rown, ►, ire or City of Yakim. SE Washington Aging and Long Term Care Council of Governments Date: ID' '� d ate: _ �� �� -- f ' Atte Ti20 f j � ' t ► r i , 1 : City Clerk City Contract No. Q 7-0 1 ? 0 oti Resolution No. It 2-0I six 1 Date: 1 ALTCCOG 8 -2015 STANDARD TIENMS AND P PRtVIISE • NS City of Yakima SPECIFIC PROVISIONS 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. CFR Title 45, Chapter XIII, Subchapter C, Part 1321 (Older Americans Act) C. WAC 388 - 106 -1100 through 1120 (Senior Citizens Services Act) D. Older Americans Act (PL 109 -365) II PROJECT DEFINITION Geriatric Preventative Foot Care services are intended to provide early detection of existing and potential foot problems as well as alleviate dry skin problems, and maintenance of healthy nails. Services include foot inspection and palpation, foot soaks, nail trimming, and instructions in foot health maintenance. Referrals for follow -up treatment are made to local physicians and podiatrists. III PARTICIPANTS The Contractor agrees that: A. The target population for geriatric preventative foot care services are the individuals age 60 and over who: 1. Need one or more of the program services to avoid additional health problems or assist with activities of daily living, thereby reducing the need for other services; AND 2. Are not eligible for or have exhausted other sources of payment for similar services (Medicare, Medicaid, insurance) or similar services are not available. As stated in the Geriatric Preventative Foot Care Program Standards. All persons served should be members of the target population. To the degree feasible, persons served should meet the vulnerability criteria. B. There will be written assessment procedures utilized by the Contractor to determine if the program target population criteria are met by the clients served. C. The indicators used by Southeast Washington Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: 2 ALTCCOG 8 -2015 Low - income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Living alone SE WA ALTC COG funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be attained for 2015 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% Living alone 40% The Contractor must report on clients served in these categories. D. Local medical professionals will be available to provide consultation services and act in an advisory capacity. E. Clinics will be held monthly at each designated facility that will include, but not be limited to, low- income housing facilities and senior centers. F. Participants shall be referred to the Information and Assistance /Case Management Program as needed. G. 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. H. 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. IV. 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. Multicultural, bilingual persons to assist multicultural, bilingual clients in receiving services; 3. Publicity of program through public service announcements, brochures, etc. 3 ALTCCOG 8 -2015 4. Meeting with other service providers /agencies to explain services the Contractor provides and how referral can be made; 5. Ability to serve individuals with disabilities. B. Services shall be delivered in accordance with the State of Washington Aging and Disabilities Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall cornply with said standards as presently constituted or subsequently modified. V. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for City of Yakima to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding 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. VI. ADMINISTRATIVE AGREEMENTS: A. Contractor acknowledges that the current sponsoring governmental entity of Area Agency on Aging region services, Yakima County, shall cease as the sponsoring governmental entity for Southeast Washington Aging and Long Term Care effective midnight December 31, 2014. The parties agree that SE WA ALTC COG its intended to be created under the formation of a stand -alone legal entity made of various member counties. Any such contract rights and responsibilities is that of SE WA ALTC COG and not that of Yakima County. The parties agree that no reliance claims of previous course of dealings, course of conduct, or any other past practices in dealing with the previous governmental sponsoring entity shall be applicable to SE WA ALTC COG in interpretation or performance of 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: 4 ALTCCOG 8 -2015 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by SE WA ALTC COG in order for SE WA ALTC COG to be assured that contracted activities remain consistent with the terms of this Agreement and the currently approved Southeast Washington Aging and Long Term Care Area Plan which shall be kept on file at the Southeast Washington Aging and Long Term Care Administrative Office. The Contractor further agrees to provide such information as requested by SE WA ALTC COG within the time limitations established by SE WA ALTC COG; 2. Submit the monthly report showing service level provided by the ninth day of each month following the month during which the services were provided. Quarterly, financial, and service reports must be submitted to SE WA ALTC COG by the end of the month following the end of each quarter; 3. 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. Inventory: The Contractor agrees to: 1. Submit to SE WA ALTC COG vendor invoice(s) at the same time with the monthly billing before reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year physical inventory, using forms provided by SE WA ALTC COG, of all equipment purchased under this Agreement. E. Contractors Meeting: The Contractor agrees to have a representative attend meetings of the Southeast Washington Aging and Long Term Care Contractors and Long Term Care Planning Committee. F. Program Publication: The Contractor agrees that: 1. The program shall be publicized on a regular basis, with all publicity and printed material identifying Southeast Washington Aging and Long Term Care 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) percent or more of the general 60+ population. 5 ALTCCOG 8 -2015 G. 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. H. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. I. 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; 3. It will continue or initiate efforts to obtain support from private sources and other public organizations for this service; 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. J. 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. 6 ALTCCOG 8 -2015 K. 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 vvill 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 Southeast Washington Aging and Long Term Care (ALTC) staff and SE WA ALTC COG Advisory Council. 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 shall be made available to SE WA ALTC COG upon request. L. DISCLOSURE OF PERSONAL INFORMATIOIN 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 ( "HIPAA'), and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 7 ALTCCOG 8 -2015 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of SE WA ALTC COG's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to SE WA ALTC COG 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 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. M. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. 8 ALTCCOG 8 -2015 c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. Client information may be provided to the client, client's authorized guardian, or a client - authorized 3 party per WAC 388 -01, and the Long Term Care Manual. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. N. 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); 9 ALTCCOG 8 -2015 h. Mainframe or mini mass storage (disk platters, arrays, etc); 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 so that unauthorized individuals cannot access 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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 42.56.210 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 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. 0. The Contractor shall indemnify and hold harmless SE WA ALTC COG for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. P. The Contractor will partner with SE WA ALTC COG's oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. Q. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. 10 ALTCCOG 8 -2015 R. 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 county 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. PAYMENT T PROVIISSIONSS CONSIDERATION Payment shall be based on claims for reimbursement as reported on the Southeast Washington Aging and Long Term Care invoice and support documentation and shall be contingent upon the receipt of all required financial and program reports by the respectively assigned due dates. 11 ALTCCOG 8 -2015 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. The 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; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of SE WA ALTC COG budgeted amount for administration or service delivery. 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: 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; or 12 ALTCCOG 8 -2015 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of SE WA ALTC COG contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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, Sec. 25. 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. E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, SE WA ALTC COG may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds SE WA ALTC COG relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, SE WA ALTC COG may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notiice. 13 ALTCCOG 8 -2015 III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the 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. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last SE WA ALTC COG working day of the month. IV. UNITS OF SERVICE A. Definition: A unit of Geriatric Preventative Foot Care service shall consist of one (1) foot care treatment. B. There will be 317 unduplicated individuals served by this Agreement (216 participants shall reside in the upper valley and 41 shall reside in the lower valley). C. Anticipated Service Level by Quarter:: r Mooroth ; UV Units LV Units Total; iJanuary - March 337. 59 396 April -June 337 59 . 396 L -__ July - September 338 ; 59 , 397 October - D ecember 338 , 59 397 Totai 1,350 236' 1,57.6 Anticipated Service Levels include 228 additional units in the upper valley funded by donations and 69 units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV flute LV Rate Total' January - March $5,319 $888 $6,207 April - June $5,319 $888 $6,207 July - September $5,319 $888 $6,207 October - December $5,319 $888 $6,207 Total $21,276 $3,552 $24,': :2: 14 ALTCCOG 8 -2015 V. PAYMENT CONSIDERATIONS 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 $24,828 from available funds as submitted on the 2015 Contract Budget Summary. This total sum shall be available during the period January 1, 2015 through December 31, 2015. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before SE WA ALTC COG funds. 15 ALTCCOG 15 -2015 PERFORMANCE AGREEMENT MO. 2015 COY (ADC,*) ESP) ADMIINKSTRATIION OF AGREEMENT THIS AGREEMENT is entered into this by and between Southeast Washington Aging and Long Term Care whose address is P.O. Box 8349, Yakima, Washington 98908, hereinafter denominated "SE WA ALTC COG ", and the City of Yakima Day Break Adult Day Care, 101 N. 65 Ave., 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 Governments Administrative office. 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 Basic Agreement No. ALTC - 15. In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PAYMENT CATEGORY AMOUNTS Adult Day Care $ 5,400 Respite $ 13,500 TOTAL FUNDING ALLOCATION $18,900 PERIOD OF AGREEMENT January 1, 2015 - December 31, 2015 / CONTRACTOR SIGNATURES I. I� y •'Rou e, ity Manager Lori . brow , Director City of Yakima SE Washington Aging and Long Term Care Council of Governments Date: 1,a 6 ( L I y { "4,13 : l o p(v,D-01/Ci Att , (� e ,, fit . °� . City Clerk - ` .. City Contract No. •- A Resolution No. ` 1 Date: la.-1/6 i . 1 ALTCCOG 15 -2015 2OII3 SE WA ALTC COG COIlIr" ACT MY OF YAG ERIA ADULT DAY CARE and RESPITE TAXIS OF CO! TEt'vTS ADMINISTRATION OF AGREEMENT (signature page) STANDARD TERMS AND PAYMENT PROVISIONS FOR MULTIPLE SERVICE PROVIDERS SPECIFIC PROVISIONS I. SERVICE SPECIFICATIONS II ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATE III. ADMINISTRATIVE AGREEMENTS PAYMENT PROVISIONS I. CONSIDERATION II. GENERAL PAYMENT CONDITIONS III. BILLING PROCEDURES EXHIBIT A ADULT DAY CARE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. PARTICIPANTS IV. SERVICE SPECIFICATIONS V. UNITS OF SERVICE VI. PAYMENT CONSIDERATIONS EXHIBIT B RESPITE STATEMENT OF WORK I. APPLICABLE LAWS AND REGULATIONS II. PROJECT DEFINITION III. TARGET POPULATION IV. FINANCIAL PARTICIPATION V. PROGRAM ADMINISTRATION VI. SERVICE AREA VII. UNITS OF SERVICE VIII. STAFFING STANDARDS IX. PAYMENT CONSIDERATIONS EXHIBIT C BUDGET 2 ALTCCOG 15 -2015 STANDARD TERMS AND PAYMENT PROVIISIIOI1 SS FOR MULTIPLE SERVICE PRJVIIDlERSS City of Yakima 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 State of Washington Aging and Adult Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. II. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Program Attachments for Adult Day Care and Respite Care to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re- negotiation of the funding 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. 3 ALTCCOG 15 -2015 III. ADMINISTRATIVE AGREEMENTS: A. Contractor acknowledges that the current sponsoring governmental entity of Area Agency on Aging region services, Yakima County, shall cease as the sponsoring governmental entity for Southeast Washington Aging and Long Term Care effective midnight on December 31, 2014. The parties agree that SE WA ALTC COG (Southeast Washington Aging and Long Term Care Council of Governments) is intended to be created under the formation of a stand -alone legal entity made of various member counties. Any such contract rights and responsibilities is that of SE WA ALTC COG and not that of Yakima County. The parties agree that no reliance claims of previous course of dealings, course of conduct, or any other past practices in dealing with the previous governmental sponsoring entity shall be applicable to SE WA ALTC COG in interpretation or performance of the its 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: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by SE WA ALTC COG in order for 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 SE WA ALTC COG within the time limitations established by SE WA ALTC COG. 2. Submit the monthly report showing service level provided by the ninth day of each month following the month during which the services were provided. Quarterly, financial, and service reports must be submitted to SE WA ALTC COG by the end of the month following the end of each quarter; 3. 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. Inventory: The Contractor agrees to: 1. Submit to SE WA ALTC COG vendor invoice(s) at the same time with the monthly billing before SE WA ALTC COG reimbursement of expenditures of authorized equipment items of $5,000 or more; 4 ALTCCOG 15 -2015 2. Complete at least once a year physical inventory, using forms provided by SE WA ALTC COG, of all equipment purchased under this Agreement. E. Contractors Meeting: The Contractor agrees to have a representative attend the Southeast Washington Aging and Long Term Care Council of Governments Contractors and Long Term Care Planning Committee meetings. F. Program Publication: The Contractor agrees that: 1. The program shall be publicized on a regular basis, with all publicity and printed material identifying the Southeast Washington Aging and Long Term Care Council of Governments 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: 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 handicap. 3. Materials publicizing the program must be printed in other appropriate languages in counties that have a specific minority 60+ population of two (2 %) percent or more of the general 60+ population. G. 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. H. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. I. 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. 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. 5 ALTCCOG 15 -2015 J. 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 Tess 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. K. 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 Southeast Washington Aging and Long Term Care Council of Governments (ALTC) staff and Southeast Washington Aging and Long Term Care Council of Governments Advisory Council. 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. 6 ALTCCOG 15 -2015 5. Conduct a self - evaluation of the program annually. The self - evaluation shall include a survey of at least 1O% of clients utilizing the service. The Contractor shall take steps to correct deficiencies found during the internal monitoring. Monitoring reports shall be made available to SE WA ALTC COG upon request. L. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388 -01 -030 and chapter 388 -01 WAC, the Health Insurance Portability And Accountability Act of 1996 (" HIPAA`), and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of SE WA ALTC COG's responsibilities under this agreement except by prior written consent of the DSHS client, his /her attorney, parent or guardian. 3. The Contractor may disclose information to SE WA ALTC COG 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 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. M. 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 HIPAA and use disclosure of PHI requirement an understand: 7 ALTCCOG 15 -2015 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long -term care programs. b. Any personal use of client information is strictly prohibited. c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. Client information may be provided to the client, client's authorized guardian, or a client - authorized 3 party per WAC 388 -01, and the Long Term Care Manual. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the Southeast Washington Aging & Long Term Care Director and /or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. N. 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 8 ALTCCOG 15 -2015 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 DSHS. DSHS shall be responsible for destroying the returned documents to ensure confidentiality is maintained. The Data provided by DSHS will remain the property of DSHS 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 42.56.210 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, 9 ALTCCOG 15 -2015 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 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. 0. The Contractor shall indemnify and hold harmless SE WA ALTC COG for any acts by the contractor staff related to the provisions of this contract, including the Disclosure of Personal Information. P. The Contractor will partner with SE WA ALTC COG oral health program to promote health and disease prevention. This may include dissemination of educational materials or Aging and Long Term Care presentations on oral health. Q. VENUE. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. R. EMERGENCY PREPAREDNESS Contractor will develop an emergency plan that includes the administrative office, local offices and clients that defines whalt 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 county 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. 10 ALTCCOG 15 -2015 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. PAYMENT PROVISIONS I CONSIDERATION Payment shall be based on claims for reimbursement as reported on the Southeast Washington Aging and Long Term Care Council of Governments 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 Toss 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. The 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; 2. Additional revenue is received for contracted activities within the terms of this Agreement; 3. The Contractor desires to transfer funds from one budget category to another. Budget category transfers shall, for the purpose of this Agreement, be defined as transfers inclusive of those occurring between sub - object categories when the cumulative amount of all transfers exceeds five percent (5 %) of SE WA ALTC COG budgeted amount for administration or service delivery. 11 ALTCCOG 15 -2015 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: 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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in -kind contributions by greater than ten (10 %) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of SE WA ALTC COG contracted funds by greater than ten (10 %) percent of their respective allotted amount. 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, Sec. 25. 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. 12 ALTCCOG 15 -2015 E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, SE WA ALTC COG may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds SE WA ALTC COG relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, SE WA ALTC COG may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the 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. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last SE WA ALTC COG working day of the month. 13 ALTCCOG 15 -2015 Exhibit A STATEMENT OF WORK 2015 ADULT DAYCARE 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 (PL 109 -365) C. WAC 388 - 106 -1100 through 1120 (Senior Citizens Service Act) D. WAC 388 -106 -0300 (COPES Services) E. WAC 388 -71 -0702 through 0776 (Adult Day Care) 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 Services is a supervised daytime program providing core services as defined under WAC 388 -106 -0800 subsection (2). Core services are appropriate for adults with medical or disabling conditions that do not require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. The adult day care 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 -71 -0215, 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; i ALTCCOG 15 -2015 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 client's plan of care and are based on the client's 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 prograrn, 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. III PARTICIPANTS The Contractor agrees that: A. The target population for the day care program is individuals who are appropriate for care services as referenced in the Adult Day Care WAC 388- 71 -0704. B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by the Office of Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low - income 75 years of age or older Racial or Ethnic minority Limited or non - English speaking Southeast Washington Aging and Long Term Care Council of Governments funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be targeted for 2015 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low - income 40% 75 years of age or older 55% Limited or non - English speaking 6% The Contractor must report on clients served in these categories. 2 ALTCCOG 15 -2015 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. 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 day care services to achieve treatment goals. 1. Adult day care center staff are responsible for determining the financial and program eligibililty of an applicant for day care services. 2. Eligibility must be determined prior to the provision of adult day care services and within thirty (30) days after the applicant has requested service. Eligible applicants may be provided services as of the date of application. 3. A Participant Intake Form (PIF) or other client tracking information shall be completed on each client served and submitted as required to the Office of Aging and Long Term Care. B. Eligibility Re- determination The purpose of the eligibility re- determination is to assess whether an adult day care client continues to meet financial and program eligibility criteria. 1. Adult day care center staff are responsible for re- determining eligibility. A new Senior Citizens Services Application must be completed to document whether the client was found to be eligible or ineligible. 2. Eligibility must be determined: a. Within thirty (30) days after the adult day care center has received information that a change has occurred in the client's circumstances that may make the client ineligible; b. At six -month intervals if change occurs; c. At twelve -month intervals 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 ALTCCOG 15 -2015 C. Reduction/Termination of Services The Discharge Plan Form must be completed when a client becomes ineligible for adult day care services or when services are reduced or terminated for any reason. 1. Adult day care 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 care 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 day care center staff, the client no longer requires adult day care services, adult day care services no longer meet the client's needs or the client is not both willing and able to effectively utilize the adult day care program to achieve treatment goals. Whenever possible, service termination should be accomplished through mutual negotiation with the client and with the involvement of client's family and /or others in his /her informal support system and the client's physician; c. Funding cutbacks require termination. • 4. A client who disagrees with a decision of adult day care staff to reduce or terminate services has ninety (90) days after receipt of the Discharge Plan Form to request a fair hearing. Services may not be reduced or terminated until the fair hearing decision is rendered if the request for a hearing is received prior to the effective date for reduction or termination. D. The day care center must be located in geographic areas which contain major concentrations or high proportions of target group older persons. E. Transportation to and from the center must be available. 4 ALTCCOG 15 -2015 F. The day care 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. G. The day care center must meet the minimum staffing requirements for a center, which operates five (5) days a week and has an average daily attendance of less than twenty (20) participants. H. The day care center should have a written plan for evaluating whether the program is meeting the day care standards and the needs of the participants. I. Participants shall be referred to other services as needed. J. 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. K. 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 service shall consist of one (1) hour of Adult Day Care service, not including transportation time. B. There will be 4 unduplicated individuals served by this Agreement. C. Anticipated Service Level by Quarter: Month Hours January - March 135 April - June _ _ 135 July - September _ _ _ 135 October - December _ 135 Tota/ 540 D. Anticipated Expenditure Rate by Quarter for client services: Month Rate January - March $1,350 April - June $1,350 July - September $1,350 October - December $1,350 Total $5,400 5 ALTCCOG 15 -2015 VI PAYMENT CONSIDERATIONS 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 2015 Contract Budget Summary. The contracted amount shall be available during the period January 1, 2015 through December 31, 2015. 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. The payment for COPES services will be in addition to the contracted amount. The COPES payment will be based on claims for reimbursement as reported on the COPES services billing. This includes clients now authorized, number of units of service and the actual number of units provided. The COPES unit rate will be $9.81 per hour or $39.25 per day and revised, if applicable, to reflect the unit rate established by DSHS. Services are reimbursed on an hourly basis up to four hours per day. Any service provided over four hours per day shall be reimbursed at the daily rate. In addition, COPES transportation rate to Day Break is $3.00 per day if utilizing the Dial -A -Ride program. 6 ALTCCOG 15 -2015 Exhibit B STATEMENT OF WORK - 2015 RESPITE CITY OF YAKIMA 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 -0702 through 388 -71 -0776 (Adult Day Services) C. Title III E of the Older American's Act (PL 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 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 illnesses 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 55 and above or disabled. 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. 1 ALTCCOG 15 -2015 IV FINANCIAL PARTICIPATION DSHS requires eligible participants to pay part of the cost of the respite care services received. A 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. 2. If the participant's 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 participant's 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 an SE WA ALTC COG TCARE - certified case manager in the participant's 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 TCARE - certified 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. 2 ALTCCOG 15 -2015 C. All authorizations for service shall be made through the case manager. Case managers shall encourage caregivers to schedule respite care in advance. If respite care cannot be provided when requested, a waiting list shall be used. D. Maximum Hours The Respite 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 TCare case manager. E. Levels of Care Provided The level of care refers to the activities that will be performed for a participant during a given respite care episode. The Respite case manager shall determine, during the in -home assessment, the level of care needed. The program shall provide for any one of or a combination of the following levels of care for the participant: Level 1: Help with activities that require no special training; e.g., companion- ship, supervision, meal preparation. Level 2: Help with activities of daily living for which special training is required, but a licensed health practitioner is not required. It includes personal care, lifting, turning and transferring. Level 3: A licensed health practitioner (LPN or RN) must perform these tasks. 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 of Respite service shall consist of one (1) hour of service. B. Level of Care: Relates to activities that will be performed for a participant during a given respite visit. Levels of care allowable for this contract are Levels I and II. C. There will be 4 unduplicated individuals served by this Agreement. 3 ALTCCOG 15 -2015 D. Anticipated Service Level by Quarter: ALTC Funded by Total Month Funds ® onat®ons U nits January - March _ 238 8 246 April - June 237 _ 9 246 July - September 238 8 246 October - December 237 9 _ 246 Total 950 34 984 Anticipated Service Levels include 34 units funded by donations. E. Anticipated Expenditure Rate by Quarter: Month Total January - March $3,375 April - June $3,375 July - September $3,375 October - December $3,375 Total $13,500 , F. 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 case manager. 4. Funds from participants and caregivers not meeting all of the eligibility criteria shall be accounted for at the Contractor level. G. Rates Rates of payment to respite care Contracting Agencies shall not exceed, and may be less than, rates paid by DSHS to Contracting Agencies for the same level of care. DSHS shall notify AAA's of the current maximum allowable rates. 1. If a Contractor has only an hourly rate, this rate shall be paid for each hour of respite care used, including 24 consecutive hours of respite care. 2. If a Contractor has only a daily rate, the rate shall be paid for 24 consecutive hours or less of respite care used. 4 ALTCCOG 15 -2015 3. If a Contractor has an hourly and daily rate, the hourly rate shall be paid for each hour of respite care when Tess than 24 hours of service is provided. The total amount paid at the hourly rate shall not exceed the Contractor's daily rate for that level of care. The daily rate shall be paid for 24 consecutive hours of respite care. The daily rate shall also be used for less than 24 consecutive hours of respite IF by using the daily rate the cost of the episode of respite care is less than using the hourly rate for the same amount of hours. 4. Workers shall be paid at least WA State minimum wage rate in accordance with labor standards and applicable legislation. 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 CONSIDERATIONS 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 2015 Contract Budget Summary. This total sum shall be available during the period January 1, 2015 through December 31, 2015. 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. 5 ALTCCOG 15 -2015 C ADULT DAYCARE/ RESPITE BUDGET OIITY OF 17AOMi January 1, 2015 ®December 31, 2015 ADULT DAY C RE FUNDING SOURCE AMOUNT Title III -B (CFDA #93.044) SCSA Total $5,400 4 unduplicated individuals, 540 units of service, © $10.00 per hour (less client match as computed on the Senior Citizen Services slide fee schedule). COPES rate for Level I is $9.81 per hour up to four hours per day or $39.25 for over four hours per day. RESPITE FUNDING SOURCE AMOUNT Title III -E (CFDA #93.52) State Family Caregiver Total $13,500 4 unduplicated individuals, 982 units of service, © $14.20 per hour (less client match as computed on the Senior Citizen Services sliding fee schedule). Service units include 34 units to be funded by participation. 1 ALTCCOG 91 -2015 AGREEMENT NO. MOD. NO. FUNDING SOURCE AGREEMENT PERIOD 2015 CITY OF YAKIMA 01 TITLE III B, SCSA 1/01/15 — 12/31/15 (footcare) THIS AGREEMENT MODIFICATION to Performance Agreement No. 2015 CITY OF YAKIMA (footcare); ALTC Agreement No. ALTCCOG 8 -2015 is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments, whose address is PO Box 8349, Yakima, Washington 98908, and City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901. This modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The parties agree that this contract modification becomes effective at the time of execution by the Southeast Washington Aging and Long Term Council of Governments Governing Board and /or Director. The purpose of this agreement modification is to amend the following: 1. Revise the SPECIFIC PROVISIONS; PAYMENT PROVISIONS. Section IV. UNITS OF SERVICE. Part C. Anticipated Service Level by Quarter. Part D. Anticipated Expenditure Rate by Quarter.; Section V. PAYMENT CONSIDERATIONS. Contractor Signatures City of Yakima Southeast Washington Aging And Long Term Care Council of Governments fit 261,3 I 4, o O'' ur! e, City Manager Lori Brown, Vector Date: / / /S/ V Date: 10 / /is Approved As To Legal Form: Daniel Clark, WSBA #35901 Date Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG 1 ALTCCOG 91 -2015 2015 AGREEMENT MODIFICATION 01 CITY OF YAKIMA FOOTC4RE SPECIFIC PROVISIONS PAYMENT PROVISIONS IV. UNITS OF SERVICE C. Anticipated Service Level by Quarter: Month UV Units LV Units Total January - March 181 92 273 April - June 155 101 256 July - September 490 38 528 October - December 491 38 529 Total 1,317 269 1,586 Anticipated Service Levels include 228 additional units in the upper valley funded by donations and 69 units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV Rate LV Rate Total January - March $2,436 $1,219 $3,655 April - June $1,905 $1,345 $3,250 July - September $7,346 $1,616 $8,962 October - December $7,346 $1,615 $8,961 Total $19,033 $5,795 $24,828 V. PAYMENT CONSIDERATIONS 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 $24,828 from available funds as submitted on the 2015 Contract Budget Summary. This total sum shall be available during the period January 1, 2015 through December 31, 2015. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before SE WA ALTC COG funds. 2 ALTCCOG 91 -2015 AGREEMENT NO. MOD. NO. FUNDING SOURCE AGREEMENT PERIOD 2015 CITY OF YAKIMA 01 TITLE III B, SCSA 1/01/15 — 12/31/15 (footcare) THIS AGREEMENT MODIFICATION to Performance Agreement No. 2015 CITY OF YAKIMA (footcare); ALTC Agreement No. ALTCCOG 8 -2015 is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments, whose address is PO Box 8349, Yakima, Washington 98908, and City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901. This modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The parties agree that this contract modification becomes effective at the time of execution by the Southeast Washington Aging and Long Term Council of Governments Governing Board and /or Director. The purpose of this agreement modification is to amend the following: 1. Revise the SPECIFIC PROVISIONS; PAYMENT PROVISIONS. Section IV. UNITS OF SERVICE. Part C. Anticipated Service Level by Quarter. Part D. Anticipated Expenditure Rate by Quarter.; Section V. PAYMENT CONSIDERATIONS. Contractor Signatures City of Yakima Southeast Washington Aging And Long Term Care Council of Governments / . 06 ' ORourke City Manager Y tY 9 Lori Brown, i ector Date: // c Date: / /2 p11/7-19 /5 CITY CONTITROT 1Wc, RESOLUTION R10 Approved As To Legal Form: �.;/�... V II Daniel Clark, BA #35901 Date Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG 1 ALTCCOG 91 -2015 2015 AGREEMENT MODIFICATION 01 CITY OF YAKIMA FOOTC4RE SPECIFIC PROVISIONS PAYMENT PROVISIONS IV. UNITS OF SERVICE C. Anticipated Service Level by Quarter: Month UV Units LV Units Total January - March 181 92 273 April - June 155 101 256 July September 490 _ 38 528 October - De cem ber 491 38 529 Total _ 1,317 269 1,586 Anticipated Service Levels include 228 additional units in the upper valley funded by donations and 69 units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV Rate LV Rate Total January - March $2,436 $1,219 $3,655 April - June $1,905 $1,345 $3,250 July - September $7,346 $1,616 $8,962 October - Dec ember $7,346 $1,615 $8,961 Total $19,033 $5,795 $24,828 V. PAYMENT CONSIDERATIONS 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 $24,828 from available funds as submitted on the 2015 Contract Budget Summary. This total sum shall be available during the period January 1, 2015 through December 31, 2015. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21°00 per unit in the Lower Valley, less client donations. Client donations must be spent first before SE WA ALTC COG funds. 2 2016JanBasicAgreement-I I COY ALTC Basic Agreement January 2016 between Southeast Washington Aging and Long Term Care Council of Governments and City of Yakima Table of Contents I PURPOSE 1 II AUTHORITY OF THE DIRECTOR 1 III EXTENT OF AGREEMENT 1 IV PERIOD OF AGREEMENT 1 V COMPLIANCE WITH LAWS 1 VI ORDER OF PRECEDENCE 1 VII RELATIONSHIP OF THE PARTIES 2 VIII DEFINITIONS 2 IX SAFEGUARDING OF INFORMATION 2 X TREATMENT OF ASSETS 3 XI LICENSING AND PROGRAM STANDARDS 4 XII STANDARDS FOR FISCAL ACCOUNTABILITY 4 XIII INSPECTION 5 XIV HOLD HARMLESS 5 XV AUDIT REQUIREMENTS 6 XVI INSURANCE AND BONDING 7 XVII NONDISCRIMINATION 7 XVIII INCIDENT REPORTING 9 XIX ASSIGNMENT AND SUBCONTRACTING 9 XX SEVERABILITY 9 XXI MODIFICATION 9 XXII SUSPENSION, TERMINATION AND CLOSE-OUT 9 XXIII INDIVIDUAL RIGHTS AND HIPAA 11 XXIV GRIEVANCE PROCEDURES 11 XXV DEBARMENT AND EXCLUSION 11 XXVI CONFLICT OF INTEREST 11 XXVII CONVENANT AGAINST CONTINGENT FEES 12 XXVIII LOBBYING 12 XXIX PROHIBITION OF POLITICAL ACTIVITES 12 XXX DISPUTES 12 XXXI DRUG-FREE WORKPLACE 13 XXXII REIMBURSEMENT LIMITS 13 XXXIII VENUE 13 XXXIV CONDITION PRECEDENT 13 XXXV CONTRACTAUTHORIZATION 14 2016JanBasicAgreement- / I CO Y THIS BASIC AGREEMENT is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments hereinafter called "Southeast Washington Aging and Long Term Care," whose address is P.O. Box 8349 Yakima, Washington 98908, and City of Yakima hereinafter called "the Contractor" whose address is 129 North Second Street, Yakima, Washington, 98901 I PURPOSE The purpose of this document is to establish a Basic Agreement containing General Terms that shall be incorporated by reference into any Contract executed between Southeast Washington Aging and Long Term Care and the Contractor. II AUTHORITY OF THE DIRECTOR OF SOUTHEAST WASHINGTON AGING AND LONG TERM CARE Southeast Washington Aging & Long Term Care hereby appoints and the Contractor hereby accepts the Director of Southeast Washington Aging and Long Term Care or a designee, as the Southeast Washington Aging and Long Term Care's representative for the purpose of administering the provisions of this Basic Agreement and subsequent Contracts, including Southeast Washington Aging and Long Term Care's right to inspect facilities and records, to receive and act on reports and documents, to request and receive additional information from the Contractor, to approve budget revisions and payment changes, to approve fee schedules for services, to assess the general performance of the Contractor, to determine if contracted services are being delivered in accordance with Federal, State, and local laws and regulations, to approve subcontracts, and to suspend this Basic Agreement or any Contract. All actions taken by the Director shall be subject to approval by the Southeast Washington Aging and Long Term Care. Southeast Washington Aging and Long Term Care reserves the right to terminate this Basic Agreement or any Contract and to commence civil action for its enforcement. III EXTENT OF AGREEMENT The Basic Agreement and Contract(s) contain all the terms agreed upon by the parties. No other understandings, written or oral, regarding the subject matter of this Basic Agreement or any Contract shall bind the parties. IV PERIOD OF AGREEMENT The terms of this Basic Agreement shall commence upon the date of execution and shall remain in full force and effect until specifically modified or terminated by mutual assent of the parties regardless of the modification or termination in whole or in part of any Contract. This Basic Agreement supersedes any prior Basic Agreement executed between Southeast Washington Aging and Long Term Care and the Contractor. V COMPLIANCE WITH LAWS The Contractor, in performance of this Basic Agreement and any Contract, shall comply with all applicable Federal, State, and local laws and regulations including HIPAA. VI ORDER OF PRECEDENCE Unless otherwise provided in a Contract, any inconsistency in the Basic Agreement or a Contract shall be resolved by giving precedence in the following order: A. Applicable Federal and State laws and Regulations; B. The terms and conditions of a Contract; C. The terms and conditions of the Basic Agreement; Page 1 of 14 201 6JanBasicAgreement- l 1 COY D. Any other provisions incorporated in writing into the Basic Agreement or Contract. VII RELATIONSHIP OF THE PARTIES The parties agree that the Contractor is an independent contractor and not an agent or employee of Southeast Washington Aging and Long Term Care. Agents, employees, or representatives of the Contractor shall neither claim to be nor present themselves as employees, agents, or representatives of Southeast Washington Aging and Long Term Care for any purpose. Employees of the Contractor are not entitled to any benefits Southeast Washington Aging and Long Term Care provides for its employees. VIII DEFINITIONS Terms used throughout this Basic Agreement shall have meanings as defined in the Washington Administrative Code (WAC). Additionally, the following words shall have the meanings as indicated: Aging and Long Term Care — Southeast Washington Aging and Long Term Care. Basic Agreement - This Agreement, which identifies the Contractor and the general terms that apply when and if Southeast Washington Aging and Long Term Care and the Contractor execute a Contract. The terms of the Basic Agreement are applicable to a Contract. Client - An individual applying for or receiving goods, services or benefits under a Contract. The terms Consumer, Customer, and Participant are synonymous. Contract - A document consisting of terms specific to contracted services, including Specific Provisions, Payment Provisions, and a Budget. Contracted Services - Those services to be provided by the Contractor under the terms of a Contract. Contractor - The individual or entity entering into this Basic Agreement with Southeast Washington Aging and Long Term Care. If a Contract is subsequently executed, the Contractor will deliver contracted services. Contractor includes authorized representatives and subcontractors retained to deliver contracted services. The term Business Associate is synonymous. Director - The Director of the Southeast Washington Aging and Long Term Care or designee. HIPAA — Health Insurance Portability and Accountability Act of 1996, 45 CFR 160, 164, privacy and security standards for Private Health Information. PHI — Private Health Information means individually identifiable information relating to the past, present or future physical or mental health or condition of an individual, provision of health care to an individual, or the past, present or future payment for health care provided to an individual. Subcontract - An agreement between the Contractor and a subcontractor, or between a subcontractor and another subcontractor, for the delivery of contracted services. The term subcontract does not include the purchase of supplies or support services that do not directly affect the client's health or welfare. The term subcontract means subcontract in any tier. Subcontractor - An individual or other entity delivering contracted services under a separate agreement with the Contractor or another subcontractor. The individual or entity is bound by the same HIPAA restrictions and conditions as the county and contractor. The term "subcontractor" means subcontractor in any tier. IX SAFEGUARDING OF INFORMATION The use or disclosure by the Contractor of confidential information and PHI concerning a client is prohibited without the written consent/authorization of the client, their designee, or responsible parent or guardian if the client is incompetent or a minor, or as otherwise provided by law, except: Page 2 of 14 20I6JanBasicAgreement- I I COY A. The Director or the Contractor may disclose information to each other, the State of Washington, or the Federal government for purposes directly connected with the administration of this Basic Agreement or any Contract. Such information includes determining eligibility, delivering services, and participating in an audit. B. The Director or the Contractor may disclose information to appropriate Federal agencies and the State of Washington for research, monitoring, statistical, and evaluation purposes. C. The Director and the Contractor may disclose PHI to each other for data aggregation services, treatment, payment or health care operations. D. The contractor agrees to develop and use appropriate procedural, physical, and electronic safeguards to prevent misuse of PHI. The contractor must limit any use or disclosure to the minimum amount necessary to accomplish the intended purpose. X TREATMENT OF ASSETS Real and personal property shall not be purchased under this Basic Agreement or any Contract without prior written approval from the Director. An inventory of such property shall be completed annually and submitted to the Director A. Definitions: 1. Nonexpendable Personal Property means tangible personal property having a useful life of more than one year and an acquisition cost of $5,000.00 or more per unit, unless defined otherwise by Contract. 2. Personal Property means property of any kind except real property. 3. Acquisition Cost means the amount expended for property, excluding interest and the book value (acquisition cost less depreciation) of any trade-in. 4. Useful Life of property means that useful service life as based on the U. S. Department of Treasury, Internal Revenue Service, policies on depreciation for tax purposes, unless the Contractor can document to the written satisfaction of the Director some different period. B. Title to all property furnished by Southeast Washington Aging and Long Term Care with County, State, or Federal funds shall remain with Southeast Washington Aging and Long Term Care, the State of Washington, or the Federal Government as their respective interests may appear. C. Title to all nonexpendable personal property purchased by the Contractor, the cost of which the Contractor is entitled to be reimbursed as a direct item of cost under a Contract, shall pass to and vest in Southeast Washington Aging and Long Term Care or State of Washington, or Federal Government as their respective interests may appear, upon delivery of such property. D. Nonexpendable personal property purchased by the Contractor under the terms of any Contract in which title is vested in Southeast Washington Aging and Long Term Care, State, or Federal Government shall not be rented, loaned, or otherwise passed to any person, partnership, corporation, association or organization without the prior written approval of the Southeast Washington Aging and Long Term Care, State, or Federal Government. E. Nonexpendable personal property furnished to or purchased by the Contractor, which is vested in Southeast Washington Aging and Long Term Care, State, or Federal Government, shall be used only for the delivery of contracted services. Page 3 of 14 2016JanBasicAgreement-I ICOY F. As a condition precedent to reimbursement for the purchase of nonexpendable personal property, title to which shall vest in Southeast Washington Aging and Long Term Care, State, or Federal Government, the Contractor agrees to execute such security agreements and other documents as shall be necessary for Southeast Washington Aging and Long Term Care, State, or Federal Government to protect their respective interests in such property in accordance with the Uniform Commercial Code -Secured Transactions as codified in Article 9, Title 62A, RCW. G. The Contractor shall be responsible: 1. For loss or damage to property of Southeast Washington Aging and Long Term Care, State, or Federal Government that results from negligence, willful misconduct, or lack of good faith on the part of the Contractor; 2 To maintain and administer property in accordance with sound management practices; and 3. To ensure that the property shall be returned to Southeast Washington Aging and Long Term Care, State, or Federal Government in condition as good as when acquired, reasonable wear and tear expected. H. Upon the loss or destruction of or damage to Southeast Washington Aging and Long Term Care, State, or Federal Government property, the Contractor shall notify the Director thereof and shall take all reasonable steps to protect that property from further damage. I. The Contractor shall surrender to the Director all property of Southeast Washington Aging and Long Term Care, State, or Federal Government within 30 days after settlement upon rescission, termination, or completion of this Basic Agreement or the Contract(s) for which the property was purchased, unless otherwise mutually agreed between the Contractor and the Director. J. The Director may, at his or her discretion, abandon in place property in which title is vested in Southeast Washington Aging and Long Term Care, State, or Federal Government under the terms of this Basic Agreement insofar as permitted by law, rule, or regulation, and thereupon all rights and obligations of Southeast Washington Aging and Long Term Care, State, or Federal Government regarding such abandoned property shall cease. XI LICENSING AND PROGRAM STANDARDS The Contractor shall comply with all applicable Federal, State, and local laws and regulations for licensing, certification and operation of facilities and programs, and accreditation and licensing of individuals, and other standards or criteria as described in this Basic Agreement or any Contract to assure quality of services. XII STANDARDS FOR FISCAL ACCOUNTABILITY A. The Contractor's fiscal management system shall: 1. Provide accurate, current, and complete disclosure of the financial status of each Contract; 2. Identify the source and application of all funds received for contracted services, distinguish costs of contracted services delivered under the terms of the Contract from all other costs and provide for accounting separation of all funds received; and 3. Report all revenue and expenditures to the Director in a manner consistent with generally accepted accounting principles. B. The Contractor agrees to maintain written accounting procedures. C. The Contractor agrees to: Page 4 of 14 2016JanBasicAgreement-1 /COY 1. Maintain records and documents that accurately reflect all direct and indirect costs related to the delivery of contracted services; and 2. Retain all fiscal and program records and other material relevant to a Contract according to the federal or state program guidelines. Fiscal records must be retained until all audits are resolved. XIII INSPECTION A. The Contractor shall give access to its facilities and records to any authorized officer, employee or agent of Southeast Washington Aging and Long Term Care, the State of Washington or the Federal Government at all reasonable times. Authorized persons shall have the right to examine the Contractor's performance, financial records, and HIPAA documentation and perform other activities to determine the Contractor's compliance with the terms of this Basic Agreement, any Contract, and HIPAA. The Director shall give the Contractor reasonable notice of monitoring, auditing, observation and other visits by its officers and employees to the Contractor's place of business. B. The Director may require the Contractor to make reasonable changes in the contracted services and HIPAA practices, as completed or to be completed, if the contracted services fail to conform to the standards and specifications set forth in the Contract. C. The Contractor shall notify the Director immediately of inspections, audits, accreditations, or program reviews related to the delivery of contracted services. The Contractor agrees to provide the Director copies of written reports of inspections, audits, accreditations or program reviews within 72 hours. XIV HOLD HARMLESS A. Indemnification, Defense, and Hold Harmless: To the fullest extent permitted by law including RCW 4.24.115, the Contractor shall indemnify, defend, and save harmless Southeast Washington Aging and Long Term Care and its officers, employees, agents, and volunteers from all claims, suits, or actions brought for injuries to, or death of, any persons, or damages arising from or relating to the Contractor's performance of this Agreement or in consequence of any negligence or breach of contract related to the Contractor's performance of this Agreement caused in whole or in part by any act or omission by the Contractor or the agents or employees of the Contractor related to performance of this Agreement. B. Contractor's Waiver of Employer's Immunity under Title 51 RCW: Contractor intends that its obligations to indemnify, defend, and hold harmless set forth above in section 15 shall operate with full effect regardless of any provision to the contrary in Title 51 RCW, Washington's Industrial Insurance Act. Accordingly, the Contractor specifically assumes all potential liability for actions brought by employees of the Contractor against Southeast Washington Aging and Long Term Care and its officers, employees, agents, and volunteers, and, solely for the purpose of enforcing the Contractor's obligations to indemnify, defend, and hold harmless set forth above in section 15, the Contractor specifically waives any immunity granted under the state industrial insurance law, Title 51 RCW. The parties have mutually negotiated this waiver. The Contractor shall similarly require that any subcontractor it retains in connection with its performance of this Agreement shall comply with the terms of this paragraph, waive any immunity granted under Title 51 RCW, and assume all liability for actions brought by employees of the subcontractor. Page 5 of 14 20 / 6JanBasicAgreement- I I COY XV AUDIT REQUIREMENTS A. Definitions Single Audit means an audit that will encompass the entirety of the financial operations of the Contractor and shall determine and report whether: 1. The financial statements of the Contractor present fairly its financial position and the results of its financial operations in accordance with generally accepted accounting principles, and whether the Contractor has complied with laws and regulations that may have a material effect upon the financial statements; 2. The Contractor has internal control systems to provide reasonable assurance that it is managing Federal financial assistance programs in compliance with applicable laws and regulations; and 3. The Contractor has complied with laws and regulations that may have a material effect upon each major Federal assistance program. In testing compliance for this section the auditor must select and test a representative number of transactions from each major Federal assistance program. Program -Specific Audit means an audit of one Federal program in accordance with Federal laws, regulations, or audit guides relative to that particular program. When a Contractor expends Federal Financial Assistance under only one Federal program and the Federal program's laws, regulations, or grant agreements do not require a financial statement audit of the Contractor, the Contractor may elect to have a program -specific audit. Subrecipient means any person or government department, agency, or establishment that receives federal financial assistance to carry out or administer a program but not an individual who is a beneficiary of such a program. Distinguishing characteristics of a subrecipient include such items as responsibility to meet compliance requirements, performance measured against meeting the objectives of a program, responsibility for programmatic decision making, and determining eligibility for assistance. Vendor means an entity responsible for providing goods or services that are required for the conduct of a Federal program. Distinguishing characteristics of a vendor include such items as providing the goods or services within normal business operations, operating for a profit, providing similar goods or services to many different purchasers, operating in a competitive environment, and not having responsibility for adherence to program compliance requirements. Federal Financial Assistance means assistance provided by a Federal agency in the form of grants, contracts, cooperative agreements, loans, loan guarantees, property, interest subsidies, insurance, food commodities, direct appropriations, and other assistance. It does not include direct Federal cash assistance to individuals. It includes awards received directly from Federal agencies or indirectly through other units of state and local governments. B. The Contractor, if a subrecipient of Federal Financial Assistance and expends (from all sources) $750,000 or more a year in Federal Financial Assistance, shall purchase annually a single or program -specific audit conducted for that year by a government auditor or public accountant who meets the standards for independence specified in the Government Auditing Standards. The Contractor agrees to: 1. Adhere to the Office of Management and Budget (OMB) Circular A-133 and other relevant Federal and State Requirements; 2. Provide access to independent auditors to its financial records; and 3. Maintain accounting records that will enable identification of all federal funds received and expended by the OMB Catalog of Federal Domestic Assistance number. Page 6 of 14 2016JanBasicAgreement-1 1 COY C. The Contractor, if a subrecipient of Federal Financial Assistance and expends (from all sources) less than $750,000 per year in Federal awards is exempt from Federal audit requirements for that year, but records must be available for review or audit by appropriate officials of the Federal Agency, pass-through entity and the General Accounting Office (GAO). D. The Contractor, if a vendor, is exempt from Federal audit requirements but records must be available for review by appropriate officials of the Federal agency, pass-through entity, and the General Accounting Office. The Contractor agrees to: 1. Ensure that transactions are in compliance with laws, regulations, and the provisions of the Contract or grant agreements; 2. Maintain accounting records that will enable identification of all federal funds received and expended; and 3. Provide access to its financial records by appropriate officials of Southeast Washington Aging and Long Term Care, State, Federal Government or their authorized representative to determine program compliance. E. The Contractor shall ensure that the audit report, with management letter, is submitted to the Director within nine months after the end of the audit period but no later than 30 -days after its receipt. F. The Contractor is required to respond to State or Federal audit requests for records or documentation, within the timeframe provided by the requestor. The Contractor must provide all records requested to either State or Federal agency staff or their designees. XVI INSURANCE AND BONDING A. Southeast Washington Aging and Long Term Care certifies that it is insured as a member of Enduris, and can pay for losses for which it is found liable. B. The Contractor shall, maintain occurrence based comprehensive general liability insurance and automobile liability insurance with minimum limits of $1,000,000 per occurrence and $2,000,000 aggregate, as well as Workers Compensation Contingent Employers Liability with minimum limits of $1,000,000 each accident or disease for each employee. Such insurance shall provide that Southeast Washington Aging and Long Term Care, its officers, employees, agents and volunteers are Primary Additional Insured's under such insurance. The coverage provided under such insurance for such Primary Additional Insured's shall be primary and not contributory to any other coverage that may be available to such Primary Additional Insured's. Prior to commencement of any work under this Agreement, the Contractor shall, provide proof of such insurance including all Certificates of Insurance and endorsements pertaining to such insurance, and if requested, any policy pertaining to insurance required under this Agreement. C. The Contractor agrees to maintain, without interruption during the term of a Contract, a Fidelity Bond in a minimum amount of $50,000, unless specified otherwise in the contract, which covers all individuals responsible for the administration of funds provided within the terms of a Contract. Certification of bonding shall be submitted to the Director within thirty days after execution of a Contract. D. The Contractor shall notify the Director immediately if either insurance or bonding coverage is terminated during the term of a Contract or is reduced below contractual requirements. XVII NONDISCRIMINATION A. The Contractor shall develop or adopt a nondiscrimination plan consistent with the Washington State Law Against Discrimination (RCW 49.60). Page 7 of 14 2016JanBasicAgreement-11COY The Contractor agrees that it shall not discriminate against any person on the grounds of race, creed, color, religion, national origin, sex, sexual orientation, age, marital status, political affiliation or belief, or the presence of any sensory, mental or physical handicap in violation of the Washington State Law Against Discrimination (RCW Chapter 49.60) or the Americans with Disabilities Act (42 USC 12101 et seq). In the event the Contractor violates this provision, ALTC may terminate this Agreement immediately and bar the Contractor from performing any services for ALTC in the future. The Contractor and subcontractor shall abide by the requirements of 41 CFR §§ 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals on the basis of protected veteran status or disability, and require affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans and individuals with disabilities. B. The Contractor shall not: 1. Deny an individual contracted services or benefits; 2. Provide contracted services or benefits to an individual that are different, or are provided in a different manner, from those provided to others; 3. Subject an individual to segregation or separate treatment in any manner related to the receipt of contracted services or benefits; or 4. Deny an individual an opportunity to participate in any program or afford an opportunity to do so that is different from that afforded others. C. The Contractor shall not use criteria or methods of administration that have the effect of subjecting individuals to discrimination because of race, creed, color, religion, national origin, sex, sexual orientation, age, marital status, political affiliation or belief, or the presence of any sensory, mental or physical handicap or have the effect of defeating or substantially impairing the delivery of contracted services to the class of individuals mentioned above through the selection of: 1. The types of contracted services or other benefits to be provided; 2. The class of individuals to whom, or the situation in which, such contracted services or other benefits shall be provided; or 3. The class of individuals to be afforded an opportunity to receive contracted services or other benefits; In accordance of the Washington State Law Against Discrimination (RCW Chapter 49.60) or the Americans with Disabilities Act (42 USC 12101 et seq). In the event the Contractor violates this provision, Southeast Washington Aging and Long Term Care may terminate this Agreement immediately and bar the Contractor from performing any services for ALTC in the future. D. The Contractor shall comply with all Federal and State nondiscrimination rules, including: 1. The Americans with Disabilities Act (ADA) of 1990, which prohibits discrimination against qualified individuals with disabilities and requires reasonable accommodations to the known physical or mental limitations of an otherwise qualified individual. 2. Title VI of the Civil Rights Act of 1964 as amended. 3. Section 504 of the Rehabilitation Act 1973 as amended. 4. The Age Discrimination Act of 1975 as amended. Page 8 of 14 20 I6JanBasicAgreement- I I COY 5. The Washington State Law Against Discrimination, RCW 49.60. E. The Contractor shall have a written procedure for resolving complaints that allege a violation of Federal laws against discrimination. A copy shall be made available to clients and applicants for contracted services. Such procedures should include time frames for Contractor response or action. Persons wishing to file a complaint shall be advised in writing of their right to file their complaint within 180 days of the alleged act of discrimination directly with the Washington State Human Rights Commission, the U.S. Equal Employment Opportunity Commission, the U.S. Department of Health and Human Services Office for Civil Rights, or the U.S. Department of Labor Office of Contract Compliance. F. The Contractor shall require subcontractors to fully comply with the provisions of this section, including sanctions for noncompliance. XVIII INCIDENT REPORTING The Contractor agrees to report any extraordinary incident to the Director, in writing, within three working days of the occurrence of an incident. A reportable incident is one that occurs or arises under this Basic Agreement or any Contract, and that involves: A. A death or injury, requiring inpatient hospital care, of a client or person under the care, supervision, or control of the Contractor at the time of the incident; B. An act of violence or serious crime in which the victim or the perpetrator is a client or person employed by or under the care, supervision, or control of the Contractor at the time of the incident; C. An incident of such public concern that the Director or the Southeast Washington Aging and Long Term Care Council of Government Governing Board may have a need to know; or D. A loss of funding so great as to jeopardize the Contractor's ability to fulfill the terms of this Basic Agreement or any Contract. D. Any unauthorized uses/disclosures of which it becomes aware, and shall take all reasonable steps to mitigate the potentially harmful effects of such breach. XIX ASSIGNMENT AND SUBCONTRACTING The Contractor shall not assign or subcontract any portion of contracted services unless the written subcontract has been reviewed and approved by the Director prior to the start of the subcontract. All contracted services that are not delivered directly by the Contractor must be delivered according to the terms of this Basic Agreement and the Contract. XX SEVERABILITY If any provision of this Basic Agreement shall be held invalid, the invalidity shall not affect the other provisions of the Agreement. To that end, the provisions of this Basic Agreement are severable. XXI MODIFICATION No modification or waiver of any clause or condition of this Basic Agreement is binding upon either party unless such modification or waiver is in writing and executed by both parties. XXII SUSPENSION, TERMINATION AND CLOSEOUT If the Contractor fails to comply with the terms of this Basic Agreement, any Contract or HIPAA, the Director may pursue such remedies as are legally available including the suspension or termination of this Basic Agreement or the Contract in whole or in part in the manner specified herein. Page 9 of 14 2016Jan BasicAgreement-11 COY A. Suspension - If the Contractor fails to comply or is unable to substantiate full compliance with the terms of this Basic Agreement or any Contract, the Director may suspend this Basic Agreement or the Contract in whole or in part pending corrective action or investigation, effective no less than seven days following written notification to the Contractor. The suspension shall remain in force until the Contractor complies to the satisfaction of the Director and is able to substantiate its full compliance with the terms of this Basic Agreement and the Contract. No obligation incurred by the Contractor during the period of suspension shall be allowable under this Basic Agreement except: 1. Reasonable, proper, and otherwise allowable costs that the Contractor could not avoid during the period of suspension; and 2. Discretionary costs that the Contractor incurred during the period of suspension if the Contractor is able to substantiate complete compliance with the terms of this Basic Agreement and the Contract. B. Termination for Cause - The Director may, by written notice, terminate this Basic Agreement or any Contract in whole or in part for substantial breach by the Contractor of duties under this Basic Agreement, any Contract or HIPAA. In such an event, the Contractor shall be liable for reasonable damages, including the reasonable cost of procuring similar services actually procured by the Director to fully execute the Contractor's duties under this Basic Agreement and the Contract(s). C. Termination for Other Grounds - This Basic Agreement or any Contract may be terminated in whole or in part by: 1. Either party, upon thirty days advance written request, in which case the two parties shall devise by mutual agreement the conditions of termination including the effective date and in case of termination in part, the portion to be terminated. 2. The Director, immediately upon written notice, if funding is withdrawn or reduced to the extent that the continuation is not in the best interest of Southeast Washington Aging and Long Term Care. D. Closeout - Upon expiration or termination of a Contract, in whole or in part, the following provisions shall apply: 1. Southeast Washington Aging and Long Term Care shall pay to the Contractor all allowable reimbursable costs not covered by previous payment upon submittal of a final invoice, subject only to the right reserved to the parties in the event of a dispute as provided in subparagraph "3" below. 2. The Contractor shall pay to Southeast Washington Aging and Long Term Care moneys received from Southeast Washington Aging and Long Term Care in excess of allowable costs, subject only to the right reserved to the parties in the event of a dispute as provided in subparagraph "3" below. 3. In the event the Director and the Contractor are unable to agree upon amounts due as provided in subparagraphs "1" or "2" above, either party shall have the right to withhold the disputed amount from final payment pending a final audit, and then pay such amounts as the audit determines are payable. 4. The Contractor shall submit all required financial and performance reports and claims for payment within thirty days after the end of the contract unless a different period is set by Southeast Washington Aging and Long Term Care. Page 10 of 14 20 / 6JanBasicAgreement- l 1 COY 5. At the option of the Director, the contractor shall return or destroy all PHI created or received from or on behalf of Southeast Washington Aging and Long Term Care and provide appropriate documentation evidencing procedure. The contractor agrees that it will not retain any copies of PHI except as required by law. If return or destruction of all PHI, and all copies of PHI, is not feasible, contractor agrees to extend the protections of this Contract to such information for as long as it is maintained. E. Notices shall be delivered by U.S. mail to the address stated in the first paragraph of this Agreement or such other address provided by the Contractor in writing to the Director. XXIII INDIVIDUAL RIGHTS AND HIPAA The contractor shall make all PHI and related information in its possession available: A. To the individual or his/her personal representative or to Southeast Washington Aging and Long Term Care, for inspection and copying. B. To the individual or his/her personal representative or to the county to fulfill any obligation to account for disclosures of PHI. C. To Southeast Washington Aging and Long Term Care to fulfill any obligation to amend PHI and related information and shall incorporate any amendments or related statements into the information the contractor holds and notify any subcontractors or agents of amendments. XXIV GRIEVANCE PROCEDURES The Contractor shall have a written procedure for resolving grievances. A copy shall be made available to clients and applicants for contracted services. Such procedures should include time frames for filing a grievance and provide opportunities for informal and formal resolution. For grievances arising from the delivery of contracted services, the grievance procedures must include the right of the grievant to appeal to the Director. Applicants and clients shall be advised of the grievance procedures and their right to due process if they feel they have been wrongfully denied or terminated from services. XXV DEBARMENT AND EXCLUSION A. The Contractor shall and does certify it is not debarred, suspended, ineligible or voluntarily excluded from participation in Federal assistance programs. The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. The Contractor shall provide immediate written notice to the Director if at any time the Contractor learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. C. The Contractor shall not knowingly assign or subcontract any portion of contracted services to a person who is debarred, suspended, declared ineligible, or voluntarily excluded from participation. XXVI CONFLICT OF INTEREST The Director may, by written notice to the Contractor, terminate this Basic Agreement in whole or in part if it is found after due notice and hearing that any of the following laws have been violated in obtaining or amending this Basic Agreement or any Contract or in making determinations with respect to this Basic Agreement or any Contract: A. RCW 42.20, Misconduct of Public Officers; B. RCW 42.23, Code of Ethics for Municipal Officers -Contract Interests. Page 11 of 14 20 1 6JanBasicAgreement- / / COY C. RCW 42.52, Ethics in Public Service Southeast Washington Aging and Long Term Care shall not be liable for payment for services rendered under any Contract to the extent this Basic Agreement or the Contract was entered into in violation of this clause. XXVII COVENANT AGAINST CONTINGENT FEES The Contractor shall assure that no person or agency has been employed or retained on a contingent fee for the purpose of seeking or obtaining a Contract. This does not apply to legitimate employees or an established commercial or selling agency maintained by the Contractor for the purpose of securing business. In the event of breach of this clause by the Contractor, the Director may: A. Annul this Basic Agreement or the Contract in whole or in part without any liability; or B. Deduct, or similarly recover from the consideration of the Contract, the amount of the contingent fee. XXVIII LOBBYING A. Federal requirements (U.S.C. Title 31, §1352): 1. No Federal appropriated funds may be paid, by or on behalf of the Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement. If non -Federal funds are used, the Contractor shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions. 2. The Contractor, if a recipient of a grant or cooperative agreement over $100,000, shall and does certify that it did and will comply with these Federal requirements. The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. State requirements (RCW 42.17.020 (27); RCW 42.17.190; RCW 34.05): No public funds may be used directly or indirectly to attempt to influence the passage or defeat of any legislation by the legislature of the State of Washington, or the adoption or rejection of any rule, standard, rate, or other legislative enactment of any State agency under the State Administrative Procedure Act. Provided, this does not prevent the Contractor from communicating with a member of the legislature on the request of that member or requesting legislative action or appropriations through appropriate channels. XXIX PROHIBITION OF POLITICAL ACTIVITIES No funds, material, property or contracted services provided under the terms of this Basic Agreement or any Contract shall be used for partisan political activity or to further the election or defeat of any candidate for public office. XXX DISPUTES Any dispute arising under this Basic Agreement or any Contract, including a disputed complaint or grievance resolution, shall, unless otherwise provided in this Basic Agreement or the Contract, be submitted in writing to the Director for settlement under Southeast Washington Aging and Long Term Care's Dispute Resolution Procedures. Page 12 of 14 20 1 6JanBasicAgreement-1 1 COY XXXI DRUG-FREE WORKPLACE A. The Contractor shall and does certify it provides a drug-free workplace in compliance with the Drug -Free Workplace Act (Public Law 100-690 Title V, Subtitle D). The Certification will be signed and submitted to the Director before the execution of this Basic Agreement. B. The Contractor shall publish a statement notifying employees of prohibitions against use, manufacture, distribution or possession of controlled substances in the workplace and specific actions that will be taken in the event of non-compliance. Employees shall be notified that, as a condition of employment, they must abide by the terms of the statement and notify the employer in writing of any conviction for a criminal drug statute occurring in the workplace within five calendar days after such conviction. This statement shall at a minimum be distributed to all employees engaged in the delivery of contracted services. C. The Contractor shall establish an on-going drug-free awareness program to inform employees about: 1. The dangers of drug abuse in the workplace; 2. The contractor's policy of maintaining a drug-free workplace; 3. The availability of drug counseling, rehabilitation, and employee assistance programs; and 4. The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace. XXXII REIMBURSEMENT LIMITS The sum of payments to the Contractor for a contracted service shall not exceed the contracted unit rate or the contracted amount whichever is greater. In the event payments to the Contractor exceed this limit, the overpayment shall be returned to Southeast Washington Aging and Long Term Care or deducted from the next Claim for Payment submitted by the Contractor. XXXIII VENUE This Basic Agreement and all Contracts shall be governed by the laws of the State of Washington. Any action, suit, or judicial proceeding for the enforcement of this Basic Agreement or any Contract shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. XXXIV CONDITION PRECEDENT This Basic Agreement shall not be binding upon the County until signature on behalf of the County is authorized by Resolution of Southeast Washington Aging and Long Term Care Council of Government Governing Board. Page 13 of 14 2016JanBasicAgreement- l I COY XXXV CONTRACT AUTHORIZATION Southeast Washington Aging and Long Term Care Council of Governments Lori Brown, [rector City of Yakima y F4 C't % i l vlic i/i ►rr, ;‘4-‘") rvtl Y City of a a. Print Name and Title Date: Date: Approved As To Legal Form: Daniel Clark, WSBA #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG CITY CONTRACT NO: at)/ la — (, d S RESOLUTION NO: R' a of D - 3 (o Page 14 of 14 CERTIFICATIONS REGARDING LOBBYING; DEBARMENT, SUSPENSION AND OTHER RESPONSIBILITY MATTERS; AND DRUG-FREE WORKPLACE REQUIREMENTS Signature of this form provides for compliance with certification requirements under the "New Restrictions on Lobbying," "Government -wide Debarment and Suspension (Nonprocurement) and Government -wide Requirements for Drug -Free Workplace (Grants)." The certifications shall be treated as a material representation of fact upon which reliance was placed when this basic agreement was entered into 1. LOBBYING As required by Section 1352, Title 31, of the U.S Code for persons entering into a grant or cooperative agreement (including subawards) over $100,000, the contractor certifies that: A) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal grant or cooperative agreement; B) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress in connection with this Federal grant or cooperative agreement, the undersigned shall complete and submit Standard Form -LLL, "Disclosure Form to Report Lobbying," in accordance with its instructions; C) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subgrants, contracts under grants and cooperative agreements, and subcontracts) and that all subrecipients shall certify and disclose accordingly 2. DEBARMENT, SUSPENSION, AND OTHER RESPONSIBILITY MATTERS As required by the certification requirements under the regulations implementing Executive Order 12549, Debarment and Suspension, the contractor certifies that it and its principals A) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in covered transactions by any Federal department or agency; B) Have not within a three-year period preceding this Agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) transaction or contract under a public transaction; violation of Federal or State antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; and C) Are not presently indicted for or otherwise criminally or civilly charged by a Government entity (Federal, State, or local) with commission of any offenses enumerated in paragraph (B) of this certification. Where the contractor is unable to certify to any of the statements in this certification, he or she shall attach an explanation to this application. 3. DRUG-FREE WORKPLACE As required by the Drug -Free Workplace Act of 1988 (Pub L. 100-690, Title V, Subtitle D) and implemented through additions to the Debarment and Suspension regulations, published in the Federal Register on January 31, 1989, and May 25, 1990: A) The Contractor certifies that it will or will continue to provide a drug-free workplace by: 1) Publishing a statement notifying employees that the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance is prohibited in the contractor's workplace and specifying the actions that will be taken against employees for violation of such prohibition, Page 1 of 2 2) Establishing an ongoing drug-free awareness program to inform employees about: a) The dangers of drug abuse in the workplace; b) The contractor's policy of maintaining a drug-free workplace; c) Any available drug counseling, rehabilitation, and employee assistance programs; and d) The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; 3) Making it a requirement that each employee to be engaged in the performance of the contract be given a copy of the statement required by paragraph (1); 4) Notifying the employee in the statement required by paragraph (1) that, as a condition of employment under the contract, the employee will: a) Abide by the terms of the statement; and b) Notify the employer in writing of his or her conviction for a violation of a criminal drug statue occurring in the workplace not later than five calendar days after such conviction; 5) Notifying the County, in writing, within ten calendar days after receiving notice under subparagraph (2)(b) from an employee or otherwise receiving actual notice of such conviction. Employers of convicted employees must provide notice, including position title, to every grant officer or other designee on whose contract activity the convicted employee was working, unless the Federal agency has designated a central point for the receipt of such notices. Notice shall include the identification number(s) of each affected contract; 6) Taking one of the following actions, within 30 calendar days of receiving notice under subparagraph (4)(b), with respect to any employee who is so convicted: a) Taking appropriate personnel action against such an employee, up to and including termination, consistent with the requirements of the Rehabilitation Act of 1973, as amended; or b) Requiring such employee to participate satisfactorily in a drug abuse assistance or rehabilitation program approved for such purposes by a Federal, State or local health, law enforcement, or other appropriate agency; 7) Making a good faith effort to continue to maintain a drug- free workplace through implementation of paragraphs (1),(2),(3),(4),(5), and (6). B) Insert in the space provided below the site(s) for the performance of work done in connection with the specific contract: Place of Performance: (Street address, city, county, state, zip code) Check if there are workplaces on file that are not identified here J As the duly authorized representative of the Contractor, I hereby certify that the Contractor will comply with the above certifications. Contractor Printed Name and Title of Authorized Representative 'Signature and Date Page 2 of 2 ALTCCOG 2016-15 PERFORMANCE AGREEMENT NO. 2016 COY (ADCRESP) 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 Governments Administrative office. 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: 2016JanBasic-11COY). In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PROGRAM Title III B Title III E SCSA AMOUNTS Adult Day Health $ 5,400 Respite $13,500 TOTAL FUNDINGALLOCATION $18,900 PERIOD OF AGREEMENT January 1, 2016 — December 31, 2016 CONTRACTOR SIGNATURES ,_1(tCF , L1/4 fe- 1en ti tM rv.we Y— Lori J. Brown,() Director City of Ya ima, Parks and Recreation' U SE Washington Aging and Long Term Care Date: t (Si a°(gyp Approved As To Legal Form: Daniel Clark, WSBA #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG Date: \� Q CITY CONTRACT NO: .D0110 001 3 RESOLUTION NO: R "� ALTCCOG 2016-15 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. The levels of service to be provided shall be as described in the Program Attachments for Adult Day Care and Respite Care to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re -negotiation of the funding 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. 2 ALTCCOG 2016-15 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: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by SE WA ALTC COG in order for 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 SE WA ALTC COG within the time limitations established by 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. Quarterly, financial, and service reports must be submitted to SE WA ALTC COG by the end of the month following the end of each quarter; 3. 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. Inventory: The Contractor agrees to: 1. Submit to SE WA ALTC COG vendor invoice(s) at the same time with the monthly billing before SE WA ALTC COG reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year a physical inventory, of all equipment purchased with SE WA ALTC COG funds. Provide this inventory report to SE WA ALTC COG once per year for record keeping purposes. E. 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. F. 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 ALTC 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: 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. 3 ALTCCOG 2016-15 G. 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. H. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. I. 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. 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. J. 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. K. Monitoring/Assessment Procedures: The Contractor agrees to: 4 ALTCCOG 2016-15 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 Advisory Council. 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 shall be made available to SE WA ALTC COG upon request. L. GRIEVANCE PROCEDURE AND HEARINGS The Contractor shall establish a system through which clients services under this approved Agreement may present grievances as outlined in the Basic Agreement, Section XXIV. M. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388- 01-030 and chapter 388-01 WAC, the Health Insurance Portability And Accountability Act of 1996 ("HIPAA"), and chapter 70.02 RCW. As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 5 ALTCCOG 2016-15 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of SE WA ALTC COG's responsibilities under this agreement except by prior written consent of the DSHS client, his/her attorney, parent or guardian. 3. The Contractor may disclose information to SE WA ALTC COG 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 shall disclose information for research, statistical, monitoring and evaluation purposes conducted by appropriate federal agencies and DSHS. SE WA ALTC COG must authorize in writing the disclosure of this information to any other party not identified in this section. N. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long-term care programs. b. Any personal use of client information is strictly prohibited. c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. 3. Disclosure of Information a. 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. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the SE WA ALTC COG Director and/or Home and Community Programs Public Disclosure Coordinator. 6 ALTCCOG 2016-15 d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. O. 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. 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 DSHS 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 42.56.210 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, ALTCCOG 2016-15 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 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. P. INDEMNIFICATION: The Contractor shall protect, defend, indemnify and hold harmless SE WA ALTC COG, its officers, employees, and agents from any and all third party claims and/or resultant costs (judgments and/or awards of damages) for injury to person(s) and/or damage to physical property including disclosure of personal information to the extent resulting directly and proximately from the acts of the Contractor, its officers, or employees related to the provisions of this contract. Q. LAWS, VENUE, JURISDICTION: This Agreement shall be governed by the laws of the State of Washington. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. R. 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 county 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. 8 ALTCCOG 2016-15 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. S. 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 T. 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. 9 ALTCCOG 2016-15 B. The 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; 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: 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; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in-kind contributions by greater than ten (10%) percent of their respective allotted amount; or 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of SE WA ALTC COG contracted funds by greater than ten (10%) percent of their respective allotted amount. 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, Sec. 25. 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. 10 ALTCCOG 2016-15 E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, SE WA ALTC COG may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds SE WA ALTC COG relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, SE WA ALTC COG may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the 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. If the last working day of a month falls on a Saturday, Sunday or holiday, payment will be made on the last SE WA ALTC COG working day of the month. 11 ALTCCOG 2016-15 Exhibit A STATEMENT OF WORK 2O16ADULT DAY CARE CITY OF YAKIMA 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 (PL 109-365) C. WAC 388-106-1100 through 1120 (Senior Citizens Service Act) D. WAC 388-71-0702 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 Services (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 or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. The adult day care 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 client's plan of care and are based on the client's 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; 1 ALTCCOG 2016-15 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. III PARTICIPANTS The Contractor agrees that: A. The target population for the day care program is individuals who are appropriate for care services as referenced in the Adult Day Care WAC 388-106-0800 through 388-106-0805 B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by Southeast Washington Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low-income 75 years of age or older Racial or Ethnic minority Limited or non-English speaking Living alone SE WA ALTC COG funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be targeted for 2016 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low-income 40% 75 years of age or older 55% Limited or non-English speaking 6% The Contractor must report on clients served in these categories. 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. 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 day care services to achieve treatment goals. 2 ALTCCOG 2016-15 1. Adult day care center staff are responsible for determining the financial and program eligibility of an applicant for day care services. 2. Eligibility must be determined prior to the provision of adult day care services and within thirty (30) days after the applicant has requested service. Eligible applicants may be provided services as of the date of application. 3. A Participant Intake Form (PIF) or other client tracking information shall be completed on each client served and submitted as required with the Monthly Service Level Report to Southeast Washington Aging and Long Term Care. B. Eligibility Re -determination The purpose of the eligibility re -determination is to assess whether an adult day care client continues to meet financial and program eligibility criteria. 1. Adult day care center staff are responsible for re -determining eligibility. A new Senior Citizens Services Application must be completed to document whether the client was found to be eligible or ineligible. 2. Eligibility must be determined: a. Within thirty (30) days after the adult day care center has received information that a change has occurred in the client's circumstances that may make the client ineligible; b. At six-month intervals if change occurs; c. At twelve-month intervals 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. C. Reduction/Termination of Services The Discharge Plan Form must be completed when a client becomes ineligible for adult day care services or when services are reduced or terminated for any reason. 1. Adult day care 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 care 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 ALTCCOG 2016-15 3. Reasons for termination of services: a. Client requests termination; b. In the professional judgment of day care center staff, the client no longer requires adult day care services, adult day care services no longer meet the client's needs or the client is not both willing and able to effectively utilize the adult day care program to achieve treatment goals. Whenever possible, service termination should be accomplished through mutual negotiation with the client and with the involvement of client's family and/or others in his/her informal support system and the client's physician; c. Funding cutbacks require termination. 4. A client who disagrees with a decision of adult day care staff to reduce or terminate services has ninety (90) days after receipt of the Discharge Plan Form to request a fair hearing. Services may not be reduced or terminated until the fair hearing decision is rendered if the request for a hearing is received prior to the effective date for reduction or termination. D. The day care center must be located in geographic areas which contain major concentrations or high proportions of target group older persons. E. Transportation to and from the center must be available. F. The day care 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. G. The day care center must meet the minimum staffing requirements for a center, which operates five (5) days a week and has an average daily attendance of less than twenty (20) participants. H. The day care center should have a written plan for evaluating whether the program is meeting the day care standards and the needs of the participants. I. Participants shall be referred to other services as needed. J. 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. K. 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 service shall consist of one (1) hour of Adult Day Care service, not including transportation time. B. There will be 4 unduplicated individuals served by this Agreement. 4 ALTCCOG 2016-15 C. Anticipated Service Level by Quarter: Month Hours January - March 135 April - June 135 July - September 135 October - December 135 Total 540 D. Anticipated Expenditure Rate by Quarter for client services: Month Rate January_ _ March $1,350:; a April -_ June _ $1,350; ;July - September $1,350 r 'October - December $1,350.' Total $5,400' 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 2016 Contract Budget Summary. The contracted amount shall be available during the period January 1, 2016 through December 31, 2016. 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. 5 ALTCCOG 2016-15 Exhibit B STATEMENT OF WORK 2016 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 388-71-0702 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 or disabled. 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 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. 1 ALTCCOG 2016-15 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. 2. If the participant's 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 participant's 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 an SE WA ALTC COG TCARE-certified case manager in the participant's 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 TCARE-certified 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 case manager. Case managers shall encourage caregivers to schedule respite care in advance. If respite care 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 TCare case manager. 2 ALTCCOG 2016-15 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 of Respite service shall consist of one (1) hour of service. B. There will be 4 unduplicated individuals served by this Agreement. C. Anticipated Service Level by Quarter: AL TC Funded by Total j MonthFunds Donations Units ;January - March _237 _ _ _ 21 258 'April - June 238' 20 258 July September 237 21i 258 {October-- December 238 22r 260, Total I 950 84 1034 Anticipated Service Levels include 84 units funded by donations. D. Anticipated Expenditure Rate by Quarter: Month Total ,January - March $3,375 :April - June $3,375 ,July - September $3,375 October - December $3,375 Total $13,500 E. 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 case manager. 4. Funds from participants and caregivers not meeting all of the eligibility criteria shall be accounted for at the Contractor level. 3 ALTCCOG 2016-15 F. Rates Rates of payment to respite care Contracting Agencies shall not exceed, and may be less than, rates paid by DSHS to Contracting Agencies for the same level of care. DSHS shall notify AAA's of the current maximum allowable rates. 1. If a Contractor has only an hourly rate, this rate shall be paid for each hour of respite care used, including 24 consecutive hours of respite care. 2. If a Contractor has only a daily rate, the rate shall be paid for 24 consecutive hours or less of respite care used. 3. If a Contractor has an hourly and daily rate, the hourly rate shall be paid for each hour of respite care when less than 24 hours of service is provided. The total amount paid at the hourly rate shall not exceed the Contractor's daily rate for that level of care. The daily rate shall be paid for 24 consecutive hours of respite care. The daily rate shall also be used for less than 24 consecutive hours of respite IF by using the daily rate the cost of the episode of respite care is less than using the hourly rate for the same amount of hours. 4. Workers shall be paid at least WA State minimum wage rate in accordance with labor standards and applicable legislation. 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 2016 Contract Budget Summary. This total sum shall be available during the period January 1, 2016 through December 31, 2016. 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. 4 ALTCCOG 2016-16 PERFORMANCE AGREEMENT NO. 2016 COY (FOOTCARE) 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, whose address is 129 North Second Street, Yakima, Washington, 98901, 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 Governments Administrative office. THE PURPOSE of this Agreement is to provide for the delivery of Footcare 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: 2016JanBasic-11COY). In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PROGRAM AMOUNTS Title III B SCSA TOTAL FUNDINGALLOCA770N $24,828 PERIOD OF AGREEMENT January 1, 2016 – December 31, 2016 CCA CONTRACTOR SIGNATURES t, (r-rkv/v,y) (j KIND -r'Lori 7 Brown 'rector City of Yakima, Parks and Recreation SE Washington Aging and Long Term Care Date: t 151 1 CP Approved As To Legal Form: Daniel Clark, WSBA #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG Date: Ia –D4(-20 /s CITY CONTRACT NO nos RESOLUTION NO: 2.. 12- /36 1 ALTCCOG 2016-16 STANDARD TERMS AND PAYMENT PROVISIONS CITY OF YAKIMA SPECIFIC PROVISIONS 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. CFR Title 45, Chapter XIII, Subchapter C, Part 1321 (Older Americans Act) C. WAC 388-106-1100 through 1120 (Senior Citizens Services Act) D. Older Americans Act (PL 109-365) E. WAC 246-840-700, 710; RCW 18.79 (Standards of Nursing Conduct) II PROJECT DEFINITION Geriatric Preventative Foot Care services are intended to provide early detection of existing and potential foot problems as well as alleviate dry skin problems, and maintenance of healthy nails. Services include foot inspection and palpation, foot soaks, nail trimming, and instructions in foot health maintenance. Referrals for follow-up treatment are made to local physicians and podiatrists. III PARTICIPANTS The Contractor agrees that: A. The target population for geriatric preventative foot care services are the individuals age 60 and over who: 1. Need one or more of the program services to avoid additional health problems or assist with activities of daily living, thereby reducing the need for other services; AND 2. Are not eligible for or have exhausted other sources of payment for similar services (Medicare, Medicaid, insurance) or similar services are not available. As stated in the Geriatric Preventative Foot Care Program Standards, a copy of which has been provided to the Contractor. All persons served should be members of the target population. To the degree feasible, persons served should meet the vulnerability criteria. B. There will be written assessment procedures utilized by the Contractor to determine if the program target population criteria are met by the clients served. C. The indicators used by SE WA ALTC COG to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low-income 75 years of age or older Racial or Ethnic minority Limited or non-English speaking Living alone 2 ALTCCOG 2016-16 SE WA ALTC COG funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be attained for 2016 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low-income 40% 75 years of age or older 55% Limited or non-English speaking 6% Living alone 40% The Contractor must report on clients served in these categories. D. Local medical professionals will be available to provide consultation services and act in an advisory capacity. E. Clinics will be held monthly at each designated facility that will include, but not be limited to, low-income housing facilities and senior centers. F. Participants shall be referred to the Information and Assistance/Case Management Program as needed. G. 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. H. 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. IV. 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. Multicultural, bilingual persons to assist multicultural, bilingual clients in receiving services; 3. Publicity of program through public service announcements, brochures, etc. 4. Meeting with other service providers/agencies to explain services the Contractor provides and how referral can be made; 5. Ability to serve individuals with disabilities. B. Services shall be delivered in accordance with the State of Washington Aging and Disabilities Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. 3 ALTCCOG 2016-16 V. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Payment Provisions: Section IV Units of Service of this Agreement. Failure to meet the service levels as defined in the Payment Provisions: Section IV Units of Service may result in a re -negotiation of the funding 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 a 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. VI. ADMINISTRATIVE AGREEMENTS: A. 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. B. Records and Reports: The Contractor agrees to: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by SE WA ALTC COG in order for 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 Administrative Office. The Contractor further agrees to provide such information as requested by SE WA ALTC COG within the time limitations established by 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. Quarterly, financial, and service reports must be submitted to SE WA ALTC COG by the end of the month following the end of each quarter; 3. 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. C. Inventory: The Contractor agrees to: 1. Submit to SE WA ALTC COG vendor invoice(s) at the same time with the monthly billing before reimbursement of expenditures of authorized equipment items of $5,000 or more; 2. Complete at least once a year a physical inventory, of all equipment purchased with SE WA ALTC COG funds. Provide this inventory report to SE WA ALTC COG once per year for record keeping purposes. D. Contractors Meeting: The Contractor agrees to have a representative attend meetings of the SE WA ALTC COG Contractors' meeting and the Long Term Care Planning Committees. 4 ALTCCOG 2016-16 E. Program Publication: The Contractor agrees that: 1. The program shall be publicized on a regular basis, with all publicity and printed material identifying SE WA ALTC 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 handicap. 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. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. H. 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; 3. It will continue or initiate efforts to obtain support from private sources and other public organizations for this service; 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. I. 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; 5 ALTCCOG 2016-16 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. J. 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 Advisory Council. 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 shall be made available to SE WA ALTC COG upon request. K. DISCLOSURE OF PERSONAL INFORMATION 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 stated in RCW 74.04.050, or its successor or replacement statute or as authorized by law. Other pertinent federal and state statutes and laws that protect Client records include the Public Records Act, codified as chapter 42.56 RCW, WAC 388- 01-030 and chapter 388-01 WAC, the Health Insurance Portability And Accountability Act of 1996 (''HIPAA'), and chapter 70.02 RCW. 6 ALTCCOG 2016-16 As required by RCW 74.04.060 The Contractor shall treat information accessed under this Agreement with the degree of confidentiality required by the federal Social Security Act. 1. 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 staff shall not access any individual client data for personal purposes. Clients shall only be permitted to access their own data. 2. The Contractor shall not use or disclose any information concerning any DSHS client for any purpose not directly connected with the administration of SE WA ALTC COG's responsibilities under this agreement except by prior written consent of the DSHS client, his/her attorney, parent or guardian. 3. The Contractor may disclose information to SE WA ALTC COG 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 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. L. 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 HIPAA and use disclosure of PHI requirement an understand: 1. Confidentiality of Client Data a. 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 HIPAA Privacy Rule — 45 CFR 160 to 45 CFR 164. b. 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). RCW 42.56.230 lists the information that is exempted from public inspection and copying. 2. Use of Client Data a. Client data may be used only for purposes of these contracted services, directly related to providing services to the client or for the operation of aging and long-term care programs. b. Any personal use of client information is strictly prohibited. c. Access to data must be limited to those staff whose duties specifically require access to such data in the performance of their assigned duties. ALTCCOG 2016-16 3. Disclosure of Information a. 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. b. Client information may be disclosed to other individuals or agencies only for purposes of administering DSHS programs. c. Questions related to disclosure are to be directed to the SE WA ALTC COG Director and/or Home and Community Programs Public Disclosure Coordinator. d. Any disclosure of information contrary to this section is unauthorized and is subject to penalties identified in law. M. 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); 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 so that unauthorized individuals cannot access client information. 8 ALTCCOG 20I 6- 16 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 2510 et. Seq. Electronic Communications Privacy Act of 1986) Part A of Title IV of the Social Security Act authorizes 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. N. INDEMNIFICATION: The Contractor shall protect, defend, indemnify and hold harmless SE WA ALTC COG, its officers, employees, and agents from any and all third party claims and/or resultant costs (judgments and/or awards of damages) for injury to person(s) and/or damage to physical property including disclosure of personal information to the extent resulting directly and proximately from the acts of the Contractor, its officers, or employees related to the provisions of this contract. O. LAWS, VENUE, JURISDICTION: This Agreement shall be governed by the laws of the State of Washington. Any action, suit, or judicial proceeding for the enforcement of this Agreement shall be brought in the Superior Court for the State of Washington in Yakima County, Washington. Q. 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. 9 ALTCCOG 2016-16 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 county 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. R. 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 S. 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. 10 ALTCCOG 2016-16 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 ATLC 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. The 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; 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: 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 2. Claims for reimbursement are inconsistent with the terms and conditions of this Agreement; or 4. Claims for reimbursement on unit rate price Agreements exceed the administrative and service delivery budgets without in-kind contributions by greater than ten (10%) percent of their respective allotted amount; or 11 ALTCCOG 2016-16 5. Claims for reimbursement on line -item cost Agreements exceed the administrative and service delivery budgets of SE WA ALTC COG contracted funds by greater than ten (10%) percent of their respective allotted amount. 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, Sec. 25. 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. E. Termination of Contract 1. Either party may terminate this Agreement immediately upon written notice, sent by certified mail, to the addresses listed on Page 1. If the Contractor fails to comply with the terms and conditions of this Agreement, SE WA ALTC COG may pursue such remedies as are legally available, including, but not limited to, the immediate termination of this Agreement. 2. TERMINATION DUE TO CHANGE IN FUNDING: If the funds SE WA ALTC COG relied upon to establish this Agreement are withdrawn, reduced or limited, or if additional or modified conditions are placed on such funding, SE WA ALTC COG may immediately terminate this Agreement by providing written notice to the Contractor. The termination shall be effective on the date specified in the termination notice. III BILLING PROCEDURES A. The Contractor shall submit written claims 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 the 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. If the last working day of a 12 ALTCCOG 2016-16 month falls on a Saturday, Sunday or holiday, payment will be made on the last SE WA ALTC COG working day of the month. IV. UNITS OF SERVICE A. Definition: A unit of Geriatric Preventative Foot Care service shall consist of one (1) foot care treatment. B. There will be 317 unduplicated individuals served by this Agreement (216 participants shall reside in the upper valley and 41 shall reside in the lower valley). C. Anticipated Service Level by Quarter: -- - - ----- - -� -- Month LV Units! Total ' IJanua March —I UV Units 337' _59! 396' !April - June _I _ 337; _ _59(__ 396 July - September 338! 59 397' ;October - December 338 59, 397; Total i 1,350. 236 ; 1,586 Anticipated Service Levels include 230 additional units in the upper valley funded by donations and 67 additional units in the lower valley. D. Anticipated Expenditure Rate by Quarter: Month UV Rate LV Rate Total January - March $5,319 $888 $6,207 April - June $5,319 $888 $6,207 July - September $5,319 $888 $6,207 October - December $5,319 $888 $6,207 Total $21,276 $3,552 $24,828 V. PAYMENT CONSIDERATIONS 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 $24,828 from available funds as submitted on the 2016 Contract Budget Summary. This total sum shall be available during the period January 1, 2016 through December 31, 2016. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before SE WA ALTC COG funds. 13 Southeast Washington 2016 Authorized Signatures for: City of Yakima Agin & Long—Term Care 1)-1-rttc; L. (3.-e - Rc c rtc„,-tiovk u t t f v s S °'r Printed Name and Title is/sof is Signature of Above Date 2) Pri- ted Name and Title 4 wl/ Iva - Ric ks co -10l Signature of Above are 3) S�-C-r , 'v] Printed Name acid , ride Signahu Above efibove' l (C� Date ALTCCOG 2016-69 AGREEMENT NO. MOD. NO. FUNDING SOURCE 2016 COY (footcare) 01 TITLE III B, SCSA AGREEMENT PERIOD 1/01/16 —12/31/16 THIS AGREEMENT MODIFICATION to Performance Agreement No. 2016 COY (footcare); AL TC Agreement No. ALTCCOG 2016-16 is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments, whose address is PO Box 8349, Yakima, Washington 98908, and City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901. This modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The parties agree that this contract modification becomes effective at the time of execution by the Southeast Washington Aging and Long Term Council of Governments Governing Board and/or Director. The purpose of this agreement modification is to amend the following: 1. Decrease the total contract amount for Upper Valley foot care services from $21,276 to $19,276; 2. Increase the total contract amount for Lower Valley foot care services from $3,552 to $5,552; 3. The total maximum contract amount is unchanged and remains $24,828. ■ See Page 2 of this modification for the STANDARD TERMS AND PAYMENT PROVISIONS. SPECIFIC PROVISIONS; PAYMENT PROVISIONS. PAYMENT CONSIDERATIONS. Contractor Signatures City of Yakima Cliff oo ity Manager Date: ne+c-he ( 51 01 Approved As To Legal Form: Southeast Washington Aging And Long Term Care Council of Governments Lori rown, ti erector Date: 10 047,20 /42 Daniel Clark,'WSBA #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG CITY CONTRACT NO: RESOLUTION NO: 05",4 mend , a --/3L. ALTCCOG 2016-69 2016 AGREEMENT MODIFICATION 01 CITY OF YAKIMA FOOTCARE STANDARD TERMS AND PAYMENT PROVISIONS SPECIFIC PROVISIONS PAYMENT PROVISIONS V. PAYMENT CONSIDERATIONS 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 $24,828 from available funds as submitted on the 2016 Contract Budget Summary. This total sum shall be available during the period January 1, 2016 through December 31, 2016. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price agreement shall be based on the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, less client donations. Client donations must be spent first before SE WA ALTC COG funds. 2 ALTCCOG 2017-16 PERFORMANCE AGREEMENT NO. 2017 COY (ADHRESPITE) 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 Governments 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 (BasicAgreement No: 2016JanBasic-11 COY). In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PROGRAM AMOUNTS Title III B Title III E SCSA Adult Day Care $ 3,400 Respite $13,500 TOTAL FUNDINGALLOG477ON $16,900 PERIOD OF AGREEMENT January 1, 2017 - December 31, 2017 CONTRACTOR SIGNATURES Cliff "' oor a " ity Manager City of Yakima Date: OLC-= l III 9040 0 Approved As To Legal Form: Daniel Clark, =''.'S3A #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG CITY CONTRACT NO. .20/6 r 25- /7 RESOLUTION NO:/`•-a0f. /3 b ov\= Lori J. Brown, irector SE Washington Aging and Long Term Care Date: \9.-I c V.10 /fg 1 ALTCCOG 2017-16 STANDARD TERMS AND PAYMENT PROVISIONS QTVOF 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 Of 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. The levels of service to be provided shall be as described in the Program Attachments for Adult Day Care and Respite Care to this Agreement. Failure to meet the service levels as defined in the Program Attachments may result in a re -negotiation of the funding 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. 2 ALTCCOG 2017-16 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: 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. Submit quarterly service reports to SE WA ALTC COG by the end of the month following the end of each quarter; 3. Submit the Quarterly financial report upon request to SE WA ALTC COG by the end of the month following the end of each quarter; 4. 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 ALTC 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: 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. 3 ALTCCOG 2017-16 G. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. H. 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. 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. I. 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. J. 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 4 ALTCCOG 2017-16 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 Advisory Council. 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 shall be made available to SE WA ALTC COG upon request. K. GRIEVANCE PROCEDURE AND HEARINGS The Contractor shall establish a system through which clients services under this approved Agreement may present grievances as outlined in the Basic Agreement, Section XXIV. L. 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); Storage Area Networks (SAN); and, j. Network Attached Storage (NAS). 5 ALTCCOG 2017-16 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. 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 42.56.210 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 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. M. 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 county 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; 6 ALTCCOG 2017-16 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. N. 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 0. 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 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. ALTCCOG 2017-16 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. The 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; 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: 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, 2CFR Part 215. 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. 8 ALTCCOG 2017-16 III BILLING PROCEDURES A. Contractor shall submit written claims 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. 9 ALTCCOG 2017-16 Exhibit A STATEMENT OF WORK 2017 ADULT DAY CARE CITYOF 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 2, Part 215, (Administration of Grants) B. Older Americans Act (PL 109-365) C. WAC 388-106-1100 through 1120 (Senior Citizens Service Act) D. WAC 388-71-0702 through 0774 (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 Services (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 or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician. The adult day care 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 client's plan of care and are based on the client's 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; i ALTCCOG 2017-16 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. III PARTICIPANTS The Contractor agrees that: A. Target population for the day care program is individuals as referenced in WAC 388-71- 0704. B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by Southeast Washington Aging and Long Term Care to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low-income 75 years of age or older Racial or Ethnic minority Limited or non-English speaking Living alone SE WA ALTC COG funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be targeted are as follows: Target Group Percentage Racial or ethnic minorities 19% Low-income 40% 75 years of age or older 55% Limited or non-English speaking 6% The Contractor must report on clients served in these categories. 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. 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 day care services to achieve treatment goals. 2 ALTCCOG 2017-16 1. Adult _ daycare center staff are responsible for determining the financial and program eligibility of an applicant for day care services using the Senior Citizens Services Application. 2. Eligibility must be determined prior to the provision of adult day care services and within thirty (30) days after the applicant has requested service. Eligible applicants may be provided services as of the date of application. 3. A Participant Intake Form (PIF) or other client tracking information shall be completed on each client served and submitted as required with the Monthly Service Level Report to Southeast Washington Aging and Long Term Care. B. Eligibility Re -determination The purpose of the eligibility re -determination is to assess whether an adult day care client continues to meet financial and program eligibility criteria. 1. Adult day care center staff are responsible for re -determining eligibility. A new Senior Citizens Services Application must be completed to document whether the client was found to be eligible or ineligible. 2. Eligibility must be determined: a. Within thirty (30) days after the adult day care center has received information that a change has occurred in the client's circumstances that may make the client ineligible; b. At twelve-month intervals 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. C. Reduction/Termination of Services The Discharge Plan Form must be completed when a client becomes ineligible for adult day care services or when services are reduced or terminated for any reason. 1. Adult day care 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 care 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; 3 ALTCCOG 2017-16 b. In the professional judgment of day care center staff, the client no longer requires adult day care services, adult day care services no longer meet the client's needs or the client is not both willing and able to effectively utilize the adult day care program to achieve treatment goals. Whenever possible, service termination should be accomplished through mutual negotiation with the client and with the involvement of client's family and/or others in his/her informal support system and the client's physician; c. Funding cutbacks require termination. 4. A client who disagrees with a decision of adult day care staff to reduce or terminate services has ninety (90) days after receipt of the Discharge Plan Form to request a fair hearing. Services may not be reduced or terminated until the fair hearing decision is rendered if the request for a hearing is received prior to the effective date for reduction or termination. D. The day care center must be located in geographic areas which contain major concentrations or high proportions of target group older persons. E. Transportation to and from the center must be available. F. The day care 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. G. The day care center must meet the minimum staffing requirements for a center per WAC 388-71-0752 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 service shall consist of one (1) hour of Adult Day Care service, not including transportation time. B. Anticipated Service Level by Contract: 340 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 $3,400 as submitted on the 2017 Contract Budget Summary. The contracted amount shall be available during the period January 1, 2017 through December 31, 2017. 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 ALTCCOG 2017-16 Exhibit S STATEMENT OF WORK 2017 RESPITE MT 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 388-71-0702 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 or disabled. 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 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. 1 ALTCCOG 2017-16 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. 2. If the participant's 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 participant's 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 an SE WA ALTC case manager in the participant's 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 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 case manager. SE WA ALTC case managers shall encourage caregivers to schedule respite care in advance. If respite care 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. 2 ALTCCOG 2017-16 VII UNITS OF SERVICE A. Definition: A unit of Respite service shall consist of one (1) hour of service. B. Anticipated Service Level by Contract: 951 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. D. Rates Rates of payment to respite care Contracting Agencies shall not exceed, and may be less than, rates paid by DSHS to Contracting Agencies for the same level of care. DSHS shall notify AAA's of the current maximum allowable rates. 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 2017-22 PERFORMANCE AGREEMENT NO. 2017 COY (FOOTCARE) 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, whose address is 129 North Second Street, Yakima, Washington 98901, hereinafter denominated the "Contractor", whose duty authorized representatives are named in documents on file at the Southeast Washington Aging and Long Term Care Council of Governments 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 Footcare 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: 2016JanBasic-11 WY). In the event the Basic Agreement is revised, this Agreement shall conform to the revisions. PROGRAM AMOUNTS Title III B SCSA TOTAL FUNDINGALLOC477ON $24.828 PERIOD OF AGREEMENT January 1, 2017 — December 31, 2017 Cliff Moor%' City Manager City of Yakima Date: I.0 IL -1),7o/ Approved As To Legal Form: CONTRACTOR SIGNATURES G.P Daniel Clark, W #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG CITY CONTRACT NO: REsoLuTioNNR `26 a Lori J. Brown, irector SE Washington A ing and Long Term Care Council of Governments Date: 1 �- 2 of d d 1(10 1 ALTCCOG 2017-22 STANDARD TERMS AND PAYMENT PROVISIONS CITY OF YAKIMA 2017 FOOTCARE SPECIFIC PROVISIONS 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. CFR Title 45, Subtitle A, Part 74, (Administration of Grants) B. CFR Title 45, Chapter XIII, Subchapter C, Part 1321 (Older Americans Act) C. WAC 388-106-1100 through 1120 (Senior Citizens Services Act) D. Older American Act (PL 109-365) E. WAC 246-840-700, 710; RCW 18.79 (Standards of Nursing Conduct) II PROJECT DEFINITION Geriatric Preventative Foot Care services are intended to provide early detection of existing and potential foot problems as well as alleviate dry skin problems, and maintenance of healthy nails. Services include foot inspection and palpation, nail trimming, and instructions in foot health maintenance. Referrals for follow-up treatment are made to local physicians and podiatrists. III PARTICIPANTS The Contractor agrees that: A. Target population for geriatric preventative foot care services are the individuals age 60 and over who: 1. Need one or more of the program services to avoid additional health problems or assist with activities of daily living, thereby reducing the need for other services; AND 2. Are not eligible for or have exhausted other sources of payment for similar services (Medicare, Medicaid, insurance) or similar services are not available. As stated in the Geriatric Preventative Foot Care Program Standards, a copy of which has been provided to the Contractor all persons served should be members of the target population. To the degree feasible, persons served should meet the vulnerability criteria. B. There will be written assessment procedures utilized by the Contractor to determine if clients meet the program target population criteria. C. The indicators used by SE WA ALTC COG to assess its effectiveness at targeting services to individuals who may be vulnerable are: Low -Income 75 years of age or older Racial or Ethnic minority Limited or non-English speaking Living alone 2 ALTCCOG 2017-22 SE WA ALTC COG funding should encourage the effective targeting of services to the vulnerable elderly by the Contractor. Specific goals to be attained for 2016 are as follows: Target Group Percentage Racial or ethnic minorities 19% Low-income 40% 75 years of age or older 55% Limited or non-English speaking 6% Living alone 40% The Contractor must report on clients served in these categories. D. Local medical professionals will be available to provide consultation services and act in an advisory capacity. E. Clinics will be held monthly at each designated facility that will include, but not be limited to, low- income housing facilities and senior centers. F. Participants shall be referred to the Information and Assistance/Case Management Program as needed. G. 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. H. 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. IV SERVICE SPEQFICATIONS 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 State of Washington Aging and Disabilities Services Administration Program Standards and information submitted in Request for Proposal. The Contractor acknowledges receipt of a copy of said standards. Services provided shall comply with said standards as presently constituted or subsequently modified. 3 ALTCCOG 2017-22 V. ANTICIPATED SERVICE LEVELS AND EXPENDITURE RATES The Contractor agrees that: A. The levels of service to be provided shall be as described in the Payment Provisions: Section IV — Units of Service of this Agreement. Failure to meet the service levels as defined in the Payment Provisions: Section IV — Units of Service may result in a renegotiation of the funding 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 a 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. VL ADMINISTRATIVE AGREEMENTS: A. 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. B. Records and Reports: The Contractor agrees to: 1. Maintain program records and reports, including statistical information, and to make such records available for inspection by SE WA ALTC COG in order for 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 Administrative office. The Contractor further agrees to provide such information as requested by SE WA ALTC COG within the time limitations established by SE WA ALTC COG; 2. Submit quarterly service reports to SE WA ALTC COG by the end of the month following the end of each quarter; 3. Submit an agreed upon monthly service unit report by the tenth day of each month. Contract payment requests will not be processed until service unit reporting is complete. Contractor shall attach the report to the invoice submission to verify service recording is complete. a. The following information shall be collected. In the event that information cannot be obtained, Contractor shall notify SE WA ALTC COG. i. Full name including first, middle initial and last ii. Street and mailing address (if different) iii. Home telephone number including the area code iv. Units of Service for Current Month v. Gender vi. Date of Birth vii. Urban/rural viii. Race and Ethnicity ix. Primary language spoken x. Household composition (lives alone) xi. Yes or No — is household income at or below 100% Federal Poverty Level 4 ALTCCOG 2017-22 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. C. Contractors Meeting: The Contractor agrees to have a representative attend meetings of the SE WA ALTC COG Contractor's meeting and the Long Term Care Planning Committees. D. 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. E. 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. F. Private Pay: The Contractor, who offers to the general public on a private pay basis a service comparable to the service described in this Agreement, must assure that SE WA ALTC COG is not charged more for the service than the private pay fee. The responsibility lies with the Contractor to justify that a service provided at a different rate is not comparable to this service. 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. 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; 5 ALTCCOG 2017-22 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 Advisory Council. 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 shall be made available to SE WA ALTC COG upon request. J. 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. 6 ALTCCOG 2017-22 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 ALTCCOG 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 42.56.210 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; a nd, 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 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. K. 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. ALTCCOG 2017-22 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. L. 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 8 ALTCCOG 2017-22 M. 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 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. The 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; 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: 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, 9 ALTCCOG 2017-22 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, Sec. 25. 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 offidals. 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. The Contractor shall submit written claims 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. IV. UNITS OF SERVICE A. Definition: A unit of Geriatric Preventative Foot Care service shall consist of one (1) foot care treatment. B. Minimum Anticipated Service Level by Contract: Lo011:44 fern 4 4 �`!. ,� Uci6ts Upper Valley 855 Lower Valley 265 C. Anticipated Expenditure Rate by Contract: NyY'.., �}5...�T^'C'.�ei` 4� .'��� 'rviaiLocatioroj �iti��'�� �3x��y �1.��<. $i'�"P.a^+t .Yir:e� aW'. 'r�®aa Base Payment $ 3,036 Upper Valley $ 16,240 Lower Valley $ 5,552 Total $ 24,828 V. PAYMENT CONSIDERATIONS As consideration for services, as described in the Specific Provisions of this Agreement, SE WA ALTC COG agrees to pay the Contractor a sum not to exceed $24,828 from available funds. This total sum shall be available during the period January 1, 2017 through December 31, 2017. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price Agreement shall be based on a monthly payment of $253 and the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, Tess client donations. Client donations must be spent first before SE WA ALTC COG funds. 10 ALTCCOG 2017-57 AGREEMENT NO. MOD. NO. FUNDING SOURCE r 2017 CITY OF YAKIMA 01 Title III B, (FOOTCARE) & SCSA AGREEMENT PERIOD 1/01/17 —12/31/17 THIS AGREEMENT MODIFICATION to Performance Agreement No. 2017 COY (FOOTCARE); ALTC Agreement No. ALTCCOG 2017-22 is entered into by and between Southeast Washington Aging and Long Term Care Council of Governments, whose address is PO Box 8349, Yakima, Washington 98908, and The City of Yakima, whose address is 129 North Second Street, Yakima, Washington, 98901. This Modification shall consist of those points enumerated below and in no way alters any other terms or conditions of the original Agreement not specifically mentioned in this Agreement Modification. The parties agree that this contract modification 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 parties agree that the original contract terms are amended as follows: 1. Decrease the total contract amount for Lower Valley foot care services from 5,552to $706; 2. Decrease the total maximum contract amount from 24,828to $19,982; 3. Revise STANDARD TERMS AND PAYMENT PROVISIONS. SPECIFIC PROVISIONS. PAYMENT PROVISIONS. Section IV UNITS OF SERVICE; Item B. Minimum Anticipated Service Level by Contract; Item C. Anticipated Expenditure Rate by Contract. 4. Revise STANDARD TERMS AND PAYMENT PROVISIONS. SPECIFIC PROVISIONS. PAYMENT PROVISIONS. Section V PAYMENT CONSIDERATION. Contractor Signatures Cliff Moore, a Manager City of Yakima Date: Z� Approved As To Legal Form: Daniel Clark, WSBA #35901 Yakima County Senior Deputy Prosecuting Attorney And Civil Legal Counsel for SE WA ALTC COG Lori). rown&Director SE Washington Aging and Long Term Care Council of Governments Date:(0n)0 II CITY CONTRACT NO: -70/6 -2 S6 407/1-14( RESOLUTION NO: R-620/-2-/,34, 1 ALTCCOG 2017-57 MODIFICATION NO. 01 2017 FOOTCARE CITY OF YAIUMA STANDARD TERMS AND PAYMENT PROVISIONS SPECIFIC PROVISIONS PAYMENT PROVISIONS IV. UNITS OF SERVICE B. Minimum Anticipated Service Level by Contract: C. Anticipated Expenditure Rate by Contract: Original.Contract Modification No 01 Service Location Units Units Upper Valley 855 855 Lower Valley 265 33 C. Anticipated Expenditure Rate by Contract: V. PAYMENT CONSIDERATION As consideration for services, as described in the Specific Provisions of this Agreement, SE WA ALTC COG agrees to pay the Contractor a sum not to exceed $19,982 from available funds. This total sum shall be available during the period January 1, 2017 through December 31, 2017. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price Agreement shall be based on a monthly payment of $253 and the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, Tess client donations. Client donations must be spent first before SE WA ALTC COG funds. 2 :Original='ContractModification No,01. ; Service' :Location _ Amount . ": t;;Amount. Base Payment $ 3,036 $ 3,036 Upper Valley S 16,240 s 16,240 Lower Valley $ 5,552 $ 706 Total $ 24,828 $ 19,982 V. PAYMENT CONSIDERATION As consideration for services, as described in the Specific Provisions of this Agreement, SE WA ALTC COG agrees to pay the Contractor a sum not to exceed $19,982 from available funds. This total sum shall be available during the period January 1, 2017 through December 31, 2017. These funds shall be used to provide Geriatric Preventive Foot Care services. Payment to the Contractor for this unit rate price Agreement shall be based on a monthly payment of $253 and the unit rate of $19.00 in the Upper Valley and $21.00 per unit in the Lower Valley, Tess client donations. Client donations must be spent first before SE WA ALTC COG funds. 2