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Home My WebLink About20133070.tiffMEMORANDUM DATE: October 28, 2012 TO: Sean P. Conway, Chair, W.,eylitzt B tilft FROM: Judy A. Griego, Director, H,e ipan Services Dep RE: mis iers /4.LOAD Agreements to Purchase Out -of -Home Placement Services between -the Weld County Department of Human Services and Various Providers to be Placed on the Consent Agenda Enclosed for Board approval are Agreements to Purchase Out -of -Home Placement Services between the Department and Various Providers. The boiler -plate Agreements were reviewed under the Board's Pass -Around Memorandum dated July 17, 2013, and approved for placement on the Board's Consent Agenda. Below are the major provisions of the attached Agreements: No. Facility Name/Term Facility Type/Location Daily Rate 1 Alternative Homes For Youth (2016) July 1, 2013 —June 30, 2014 Residential Child Care Facility Dacono, Colorado $181.64 $101.55 EP 2 Arapahoe House (88692) July 1, 2013 — June 30, 2014 Residential Child Care Facility Thornton, Colorado $181.64 3 Ariel Child Placement Agency (90205) July 1, 2013 — June 30, 2014 Child Placement Agency Services Child Residential Habilitation Program Wheat Ridge, Colorado $16.32-$40.11 4 Attention Homes (7496, 11679) July 1, 2013 — June 30, 2014 Residential Child Care Facility Residential Child Care Facility Boulder, Colorado $135.00 $139.00 5 C & M Group Home (9875) July 1, 2013 — June 30, 2014 Group Home/Group Center Care Greeley, Colorado $50.04 6 Children's Ark DBA Axios Youth Community (40322) July 1, 2013 — June 30, 2014 Residential Child Care Facility Pueblo, Colorado $165.74 7 Commonworks D.B.A. Synthesis (104085) July 1, 2013 — June 30, 2014 Child Placement Agency Services Child Residential Habilitation Program Group Home/Group Center Care Denver, Colorado $16.32-$40.11 8 Denver Children's Home (49551) July 1, 2013 — June 30, 2014 Residential Child Care Facility Denver, Colorado $181.64 9 Devereux Cleo Wallace (39794) July 1, 2013 — June 30, 2014 Residential Child Care Facility Westminster, Colorado $181.64 10 El Pueblo Boys' and Girls' Ranch (45146) July 1, 2013 — June 30, 2014 Residential Child Care Facility Pueblo, Colorado $181.64 11 Excelsior Youth Centers (45243) July 1, 2013 — June 30, 2014 Residential Child Care Facility Aurora, Colorado $181.64 12 Family Crisis Center (45204) July 1, 2013 — June 30, 2014 Residential Child Care Facility Denver, Colorado $181.64 13 Frontier Family Services (38041, 84655, 1526756) July 1, 2013 — June 30, 2014 Child Placement Agency Services Group Home/Group Center Care Longmont, Colorado $16.32-$40.11 $73.01 14 Griffith Centers for Youth (1543863, 1531601, 39212) July 1, 2013 — June 30, 2014 Child Placement Agency Services Group Home/Group Center Care Residential Child Care Facility Denver, Colorado $115.00 $115.00 Si R1-64 nnno onvn 61 iOa- I 0 - 30 -i 15 Hope & Home (29867) July 1, 2013 — June 30, 2014 Child Placement Agency Services Group Home/Group Center Care Colorado Springs, Colorado $16.32-840.11 16 Kids Crossing (79752, 1530211, 1534441, 1541496, 1542790, 1545224; 1551132, 1552984; 1555972, 1590619; 1594381; 1597038, 1623469; 1621890 Child Placement Agency Services Group Home/Group Center Care Colorado Springs, Colorado $16.32-$40.11 $92.05 $95.34 $92.05 $88.77 July 1, 2013 — June 30, 2014 $92.05 $118.36 17 Kids Resource Network of Colorado Springs (1508602, July 1, 2013 — June 30, 2014 Child Placement Agency Services Group Home/Group Center Care Colorado Springs, Colorado $16.32-840.11 18 Lutheran Family Services Rocky Child Placement Agency Services $16.32-$40.11 Mountains (45080) Denver, Colorado July 1, 2013 — June 30, 2014 19 Maple Star Colorado (90967; 13416) Child Placement Agency Services $16.32-840.11 July 1, 2013 — June 30, 2014 Group Home/Group Center Care $86.00 Denver, Colorado 20 Marie Alirez Group Home (70335) Group Home/Group Center Care $50.04 July 1, 2013 — June 30, 2014 Greeley, Colorado 21 Mount St. Vincents Home (45174) Residential Child Care Facility $181.64 July 1, 2013 — June 30, 2014 Denver, Colorado 22 Mountain Crest Poudre Valley Health Residential Child Care Facility $181.64 Care Inc. D/B/A Poudre Valley Hospital Fort Collins, Colorado $160.00 EP (42261) July 1, 2013 — June 30, 2014 23 New Start Youth Services LLC (1528224) Child Placement Agency Services $16.32-$40.11 July 1, 2013 — June 30, 2014 Pueblo, Colorado 24 Quality Life Services LLC (32066) Child Placement Agency Services $16.32-$40.11 July 1, 2013 — June 30, 2014 Child Residential Habilitation Program Broomfield, Colorado 25 Reflections For Youth, Inc. (1530130) Residential Child Care Facility $164.67 July 1, 2013 — June 30, 2014 Loveland, Colorado $132.00 EP 26 Regents of the University of Colorado, a body corporate, for and on behalf of the Residential Child Care Facility Denver, Colorado $171.15 UC Denver (49488) July 1, 2013 — June 30, 2014 27 Rocky Mountain Kids (1599808, Group Home/Group Center Care $93.67 1599810) Colorado Springs, Colorado $100.00 July 1, 2013 — June 30, 2014 28 Roundup Fellowship (45105, 45201, Child Residential Habilitation Program $159.32 45211, 45212) Residential Child Care Facility July 1, 2013 — June 30, 2014 Denver, Colorado 29 Savio House (48170) Residential Child Care Facility $181.64 July 1, 2013 — June 30, 2014 Denver, Colorado 30 Shiloh House (20335, 54169, 62291, Residential Child Care Facility $176.45 70967, 1528492, 1539982; 1588986) Littleton, Colorado $176.98 July 1, 2013 — June 30, 2014 31 Smith Agency Inc. (44882; Child Placement Agency Services $16.32-$40.11 1540493; 6566; 96482; Child Residential Habilitation Program $155.30 July 1, 2013 —June 30, 2014 Group Home/Group Center $155.30 Residential Child Care Facility $155.30 Aurora, Colorado 32 Special Kids Special Families (43184) Child Placement Agency Services $16.32-$40.11 July 1, 2013 -June 30, 2014 Child Residential Habilitation Program Colorado Springs, Colorado 33 Strong Foundations, LLC (1594056, Child Placement Agency Services $16.32-840.11 54150) Group Home/Group Center Care $71.74 July 1, 2013 — June 30, 2014 Greeley, Colorado 34 Tennyson Center for Children (1529814) July 1, 2013 — June 30, 2014 Residential Child Care Facility Denver, Colorado $181.64 $300.00 SSU 35 Third Way Center (49487, 65346, 77810, 1507881; 1547437) July 1, 2013 — June 30, 2014 Residential Child Care Facility Denver, Colorado $180.12 $176.57 36 Turning Point Center for Youth (45179, 1616504) July 1, 2013 — June 30, 2014 Residential Child Care Facility Fort Collins, Colorado $178.89 37 Whimspire CPA July 1, 2013 — June 30, 2014 Child Placement Agency Services Denver, Colorado $16.32-$40.11 If you have any questions, give me a call at extension 6510. AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this /,7 day of , 20 I. by and between the Board of County Commissioners of Weld County, on be f of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Alternative Homes For Youth, whose address is PO Box 9, Dacono, CO 80514, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services Bv: Deputy C to th . m � s `a J " � William F. Garcia, Chairman 0CT 302013 Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES By: NTRACTOR: ternative Homes For Youth OBox9 Dacono, CO 80514 Coin ty Director's (or : v ignee's) lire or's (or designee's) Signature S�g�aturead� Ilate any Date 14 SS -23A Revised 6/2013 'z/..3 O07D 4 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Alternative Homes For Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#2016, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $101.55 per day for children placed within the Residential Child Care Facility Emancipation Program. c. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child Exhibit "A" to the SS23A 1 Revised 6/2013 care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 013 day of 20 17 , by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Arapahoe House, whose address is 8801 Lipan St, Thornton, CO 80260, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WTINESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 c 70J3-3d7D B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information conceming these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: I. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of finds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: R as .+� C� The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Servic By: �tlt[! i !y.!�?•ia" _ By: Deputy C rk to the Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES By: NTRACTOR: apahoe House 801 Lipan St Thornton, CO 80260 William F. Garcia, Chairman OCT 302013 By: 41,41ay. N. — Director's (or designee's) Signature and Date 08itfI2pi3 SS -23A Revised 6/2013 14 t2/3- 3 D 70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Arapahoe House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#88692, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ® CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): c Ctt 0 THIS AGREEMENT is made and entered into this day of �y 20 13 , by and between the Board of County Commissioners of Weld County, on be if, of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Ariel Child Placement Agency, whose address is 4660 Wadsworth Blvd, Wheat Ridge, CO 80033, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 0,26/`4-�3O�C1 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: By: Approval as to Substanc WELD COUNTY DEP OF HUMAN SERVICES By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Servic William F. Garcia, Chairman OCT 302013 riel Child Placement Agency 4660 Wadsworth Blvd Wheat Ridge, CO 80033 By: Director's (o and Date signee's) Signature SS -23A Revised 6/2013 14 &O/S- 3' 70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Ariel Child Placement Agency, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#90205. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week O2) 3-4 round trips a week. O3%) 7 round trips or more Comments: ❑1) One round trip a week ❑1%) 2 round trips a week ❑2%x) 5 round trips a week ❑3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required O2) Three times a month ❑3%) Three times a week or more Comments: O1) Once a month ❑1%z) Two times month O2%) Once a week O3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑1) Less than a'/z hour per day 01%) Y hour a day ❑2) 1 hour a day O2 /) 1'1-2 hours per day O3) 2'A-3 hours per day ❑3%:) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑ 1) Less than 5 hours per week 01%) 5 to 7 hours per week ❑2) 8 to 10 hours per week O2%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours O3%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? O Basic Maint.) 0-2 hours per week ❑2) 8 to 10 hours per week ❑3'h) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1%) 5 to 7 hours per week O2%) 11 to 15 hours per week O3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑ 1) Face-to-face contact one time per month with child and minimal crisis intervention. ❑ 1%) Face-to-face contact one time per month with child and occasional crisis intervention. O2) Face-to-face contact two times per month with child and occasional crisis intervention. O2%) Face-to-face contact three times per month with child and occasional crisis intervention. O3) Face-to-face contact weekly with child and occasional crisis intervention. ❑3/) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? O0) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions ([:heck one box for each category Assessment Areas None Mild \tiltf Moderate hider.te tli"L High/ Comments: qt., of nr{ `1luderale. HiK 2 1/2 SevZre 0 I 1 1/2 2 3 3 1/2 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ ■ ■ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ❑ Stealing ❑ ❑ ❑ ❑ ❑ ❑ ■ Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ ■ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ❑ Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑ ❑ ❑ Runaway ❑ ❑ ❑ ❑ ❑ ❑ • Sexual Offenses ❑ ❑ ❑ ❑ ❑•❑ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each categney Assessment Areas None Mild Mild/ Moderate Modernte1 High H&1�o Severe COmmerits: Ntodcrate. Mull 0 1 11/2 2 2 1/2 3 3 1/2 �Gry3 .--214-44, ''''llnlih -g , lr Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ • •❑ Disruptive Behavior ❑ ❑ ❑ ❑ 0 ❑ ❑ Delinquent Behavior ❑ ❑ 0 ❑ ❑ ❑ ■ Depressive -like Behavior ❑ ❑ ❑ ❑ ❑ ❑ 0 Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ • • Emancipation ❑ ❑ ❑ 0 ❑ ❑ • Eating Problems ❑ ❑ 0 ❑ 0 ❑ ❑ Boundary Issues O ❑ ❑ ❑ ❑ ■ • Requires Night Care ❑ 0 ❑ ❑ ❑ ❑ ■ Education 0 ❑ 0 0 ❑ ■ ■ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ • ■ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 11/2 ❑ 2 ❑ 21/2 ❑ 3 ❑ 3'/2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE a�,x }'' fi`: B F� 4 � ��+�.! �'t ₹' ?�!, `I`,,,.. ��t�x�.�t{/i i3x�µ:. Fv k 4 ! :E P LS k$ i {n� �v.n � £^ '5: �'� tl� Y Ri' 'k b �1 .0 -.✓'-.',f z*,�.y ''i }y��`§.zy 333 i C3 n i a�®� t ia5gL3i-. R County Basic Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. $0.00 Not needed or provided by another source, i.e. mental health. $19.73 +$.66 Respite Care ($20.39/day) $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $4.93/day Regularly scheduled therapy, up to 4 hours/month. $2.99/day $23.01 +$.66 Respite Care ($23.67/day) $16.77/day* 2 $26 30 +$.66 Respite Care Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. $4.47/day 2 1/2 +$.66 Respite Care r 06/day* 3 +$.66 Respite Care ($33.54/day) $21.70/day* Ongoing crisis interventm as needed, weekly face-to-face visits with child, and intensive coordination& multiple services $14.79/day Regularly -, sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. RCCF . Down +$ 66 Respite Care •�. • Ongoing which - -• es high level of case involvement child and provider and 2-3 face-to-face contacts per week minimum. Negotiated Assess/ Emergency Level Rate . $29.59 +$.66 Respite Care ($30 25/day) 6'. $20.06/day* 1? Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 • AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHAP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this A.3 day of / , 20 by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Attention Homes, whose address is 3080 Broadway, Suite C, Boulder, CO 80304, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 aD/ •3 )7a B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By. Deputy Cl toc�to the Bad. By rlliam F. Garcia. Chairman Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES;' By: NTRACTOR: ention Homes 80 Broadway, Suite C oulder, CO 80304 By: OCT 302013 Di l is (or designee's) Signature any ate SS -23A Revised 6/2013 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Attention Homes, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#7496, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $135.00 perday for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Attention Homes, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#11679, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of S139.00 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) El OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this (93 day of Acta , 20 L , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and C & M Group Home, whose address is 1920 81st Ave, Greeley, CO 80634, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 O20/x-3"70 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible chi]d(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work 9 SS -23A Revised 6/2013 hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10 SS -23A Revised 6/2013 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. 11 SS -23A Revised 6/2013 F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 12 SS -23A Revised 6/2013 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement and Exhibits A and B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be perfotured or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or 13 SS -23A Revised 6/2013 administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld • County, on behalf of the Weld County Department ATTEST:-RaN� of Human Services By: Deputy CI Approval as to Substanc WELD COUNTY DEPX. OF HUMAN SERVICE By: By: ONTRACTOR: & M Group Home 920 81 ve Gree v. C O 80634 William F. Garcia, Chairman OCT 3 0 2013 �aa Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 a?7'/S- JSe≤'7' EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and C & M Group Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $50.04, per day for children placed within the Group Home identified as Provider ID#9875. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the County's Department Administrator before payment will be release to provider. 3. The services purchased under this Agreement for Group Home services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 4. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 5. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 6. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations will be placed in the group home placement binder. 7. Contractor agrees to meet with the Department of Human Services Group Home Coordinator for a minimum of two hours weekly (7.709.21). 8. Contractor agrees to work collaboratively with Department staff, mental health professionals, GAL's, CASA volunteers, and other service providers in arranging times Exhibit "A" to the SS23A 1 Revised 6/2013 that Contractor's home is open to professional visits. Contractor also understands that the County Department Caseworker and GAL have the right to make unannounced home visits to check the child's safety, needs, and environment. 9. Contractor agrees to ensure that hired staff are completing training specific to the children they service, and are current on all trainings and other requirements as mandated by CDHS Volume 7 Policy and Procedure Manual section 7.700. 10. Contractor agrees to accompany key professionals to school conferences, IEP meetings, school -related staffings, Foster Care Reviews and Court Hearings. 11. Contractor agrees to immediately report any significant issue, regarding the youth, to the youth's assigned caseworker. Issues may be medical, behavioral, legal/ criminal, or educational in nature. If a youth becomes a threat to him/herself or others, appropriate "critical incident" documentation must be prepared by the specialized group home parent according to State guidelines (7.701.52), in addition to notification to the caseworker. While specialized group home parent attempts to maintain the youth at the group home level of care, the specialized group home parent will be familiar with Weld County's continuum of care and understand when a child needs to be forwarded or regressed through the continuum. 12. Contractor agrees to immediately report to the County and/or local law enforcement any known or suspected child abuse or neglect as set forth in Section 19-3-304, C.R.S. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM D SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 023 day of , 20 13, by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Children's Ark DBA Axios Youth Community, whose address is 400E. Routt Ave., Pueblo, CO 81004, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 app/a_SD 70 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a peuuanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department ATTEST0. of Human Services By: y'/4! Deputy C irk Approval as to Substal WELD COUNTY DEP OF HUMAN SERVICES By: CONTRACTOR: William F. Garcia, Chairman OCT 302013 Children's Ark DBA Axios Youth Community 400E. Routt Ave. Pueblo, CO 81004 By: Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Children's Ark DBA Axios Youth Community, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#40322, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $165.74 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A 1 Revised 6/2013 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 ee AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ® CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE El INDEPENDENT LIVING El PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) O OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 43 day of , 20 /3, by and between the Board of County Commissioners of Weld County, on be f of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Commonworks D.B.A. Synthesis, whose address is -5310 Ward Ruad,eis"). ; �e"� L hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. (-.° WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and. WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. I SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. l 4. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in. regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3, Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State.of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: B Approval as to Subst WELD COUNTY DE OF HUMAN SERVIC The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: /21... W iam F. Garcia, Chairman OCT 302013 Commonworks D.B.A. Synthesis 53-3 ad c - As at e-��\Lk?).le•15-�'t�c By: $odic.. 43110 113 Director's (or designee's) Signature and Date 14 SS -23A Revised 6/2013 �/3- 70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Commonworks D.B.A. Synthesis, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#104085. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. ❑3'/z) 7 round trips or more Comments: ❑1) One round trip a week ❑IA) 2 round trips a week ❑2'/z) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required ❑1) Once a month ❑1'/z) Two times month 02) Three times a month ❑2%z) Once a week 03) Two times a week ❑3'/z) Three times a week or more Comments: P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑1) Less than a' 'A hour per day O11/2) 1/2 hour a day ❑2) 1 hour a day 02 %z) I'/z-2 hours per day 03) 2'/z-3 hours per day ❑3'/z) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week 01%) 5 to 7 hours per week ❑ 2) 8 to 10 hours per week ❑2%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours ❑3') Nighttime hours Comments: P S. How much time is the Contractor required to assist the child because of impairments beyond ate appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week ❑2) 8 to 10 hours per week ❑3%z) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1'h) 5 to 7 hours per week 02'A) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑1) Face-to-face contact one time per month with child and minimal crisis intervention. ❑1'A) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. ❑2'/z) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. ❑3%z) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's, individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) Ell) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that a Rating of Conditi Ion ektint 'bo' ft;r kaelicategvrl) to this child. -..w..„.,..A♦.� [[ LL ,pp Yyf� ♦ ��.{q�pp� A ceoiment Ar ~G ti nc ', 33 �aS ' 4".;.,, 7 a� �. �.a iii .. .: �1 to 4 T J� n�j.. +...'lr i' r,. t -,,, , �� \R'y 19 1 ' t•\' �,? }:r a �d .T :T' dx� \i � .: ','� � A�..S{y HO Std 1 r - ''•1 .:x.11) v4 a. Vt ,..-'I. uM•.c. i 1`�, •'1FYLt...�'i\.. ~ �St� s C�'l natr ollis 1'f yS�'_eki•�,'� Gel ' ,'�:-'i. '�` �r "P v tj iy '+L11 t FK, `3M�+1E.. 'k ,r��$ r l . .:�wi'1l'Jt..e C: rte .u.J?:�1�' ';!0: 4t•'nW ��,'•4 :,3}y� �..'xim :V, 'h y� ''`p' Sr lx'I'.te' �'tt. 1} •,�. e... i r �, - �a�y'Fjy. F v� Aggression/Cruelty to Animals ❑ 0 O O ❑ • a Verbal or Physical Threatening O ❑ O O ❑ ■ ■ Destructive of Property/Fire Setting 0 ❑ O O ❑ ❑ ■ Stealing O O ❑ ❑ ❑ a ■ Self -injurious Behavior 0 ❑ O 0 ❑ O ■ Substance Abuse ❑ O ❑ O ❑ ■ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ Enuresis/Encopresis O O ❑ ■ ■ ■ a Runaway ❑ 0 O ❑ ❑ ❑ O Sexual Offenses ❑ ❑ 0 0 ❑ ❑ ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that a iply to this child. ***Wm' i ~m' • .-� ... '. A'. .. lYa.. ;•' N`c.F.�M yy�Y. X11 1 ' Fi •tFi4 �: 11/ .. ai' tk � .. +P' A � .�, f Z k• ,� ` �ri'�:k� r q, 0 w� , �� }R� s' ' 4" 1 *"` ., .:.. rs _: } .i.:ti M t�.� -' �. .. :. ^F 4- .76. \ .� � zr 'f, ��"^ r $� ' ` .rt 't `° •.^} .. �,..N y.,.i �t , t ' Y.a is ,,N'mFY:SN , } � �t �� ..�'• d a .€ :.. _ti�,y`f• .• .'. '?� �'1. 1' }k+} ;• ." ;,��+' '$ yt. �, e 'YF �'�� c .�'•. a+ " u': �. �r.$,1.✓_:'�.�,,\'3�..�L�XT f. ..: J Tf� 1! -...4. .t t „Lt •�' 1 .. ii- 1- x �, S� � wv 4a;( c `` ,._ .�t ...1 :%1t. „�^ J _yam.- . •� itr � 1 v.:�. t ' , t�, `da? C $ +'� t 1 - . •�\ tA). t �l h'yM tr 4 "1tYa „ 'g �.'�;- �.'-.. ., �_>{.b.;` Y YY ii�+.�4:.w. 1... .1 ��" {` 'ti PJ.1 , �.. 1 •. t t a' s>e ; 1•\n F'a l�Y 1i.. o- t ... ?se.. �, -'+Y•.UC�v^J5Pt,:.t!. ❑ 1.,. .a \1 �lml ^�W\1 a�1t. �'tlT1•Lv} ` }\` t4� . },' h a1 1� et-•... � '�A�+��t,, tEC } M� n M�• , T9M11`�'t ✓, j `t --, �1y' '' �';F t .+ t k, i•h'Y4�y, .Gfi �_ 4 ..d��ks Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ i i Disruptive Behavior ❑ ❑ O • a ■ i Delinquent Behavior ❑ O O ❑ ❑ • ■ Depressive -like Behavior ❑ O O i ■ a ■ Medical Needs (If condition is rated "severe`, please complete the Medically fragile NBC) ❑ ❑ O O ❑ 0 • Emancipation O ❑ O ❑ ❑ ❑ ■ Eating Problems O ❑ • ■ ■ ■ ■ Boundary Issues ❑ ❑ ❑ ❑ ■ ■ U Requires Night Care ❑ O O ❑ O ■ I. Education ❑ ❑ ❑ O O ❑ • Involvement with Child's Family ❑ ❑ O O ❑ O ■ CHILD'S OVERALL LEVEL OF {check level of need) 0 0 ❑1 NEED FROM BEHAVIOR ❑ 2 ASSESSMENT: 0 3 0 3'/z I ■ 1' /2 II 2'/z Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE ate,: ' .,,. a„h ,�•�,'''`. ya"t\' qKuYOF4� Ypp*Clc � till`0.G'�- � nF�y •R'Ne`ur`�,ua .k'' ' �I.1��: Gyy� i� f { $n}, County Basic Maint ' .;•, y �. ' $.rt2•. * mow, 'nzf ply ;, .. "xaT.u. r:. `•T'\ • �'-%•. .Ftt- 3a 0 }i � } , . csaL Y '�kn t`� 3v� e � 5 be'V� 2z ti z ' It ti.`,.., • 1 7 - 9� a,,�M{ J it ft t '.`• `der" Age 0-10.....$16.32/day Age 11-14..•$18.05/day Age 15-21...$19.27/day '66/da y + $ Respite Care tat A�' J y �1 ?R.�.,` ` Lk ,4. st; 'ca � ,x'r �v��S"i� �. , �y �•l� 'mid' h�.�iy3S3,��"�"M4 { �w e,s d,� 4.,,,F.. 14 ..,fin;,;°kid No crisis involvement, \ 'f`.+``�• .,a.. '�,"? ;y. l'} a11, e •, nv his; d a, ...p �S •}dt i4�yft \1 < h, G \ z•�vx. t f jl' \� ��FF t ' \ ,n 'espy^��. Yid '4S �f fi :..r { `any'. ,.j�+i !J 1-f_ i\t ' '�.q+ ":dl,' , ,.'�.,. •,S2at:,.'a•" 1t; t•5' a '1; °+le\ � �l f'", l'4 tit: ,g' r. ` .° ' t �'�,,� $ � µ� , yp + }.i ce. \ i� 3• ` ^+ , :\ _ a yv 9r $L 4 .¢ i . 3 �` 1'4,, ''..3. ` -, ^»� %Y2,. 1 fl.,,1.z.,.,N.(U.�e.�.,.'..,�ak.w— ii ' �F `.; . .. Rat, �4., nWr ' X �t {' }�dr 1>:5rNitiNf '-'`�+.,...�.{ t.evii• $11.64/day' intervention, Minimal CPA one face-to-face visit with child per month. s ? 1i, & Not needed or provided by another source, i.e. mental health.4 o: — 1 •re,:• �4, '.. - $19.73 +$.66 Respite Care ($20.391day) .. ', t rih� $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month y 2 S.' + `~ ; p, ;, �F $4.93/day Regularly scheduled therapy, up to 4 hours/month. sii , z Wit. $2.99/day 1 1/2 z y "k $23.01 +$.66 Respite Carey ($23.67/day) $16,77'- • y i ------------ --- 2 r.Y, 2�•y $26.30 +$.66 Respite Care ($26.96/day) r�r£ `�`�-" '', ;e3 $t8.421day` Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contactsper monthgroup `4,': t A, $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of therapy. q. $4.47/da y 2 112 f z_ -'a $29.59 +3-66 Respite Care ($30.25/day) $20.06/day' t 1r ---------- ----_. , t'., 3 Wa' ,`01 u .:% $32.88 +$.66 Respite Care ($33.54/day) ,: r € Ongoing crisis intervention as needed, weekly face to face visits with child, and intensive coordination of- multiple services_ ,' ` ' w $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. F' , ' g $6.02/da y 31/2 $36.16 +$.66 Respite Care 4_ $23.35/day'a ----------------- , + -------- 4ta RCCF Step Down , ` �`�� ' •;t;<<,}. �F $39.45 +$.66 Respite Care ($40.11/day) r'''",,:''',,,5`,yr � 'fi w. t, Ongoing which management child and contacts crisis intervention as needed, includes hi h level of case 9 and CPA involvement with provider and 2 3 face to -face er week minimum. 1 , 4( P $20.06/day' '�O it9 --------- , :h } L t yt - --- -- ---- Negotiated {`, 1t , :.,n -----.,..-- Assess/ Emergency Level Rate $29.59 +$.66 Respite Care ($30.25/day) s ; ective • Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of / , 20 13, by and between the Board of County Commissioners of Weld County, on beh f of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Denver Children's Home, whose address is 1501 Albion Street, Denver, CO 80220, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 °W - 9v 7D B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and refen•ed to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations wider this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: B Approval as to Subst WELD COUNTY D OF HUMAN SERVIC The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: CONTRACTOR: c`ia, Chairman Denver Children's Home 1501 Albion Street Denver, CO 80220 OCT 302013 Director's (or designee's) Signa' e and Date SS -23A Revised 6/2013 14 moo_- SD2a EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Denver Children's Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#49551, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A I Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor willcomplete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of , 20 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Devereux Cleo Wallace, whose address is 8405 Church Ranch Blvd, Westminster, CO 80021, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 020/3 -SO 7O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) maybe placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department ATTEST of Human Services 0 By: Deputy C k to ; r,: William F. Garcia, Chairman j. Approval as to Substan WELD COUNTY DEP, OF HUMAN SERVICE By: Co S ONTRACTOR: Devereux Cleo Wallace 8405 Church Ranch Blvd Westminster, CO 80021 OCT 3 0 2013 S/221/5 Director's (bar designee's Sig a ure and Date SS -23A Revised 6/2013 14 7D/24--Sd7O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Devereux Cleo Wallace, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#39794, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day unless otherwise negotiated based on the needs of the individual child placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 8/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations scheduled within 14 days and dental examinations scheduled within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 8/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this // day ofkk, 20 13, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and El Pueblo Boys' and Girls' Ranch, whose address is One El Pueblo Ranch Way, Pueblo, CO 81006, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 RECEIVED AUG 0 02o/f-. 17D B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 RECEIVED AUG 0 5 7713 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 RECEIVES It Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 RECEIVED AUG 0 5 "1,; full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 RECEIVED l;Uii 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 RECEIVED /OA Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 [�I GEI\/LD RUG accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 �CE VEB 0 5 7013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 RECEIVED AN 0 2li1 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 L RECEIVED AUG Q UIJ VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 RECEIVE �^UG 7513 Cr :.�,: �' H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 R`'CEIVEF: and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 RECEIVED AUG 0 , WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: BY: 1E/iAc ' Deputy C 7k to th Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services —William F. G Chairman NTRACTOR: Pueblo Boys' and Girls' Ranch ne El Pueblo Ranch Way Pueblo, CO 81006 OCT 3 0 2013 By �� 0 r/3 Dir ctor's (or designee's) Si atur and Date SS -23A Revised 6/2013 14 Ow/3-se 7O RECEIVED 4i19 a EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and El Pueblo Boys' and Girls' Ranch, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45146, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A I Revised 6/2013 RFCEIVED AUG nl r 113 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld CountyyDepartment of Human Services to shorten the duration of placement. scheclutest* 9. Contractor agrees to have physical examinations completed -wit n 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. ckt.vi9e_iacc, n-tva.cf app>aued ioj Les l i6ohb)chtla 6tle(carc 8lcll3Qe-ovta." cicheci ✓ianc`G_1 S��xUt5� Exhibit "A" to the SS23A 2 Revised 6/2013 RECEIVED AUG 0 7: AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this a3 day of % 20 IS, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Excelsior Youth Centers, whose address is 15001 E. Oxford Ave, Aurora, CO 80014, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 020,3_, 307e) B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST eiLK..' By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services Deputy erk to t�1 William F. Garcia, Chairman Approval as to Substanc WELD COUNTY DEP OF HUMAN SERVICES By: Co S. y Dir cto s (or d ure an1S, ate ONTRACTOR: xcelsior Youth Centers 15001 E. Oxford Ave Aurora, CO 80014 By: OCT 3 0 2013 Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 &0%e .D7i EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Excelsior Youth Centers, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45243, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of / , 20 13, by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Family Crisis Center, whose address is 2929 W 10th Ave, Denver, CO 80204, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 0,70/24- 302O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld " r":• County, on behalf of the Weld County Department ATTEST:of Human Services By: eputy Clerk to Approval as to Substane WELD COUNTY DEP OF HUMAN SERVICES By: C S ONTRACTOR: amity Crisis Center 2929 W 10th Ave Denver, CO 80204 By: e Director and Date William F. Garcia, Chairman OCT 302013 (or designee's) Signature 43 SS -23A Revised 6/2013 14 02073-.3Z'70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Family Crisis Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45204, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of 5181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 SHGDP.6 Etu, v 83S AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this I ( day of�, 20 by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Frontier Family Services, whose address is 1290 Boston Ave, Longmont, CO 80501-5810, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 &C/."- 3O7d B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Depai intent may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Deputy Cl to Approval as to Substanc WELD COUNTY DEPA OF HUMAN SERVICES ctor's d Date The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services William F. Garcia, Chairman OCT 3 0 2013 NTRACTOR: rontier Family Services 1290 Boston Ave Longmont, CO 80501-5810 Director's (or desi and Date nature SS -23A Revised 6/2013 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Frontier Family Services, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#38041. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A I Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ['Basic Maint.) Less than one round trip a week O2) 3-4 round trips a week. O3%) 7 round trips or more Comments: 01) One round trip a week ❑1'/2) 2 round trips a week ❑2%) 5 round trips a week ❑3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required O2) Three times a month O3%) Three times a week or more Comments: DI) Once a month 01%) Two times month ❑2'/2) Once a week O3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? O Basic Maint.) No educational requirements 01) Less than a %2 hour per day ❑1'/2) % hour a day ❑2) 1 hour a day O2 %2) I %-2 hours per day O3) 2'/2-3 hours per day O3%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? O Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week ❑1%) 5 to 7 hours per week ❑2) 8 to 10 hours per week O2%) 11 to 14 hours per week O 3) Constant basis during awake hours O3%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week O2) 8 to 10 hours per week O3%) 21 or more hours per week Comments: 01) 3 to 4 hours per week 01%) 5 to 7 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ['Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. ❑1%) Face-to-face contact one time per month with child and occasional crisis intervention. O2) Face-to-face contact two times per month with child and occasional crisis intervention. O2%) Face-to-face contact three times per month with child and occasional crisis intervention. O3) Face-to-face contact weekly with child and occasional crisis intervention. O3%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? O0) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior intensity of conditions which create the need for services that apply to this child. itns �EHtlt ing f I�nx for n�h c ttcgor)') Assessment AreasMild/ None Mild MoileraN Nlodera€e/ Iligh EfiLh1 Severe Com vents: Moderate. High 0 •1 1 1/2 2 2 1/2 3 3 1/2 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ ■ Verbal or Physical Threatening ❑ ❑ ❑ 0 ❑ ❑ i Destructive of Property/Fire Setting ❑ 0 ❑ ❑ ❑ ❑ ■ Stealing ❑ ❑ ❑ ❑ ❑ ❑ ■ Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ■ ■ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ■ is Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑ ❑ ❑ Runaway ❑ ❑ ❑ ❑ ❑ ❑ ■ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child • 3s' 3 � �... �:�:..k]�.i�_'�hP�'�� i t �s 3 �� i �4 :�,G��a}' ox .nEV a...... i� i:?5 H i � �i!`�� ice„ � xvr,vi°" � ..vee �i1�9tiu x x. d � L�! L ��tyy i�j�k T.nM.=4'M.�.a,..... ��&�.dh'6ve..£n'9^'�va !u .! .� � (� ��L 4r� L�.�.u��h��6a�`,�^!G;};;E'.i��:r"54��Y�3•�.�}'� :�i£' ! !? Ct !" � 'i�„.��4��'I�t ..${l�N`v0 I � "*y!3:, x ~� !y 5!`b�i ri..,.'t .::., e`f?• �^�[. e mid! I . Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ ❑ ■ ■ Disruptive Behavior ❑ ❑ ❑ ❑ 0 ❑ ❑ Delinquent Behavior ❑•❑ ❑ ❑ ❑ ❑ Depressive -like Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Medical Needs Of condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ _ ❑ 0 ❑ ■ Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ❑ Eating Problems ❑ ❑ ❑ ❑ ❑ ❑ ❑ Boundary Issues ❑ ❑ O ❑ ❑ ❑ ❑ Requires Night Care ❑ ❑ ❑ ❑ ❑ ❑ ❑ Education ❑ ❑ ❑ ❑•❑ ❑ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ❑ ❑ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 1'/z ❑ 2 ❑ 2'h ❑ 3 3'/2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE County Basic Maintr`' g r Age 0-10 $16.32/day'. Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care ` I u5Y' ��' �ty2t' F e '$F,Rt ILit''ixe, Z°'�.t� .......__.. $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. L V !" :f ' `! � ��'d' �+y b �' 9 rI .! '. 'it2� ._. -�`4111Itt�- $0.00 Not needed or provided by another source, i.e. mental health. 1 tiI a''-'�' $19.73 +$.66 Respite Care ($20.39/day) ! },-.,', -z: $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month ;:: $4.93/day Regularly scheduled therapy, up to 4 hours/month. 'I $2.99/day 1 1/2 m $23.01 +$.66 Respite Care ($23.67/day)�, $18.77/day* a• .�. 2 $26.30. +$.66 Respite Care ($26.96/day) $18.42/day* Occasional crisis intervention as needed,. two face-to-face visits with child, 2-3 contacts per month $9.86/day ss Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. 5 Y + +. r� $4.47/day 2 1/2 k'. $29.59 +$.66 Respite Care ($30.25/day) * $20.06/day* arvu a 3 " r $32.88 +$.66 Respite Care ($33.54/day) r:€ T Y'u� $21.70/day* Ongoing crisis intervention as needed, 9 9!t� weekly face-to-face visits with child, and intensive coordination of multiple p services. $14.79/day ; Regularly scheduled week) 9 Y Y. a)v multiple sessions, can include more than 1 person, i.e. family n therapy, for 9-12 hours/monthly. ��$$ $6.02/day 3 1/2 9k �" ' $36.16 + .66 Respite Care $$23.35/day* ($36.82/day)!_. I 4 RCCF Step Down $39.45 +$.66 Respite Care ($40.11/day)".? $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with 9 child and provider and 2-3 face-to-face contacts per week minimum. m T` c' Negotiated Assess/ Emergency Level's: Rate ,its. ;! $29.59 +$.66 Respite Care ($30.25/day) $20.06/day*? l s,..5. Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Frontier Family Services, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $73.01, per day for children placed within the Group Home/Group Center identified as Provider ID #1526756. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A L. 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Frontier Family Services, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $73.01, per day for children placed within the Group Home/Group Center identified as Provider ID #84655. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A I Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the. County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 612013 RECEIVED AUG 05 2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): SEP 0 0 "113 INGDEIS THIS AGREEMENT is made and entered into this day of , 20 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Griffith Centers for Children Inc., whose address is 1724 Gilpin Street, Denver, CO 80218, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/20O and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: By: Deputy Cl-t to he .jar Approval as to Substance: WELD COUNTY DEPART OF HUMAN SERVICES By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services iam F. Garcia, Chairman 1961! ' 07 2 TRACTOR: OCT 3 0 2013 Ptc U SCA fish Centers for Children Inc. r+✓ 724 Gilpin Street Denver, CO 80218 tiact1 1 By. ector' (or designee's) l3 Signature and Date SS -23A Revised 6/2013 14 &az? -SO7e EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Griffith Center for Children, hereinafter referred to as, "Contractor." I. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $115.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1543863. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Griffith Center for Children, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $115.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1531601. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Griffith Centers for Children Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#39212, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A 1 Revised 6/2013 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 43 day of / 20 (, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Hope & Home, whose address is 4945 N 30th Street, Suite 300, Colorado Springs, CO 80919-3152, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. S a I 1 SS -23A Revised 6/2013 0W:8-.3/-76 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTESTr6�-%G. By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services Deputy CI'rk to the Billiam F. Garcia, Chairman OCT 302013 Approval as to Substance: ?1@6t WELD COUNTY DEPAR OF HUMAN SERVICES By: or's (or d ate TRACTOR: e & Home 5 N 30th Street, Suite 300 olorado Springs, CO irAg (or designee's) Signature and Date SS -23A Revised 6/2013 14 690 -SO 2O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Hope & Home, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#29867. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ['Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. ❑3'%z) 7 round trips or more Comments: ❑1) One round trip a week 01%) 2 round trips a week ❑2'%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? P 3. ❑ Basic Maint.) No participation required 02) Three times a month ❑3/) Three times a week or more Comments: 01) Once a month ❑1'/) Two times month ❑2'/:) Once a week 03) Two times a week How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑l) Less than a''/3 hour per day 011/2) 1/2 hour a day 02) 1 hour a day 02 %) 1'42 hours per day 03) 2'/:-3 hours per day ❑3%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week 01%) 5 to 7 hours per week ❑2) 8 to 10 hours per week 02%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours 03%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? O Basic Maint.) 0-2 hours per week 02) 8 to 10 hours per week O 3%) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1%) 5 to 7 hours per week 02%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? DO) Not needed or provided by another source (i.e. Medicaid) 01) Less than 4 hours per month 02) 4-8 hours per month 03) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areas None Mild Mild! Nloslerate Moderate, tip Ilirfii Comments: Moderate. PO Severe 0 I 1 1/2 2 2 1i2 3 3 1/2 Aggression/Cruelty to Animals O ❑ ❑ ❑ ❑ ❑ ■ Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ • ■ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ❑ Stealing ❑ ❑ ❑ ❑ ❑ ❑ ❑ Self -injurious Behavior ❑ ❑ ❑ ❑ O ❑ ❑ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ■ Presence of Psychiatric Symptoms/Conditions O ❑ ❑ ❑ • ■ • Enuresis/Encopresis O ❑ ❑ ❑ ❑ ❑ • Runaway ❑ ❑ ❑ ❑ ❑ ■ • Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ • Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of ( nditions (Check one box for each category t � a 9 y �' - TM i, T --94mi1d �, " ,` 1ILId 41oder.i tc Moderate/ tli�,�h flight Comments: T ` � S r -� � :: �s..r �M oderaie. t 1i�eh Se%ere 1112 2 21 2 3 31/2 Inappropriate Sexual Behavior ❑ ❑ ❑ ❑•❑ ■ Disruptive Behavior ❑ ❑ ❑ ❑ ❑ ❑ ■ Delinquent Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Depressive -like Behavior ❑ ❑ ❑ ❑ ❑ ■ ■ Medical Needs (if condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ U 111 Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ❑ Eating Problems ❑ ❑ ❑ ❑ ❑ ■ ■ Boundary Issues ❑ ❑ ❑ ❑ O ■ ■ Requires Night Care ❑ ❑ ❑ ❑ ❑ O ■ Education ❑ ❑ ❑• ❑ Involvement with Child's Family ❑ ❑ ❑ LI ❑ ❑ U CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 11/2 ❑ 2 ❑ 21/2 ❑ 3 ❑ 31/4 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE 5i�3t 'Iiw�,, r:tsvf ® v� e at i et ti ` 4E-'@ t+, P " „�•+`' a'1..`II�Y'' d •HEIFi"S. '".. Fa2� ? IFl County Basic Maint. ` Age 0-10 $16.32/day Age 11-14...$18.05/day Age 1 9 15-21...$19.27/day=Y �� s(F + $.66/day Respite Care (.„ IG a $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month.1. F. ;(1�u $0.00 Not needed or provided by another source, i.e. mental health. ;,_c 1 $19.73 +$.66 Respite Care ($20.39/day) $15.13/day* ' -- $4.93/day Regularly scheduled therapy, a up to 4 hours/month. `. lit,frz $2.99/day .. Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month 1 1/2 $23.01 ! ,. +$.66 Respite Care ($23.67/day) $16.77/day* 2 $26.30 +$.66 Respite Care 1^ y ($26.36/day) $18.42/day' S, Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $9.86/day -.-- ?r> ;.y Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. > ' fi $4.47/day 21/2 $29.59 +$,66 Respite Care ($30.25/day) $20.06/tlay*. 3 $32.88 n�� +$.66 Respite Care ($33.54/day) $21.70/day* �y Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $14.79/day ..t,. � Regularly scheduled weekly, multiple sessions, can include y :° more than 1 person, i.e. family >Cy. therapy, for 9-12 hours/monthly. 9 x � 1 $6.02/day 3 1/2 $36.16 +$.66 Respite Care rn' ($36.82/day) ?ti $23.35/day* "!' PytndS 4 RCCF Step Down ?:r $39.45 +$.66 Respite Care ($40.11/day) $24.99/day* '�-s. Ongoing crisis intervention as needed, which includes high level of case 3. management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. k m h - g R Negotiated Assess/ Emergency Rate Ld #E + t $29.59 +$.66 Respite Care ($30.25/day) $20.06/day* u' Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 02,3 day of Atl , 20 )3 , by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Kids Crossing, whose address is 1440 E Fountain Blvd, Colorado Springs, CO 80910-3502, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 r 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services l 9R By: Deputy Cl ' to theWilliam F. Garcia, Chairman Approval as to Substance WELD COUNTY DEP OF HUMAN SERVICES By: C S NTRACTOR: ds Crossing 440 E Fountain Blvd Colorado Springs, CO 80910-3502 OCT 302013 By: ( Dire ' t r� gn�,_� 's (or designee's) Signature and Date SS -23A Revised 6/2013 14 2o/3- 3O2O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#79752. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ['Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. 03%) 7 round trips or more Comments: ❑1) One round trip a week ❑1'/) 2 round trips a week 02%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month ❑3%) Three times a week or more Comments: ❑1) Once a month ❑1'/) Two times month 02%) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements O1) Less than a %3 hour per day 011/2) 1/2 hour a day ❑2) 1 hour a day 02 %) 1'h-2 hours per day ❑3) 2Y:-3 hours per day 03%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed 01) Less than 5 hours per week ❑1'%) 5 to 7 hours per week 02) 8 to 10 hours per week 02%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours ❑3%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? O Basic Maint.) 0-2 hours per week 02) 8 to 10 hours per week ❑3%) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1'/) 5 to 7 hours per week 02%) 11 to 15 hours per week 03) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. ❑1'%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? 00) Not needed or provided by another source (i.e. Medicaid) 01) Less than 4 hours per month 02) 4-8 hours per month 03) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior intensity of conditions which create the need for services that apply to this child. Rating of Conditions ((.:heck one boa for each category) r Areas dune Mild Nriid- Mffllrrate Moderate, High High; C:omtnent isment 5r e ME E., Modcrxle. tligh Severe 0 1 1 1-2 2 hF3: 21/2 3 31/2 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ ❑ Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ ❑ ■ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ■ Stealing ❑ ❑ ❑ ❑ ❑ ❑ ❑ Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ■ • Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑ ❑ ❑ Runaway ❑ ❑ ❑ ❑ ❑ ❑ ❑ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ❑ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions .�a€ (Check one box for each category) Assessment Areas None �i, i_ld NMI/ �, ;4t' rate Moderate/ 1I oh tliji Severe Comments: I1o(lerate. Ili¢h 0 � 11/2 �'"' 21/2 3 31/2 Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ ❑ O ■ Disruptive Behavior ❑ ❑ ❑ ❑ ❑ ❑ O Delinquent Behavior ❑ ❑ ❑ ❑ ❑ O • Depressive -like Behavior ❑ ❑ O ❑ ❑ O ■ Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑•❑ ❑ • Emancipation ❑ ❑ ❑ O ❑ ❑• Eating Problems ❑ ❑ ❑ ❑ ❑ ❑ ■ Boundary Issues ❑ ❑ ❑ O ❑ ■ ■ Requires Night Care ❑ ❑ ❑ ❑ ❑ ❑ ❑ Education ❑ ❑ O ❑ ❑ ❑ ❑ Involvement with Child's Family O ❑ ❑ ❑ ❑ ❑ ❑ CHILD'S OVERALL LEVEL OF (check level of need) ❑ 0 ❑ 1 NEED FROM ` BEHAVIOR ASSESSMENT: 2 ❑ 2Y2 ❑ 3 ❑ 31/2 ■ 1 %2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE 4 ��p 5 F �dlri.i4r ,. { v" i��y� g x .. ; C.S._ �xF �'�+ �'•sSd.M ��...Vg['�, .v k' . d County Basic Maint. S:i �=.',!x ( Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $,66/day Respite Care a; -- :_ $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. $0.00 Not needed or provided by another source, i.e. mental health. 1 $19.73 +$.66 Respite Care ($20.39/day) x-- $15.13/day* Minimal crisis intervention as needed,r one face-to-face visit per month with child, 2-3 contacts per month.. $4.93/day Regularly scheduled therapy, 9 y era py, up to 4 hours/month. ss $2.99/day 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) 4$.'.•v` $16.77/day* ads( 2 1"l $26.30 +$.66($26.96/day)are '-"'' $18.42/day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. ' $4.47/day 2 1/2 $29.59''''! +$.66 Respite Care ($30.25/day) $20.06/day* ;rmR 't 3 ,rkfl vii ,L. =rs $32.88 +$.66 Respite Care ($33.54/day) vaa� uv;r $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. s� $; $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. r: $6.02/day 3 1/2 '"L"'• $36.16 +$.66 Respite Care ($36.82/day) $23.35/day* 4 RCCF Step Down _�-'.' r •.!`.v'; $39.45 +$.66 Respite Care ($40.11/day) $24.99/day* _,��. f� Ongoing crisis intervention as needed, a1 which includes high level of case ;,_;v management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. get Iav h1< - Negotiated Assess/ Emergency Level Rate is $29.59 +$.66 Respite Care ($30.25/day) Y) $20.06/day* s9 Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1530211. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1534441. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. Exhibit "A" to the SS23A 1 Revised 6/2013 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1541496. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1542790. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1545224. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.34, per day for children placed within the Group Home/Group Center identified as Provider ID #1551132. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $95.34, per day for children placed within the Group Home/Group Center identified as Provider ID t/1552984. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A I Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1555972. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Group Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1590619. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. Exhibit "A" to the SS23A 1 Revised 6/2013 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $88.77, per day for children placed within the Group Home/Group Center identified as Provider ID #1594381. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1597038. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $92.05, per day for children placed within the Group Home/Group Center identified as Provider ID #1623469. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Crossing, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $118.36, per day for children placed within the Group Home/Group Center identified as Provider ID #1621890. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into thisL day of , 201a, by and between the Board of County Commissioners of Weld County, on beh 1 of the Weld County Department of Human Services, whose address is P.O. Box 758, herein fter referred to as, "County," and Kids Resource Network of Colorado Springs, whose address is 6285 Leham Dr., Suite 101, Colorado Springs, CO 80918, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 7C/9 - SOX) B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal finds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: Approval as to Substan WELD COUNTY DEP OF HUMAN SERVICE By: County Director's (or designee's Signature and Dat The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: ONTRACTOR: illiamF. Garcia, Chairman OCT 302013 ids Resource Network of Colorado Springs 6285 Leham Dr., Suite 101 Colorado Springs, CO 80918 By: Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 /�©7D EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Kids Resource Network of Colorado Springs, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#1508602. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A I Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ['Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. 03%) 7 round trips or more Comments: 01) One round trip a week ❑1'/:) 2 round trips a week 02%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month 03%) Three times a week or more Comments: 01) Once a month 01%) Two times month 02%) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements 01) Less than a''/2 hour per day 01%) 'A hour a day 02) 1 hour a day 02 'A) 1'A-2 hours per day 03) 2'/i-3 hours per day ❑3%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week O1%) 5 to 7 hours per week 02) 8 to 10 hours per week 02%) II to 14 hours per week O 3) Constant basis during awake hours 03%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week ❑1) 3 to 4 hours per week 01%) 5 to 7 hours per week 02) 8 to 10 hours per week 02%) 11 to 15 hours per week ❑3) 16 to 20 per week 03%) 21 or more hours per week Comments: A 1. How often is CPA/County case management required? (Does not include therapy) ['Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. ❑3) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) 01) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. r<x --,.., iYr "i 3 t -�.7 t t� '': �. , r , (/ ktec once \!. , 7 ^' ' a- each ` $t + �1 .gipp , Y h ,il �' �' _'t� - :t . 4} �:i ., 4tiGi..;. S t i t ! �' FJ'� 4 s r t !� t ,(� r is 4 f 'L}6 !! C{ .= fk' It,. , s �' S 1 s7 . { r"--,- Assessment Ai S None- Lf3 : _— Midi gar Moderate r Moderate/ 4.... X 2 Hieh j �. . frt h ' a. r� 11�Yi -'¢ Cotm13e1nIs y is Moderate - High - 0 1 1 1/2 2. 2 1/2 µµms�,: Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ • Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ ■ • Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ■ ■ Stealing ❑ ❑ ❑ ❑ ❑ ■ ■ Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ■ ■ ■ Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑ ❑ ■ Runaway ❑ ❑ ❑ ❑ ❑ ❑ ■ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ❑ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. . n. u r a ' � s � � .• Ti ' Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE .. ..1 , � '. ' 1.EVEt. SERVICE:f:ru: � h .,..Y., il. . ;, :. ;.}7..ir.r r......o iiE�N1 ENDS ?^-xi. n � y ^' s "- r_�: :�r. t ( ...,;':" � �e_ ' .,.;£l.x � 1, 1 � 1•: •.::..�,... r . _. : , {s�._,,ZJ ": h ... .., : i 1- y'aC'MA'4N� �EE,E{ " y 'i 3:r :: €_.:'- -: fr _ i..� a g ,l i^c•_;_?r,`: S. ... '.'�„ t a :^ o a �i r -.li a iIi1: D 1 Level - : Ch�ld.Mamtenance ... r. - ," : � -.. .... ..:. „AdministrativeMaintenance ;' .Tr;-. . - .. ,.e : ., ,.. i _i.- tease Managerrlerlt &vdmin. Overhead} r r -- :- : -' Admlgi r ; r,... . • ' ;<..; , fe!af�Ywft .*MOW, .-. =:r'`-� -:' .:E' i i:Ji�': ..;:: ;dam€.:r: County Basic Maint. r ah , A Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care q ? , r`_ * Y No crisis intervention, Minimal CPA involvement, one face -to face visit with child per month. t " $0.00 Not needed or provided by another source, i.e. mental health. 1 {.f $19.73 +$.66 Respite Care ($20.391day) Fe; `$'si Sr- $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month!with child, 2-3 contacts per month , fi - m ,? $4.93/day Regularly scheduled therapy, up to 4 hours/month. , $2.99/da y 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) $16.77/day* ---- 2 z $26.30 +$.66 Respite Care ($26.96/day) " .; ; Si :; $18.421day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month �u ti - tea $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. $4.47/day 21/2 $29.59 + Care $•66 Respite ($30.25/day) -iii $20.06/day* _- ------------------- ----_____ 3 $32.88 +$.66 Respite Care ($33.54/day) V., ' - r $21-70/da * Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. b. Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/month€y. $6.02/day 3 1/2 - $36.16 +$.66 Respite Care ($36.82/day) ;., 4A fls $23.35/day* r^` 1 ---------------- 4 RCCF Step Down $39.45 +$.66 Respite Care ($40.11/day) "i.-,_,i' tip: - L $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. - f r — _ — __ Negotiated g 1y:, ., �,;�..�i.. >"'T4 hn-�Y - � r ,s.n.�� _ Jr ` t''a- . rr- �� .:i.s�.`r-lisa,�.s�,�," '-3i'� ..-��ifr�`�%; .",�-.� - _..� �� *k�•,.S+F� 4 �'5 €� • •�,€,alt�' .. • t Assess/ Emergency Level Rate $29.59 +$.66 Respite Care ($30.25/day) r_. $20.06/day* h' —_____ ------------- , __ Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A CHILD PLACEMENT AGENCY SERVICES (CPA) O CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) O GROUP HOME/GROUP CENTER CARE O INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) O RESIDENTIAL DRUG/ALCOHOL PROGRAM O SHELTER CARE O SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): 4 ,49 THIS AGREEMENT is made and entered into this ? day of % , 20 /2, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Lutheran Family Services Rocky Mountains, whose address is 363 S. Harlan Street, Denver, CO 80226, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. SS -23A Revised 6/2013 8.0 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible children) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. H. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. I -I. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(renj is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the children) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL, PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: By: Deputy Cl to the Approval as to Substance: 851 WELD COUNTY DEPAR M OF HUMAN SERVICES The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: TRACTOR: B William F. Garcia, Chairman OCT 302013 ur"eran Family Services Rocky Mountains = S. Harlan St enver, CO -S 6 irector's and Date 14 vtexw ee's) Signat SS -23A Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Lutheran Family Services Rocky Mountains, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#45080. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A Revised 6/2013 LAMB! WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below. please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week ❑2) 3-4 round trips a week. ❑3'/z) 7 round trips or more Comments: 01) One round trip a week ❑I'/A) 2 round trips a week ❑2'/s) 5 round trips a week 03)6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? O Basic Maint.) No participation required ❑2) Three times a month ❑3'/:) Three times a week or more Comments: ❑1) Once a month 011/2) Two times month ❑2'/) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑ i) Less than a %7 hour per day ❑ 1'/) '/ hour a day ❑2) 1 hour a day 02 %:) I'/-2 hours per day 03) 2'/-3 hours per day ❑3%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? O Basic Maint.) No special involvement needed ❑i) Less than 5 hours per week 011/2) 5 to 7 hours per week 02) 8 to 10 hours per week ❑2'/:) 11 to 14 hours per week O 3) Constant basis during awake hours ❑3%:) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age aovrojoriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week ❑2) 8 to 10 hours per week ❑3'/) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1'/) 5 to 7 hours per week ❑2%:) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) O1) Face-to-face contact one time per month with child and minimal crisis intervention. DI 1/2) Face-to-face contact one time per month with child and occasional crisis intervention. ❑2) Face-to-face contact two times per month with child and occasional crisis intervention. ❑2/) Face-to-face contact three times per month with child and occasional crisis intervention. ❑3) Face-to-face contact weekly with child and occasional crisis intervention. ❑3'') Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) ❑i) Less than 4 hours per month ❑2) 4-8 hours per month 03) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 1',Ati11s11 "t5" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. : , ... :'. :-..... ..�..:. .'....::..:..:i.... ....r..::ee.:: _: �:^a._:.•r; x _............. ...:. _ _ ..... +•�: r. •4s i<,.;s s . .:.. ....... : . v...-. , ..< ... _.-,.. i ... .... _ . ..s '. :„,7' ..:.: ,..„..: :.:..::... c_�;:::i:: !:!:':s.:r''."!::,y`)r :� �i:'�.•r_r"•_. ..^ ....:r. .. .;;....,..•....:......... ..... ..t:........ ._ ... ..: :....?.:;;• .».r: ••.:.... .. ,...� .s .r.. . _._. _..... . ... . . .: . , ...., �.r:.:.. ,•_c.s • r.....y ... .,, ..:. .. ... :::..................;W ::::::::::::.:....:..,.,....- .. -..... .. ......,':..�.. 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Aggression/Cruelty to Animals • ❑ ■ •❑ • • Verbal or Physical Threatening O O O 0 ❑ ❑ • Destructive of Property/Fire Setting ■ O ❑ O ❑ ❑ O Stealing ■ ❑ ■ •❑•❑ Self -.injurious Behavior ❑ ❑ O ❑ ❑ ■ ■ Substance Abuse ❑ ■ O ■ ■ O ❑ Presence of Psychiatric Symptoms/Conditions • ❑ ❑ • ❑ ❑ ❑ Enuresis/Encopresis O ❑ ❑ O ❑ a ■ Runaway ■ ■ ❑ ❑ 0 0 ■ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ■ ■ Exhibit "B" to the SS23A Revised 6/2013 • LAllllfl l "Li" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. 1pelt • Inappropriate Sexual Behavior ❑ L71ri O ,€OIIi��l�iblili4 t t w riu ......._..:.:._...........:....:.................. ...r�� ..,. te:'�crrvY3i�...::`. or each'categc ❑ Disruptive Behavior a a a a Delinquent Behavior Depressive -like Behavior a ❑ a Medical Needs (Iicondition is rated "severe", please complete the Medically fragile NBC) a a a a Emancipation Eating Problems a a a Boundary Issues a a Requires Night Care a a O ❑ Education a Involvement with Child's Family ❑ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 D 1''A n 2 ❑ 2''A Exhibit "B" to the SS23A 3 3V2 4 Revised 6/2013 • EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE LEVEL OF , SERVICE COMMENDED ROVIDER-RA P1 -P6 EOOMMENDED AGENCY RAT RAPY RATE MEDICAL NEEDS.. DDENDUM Level;! County Basic Maint. Child Maintenance Age 0-10.....$16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care Administratnre Mainien�nce ase.Management.& Admin �verhea $11.84/day' No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. Administrable Sennae. :. (Tfierapy!Misc;;SerVice $0.00 Not needed or provided by another source, i.e. mental health. • vel. $19.73 +$.66 Respite Care ($20.39/day) $15.13/day' Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $4.93/day Regularly scheduled therapy, up to 4 hours/month. 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) $16.77/day' 2 2 1/2 $26.30 +$.66 Respite Care ($26.96/day) $18.42/day` Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. $29.59 +$.66 Respite Care ($30.25/day) $20.06/day' 3 $32.88 +$.66 Respite Care ($33.54/day) 3 1/2 $36.16 +$.66 Respite Care ($36.82/day) 4 RCCF Step Down Assess/ Emergency Level Rate $39.45 +$.66 Respite Care ($40.11 /day) $29.59 +$.66 Respite Care ($30.25/day) $21.70/day' Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $23.35/day' $24.99/day' Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. $20.06/day' Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 % to RECEI V Eo AUG 05707 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of 20 1J , by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Maple Star Colorado, whose address is 2250 S Oneida Street, Suite 100, Denver, CO 80224-2557, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department ATTES �a ,,¢„ of Human Services By: Deputy Cleflc to the Boa .d.j Willi aiFfF Garcia, Chairman 0CT 302013 Approval as to Substanc WELD COUNTY DEPA OF HUMAN SERVICES By: le Star Colorado 0 S Oneida Street, Suite 100 enver, CO 80224-2557 By: 1 -t -A21 Director's (or d and Date &A; ikAili-) 8-9 -/ ee's) Signature SS -23A Revised 6/2013 14 070/3 3U 7D EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Maple Star Colorado, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#90967. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? O Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. 03%) 7 round trips or more Comments: ❑1) One round trip a week 01%) 2 round trips a week 02%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month 03%) Three times a week or more Comments: 01) Once a month ❑i%) Two times month 02%) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑2) 1 hour a day 03%) More that 3 hours per day Comments: ❑1) Less than a %2 hour per day ❑1%n)'/ hour a day 02 %) 1'/z-2 hours per day 03)21/2-3 hours per day P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑l) Less than 5 hours per week 01%) 5 to 7 hours per week ❑ 2) 8 to 10 hours per week 02%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours 03%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week 02) 8 to 10 hours per week 03%) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1%) 5 to 7 hours per week 02%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ['Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑ l) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. ❑3) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? 00) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month 02) 4-8 hours per month 03) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF' HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions4; (Check one box for each category) Assessment Areas None VIi1d mild/ moderate/ Iliglr moll Continents: iii;ti E � •• l� r Models te. Niodcrate Melt Severe 0 1 11/2 2 21/2 3 31/2 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ ❑ Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ■ Stealing ❑ ❑ ❑• ■ ■ ■ Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ O Substance Abuse ❑ ❑•❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ❑ ❑ Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑•❑ Runaway ❑ ❑ ❑ ❑ ❑ ❑ ■ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. :Rating ol't`ondititzn� (Check one box for each category) Assessment Areas None 'L1ild liltll :Moderate yloderate! IILh tliEh1 ' Comments: p�k 31oder:tle. Mali Severe 0 1 1 1/ 2 1,2 3 3 I;Z Inappropriate Sexual Behavior 0 ❑ ❑ ❑ ❑ ❑ ❑ Disruptive Behavior 0 0 ❑•❑ ❑ ❑ Delinquent Behavior ❑ ❑ ❑ ❑ ❑•❑ Depressive -like Behavior 0 ❑ ❑ ❑ ❑ ❑ ❑ Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ❑ Eating Problems ❑ ❑ ❑ ❑ ❑ 0 ❑ Boundary Issues ❑ ❑ ❑ • • • • Requires Night Care ❑ ❑ 0 0 ■ ■ ■ Education ❑ ❑ ❑ 0 0 0 ■ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ■ ■ CHILD'S OVERALL LEVEL OF (check level of need) ❑ 0 ❑ 1 NEED FROM BEHAVIOR ASSESSMENT: ❑ 2i/2 ❑ 3 ❑ 3'/z ■ l'/2 ill 2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE fivv4r,Y! }� ::. 5 kb q eF 1➢'L 1L}!}''4iy31y :t`,3: �i: i i..As: 1 'ev t'i't '5 'eI`u'.`e b '8 4 P' -*I �S�C' Hi...;.�-; Anv�.i48 MC- County Basic Maint. l;a j^ 5i �.: Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/dayt $.66/day Respite Care 777 -°° Vii•* $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. P i d_3 .f=ail ;:(= $0.00 Not needed or provided by another source, i.e. mental health. >T.tEf y+� 1 $19.73 .Care, +66 Respite ($20.39/day) $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month ':*� 'fd r.;' q��, $4.93/day Regularly scheduled therapy, up to 4 hours/month. $2.99/day 1 1/2 $23.01 Respite +$,66 Respite Care ($23.67/day) ! $16.77/day" 2 n,n ri,> $26.30 +$.66 Respite Care ($26.96/day) t fir- $18.42/day" Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month C�:5, as m= ''Ws l 3 $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. t₹> 1" $4.47/day 2 1/2 sir $29.59 +$.66 Respite Care ($30.25/day) $20.06/day* 3 1i ,f S?y� $32.88 +$.66 Respite Care ($33.54/day) ;f,1 s'=sa $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. ��'� $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $6.02/day 3 1/2 $36.16 +$.66 Respite Care ($36.82/day) $23.35/day" $" 4 RCCF Step Down 1 m_ r mr * ''} $39.45 +$.66 Respite Care ($40.11/day) ="��'-" vH'H $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. t OH Negotiated Assess! Emer enc 9 y Levelzssf Rate m :gym $29.59 +$.66 Respite Care ($30.25/day) s c5 a $20.06/day* • am1 X97 Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Maple Star Colorado, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $86.00, per day for children placed within the Group Home/Group Center identified as Provider ID #13416. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A ] Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this ,3 day of , 20 13, by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Marie Alirez Group Home, whose address is 1405 26th Street, Greeley, CO 80631, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 aoi3, 3070 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work 9 SS -23A Revised 6/2013 hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 10 SS -23A Revised 6/2013 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. 11 SS -23A Revised 6/2013 F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 12 SS -23A Revised 6/2013 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement and Exhibits A and B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or 13 SS -23A Revised 6/2013 administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST �.qw P _.S.CnJ& The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: AIiL. `! '.i ' i' By: Deputy C rk to th Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES By: Wiliam F. Garcia, Chairman ONTRACTOR: arie Alirez Group Home 405 26th Street Greeley, CO 80631 OCT 302013 BY:Ca9Z Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 0?D -.3672 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Marie Alirez Group Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $50.04, per day for children placed within the Group Home identified as Provider ID#70335. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the County's Department Administrator before payment will be release to provider. 3. The services purchased under this Agreement for Group Home services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 4. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 5. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 6. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations will be placed in the group home placement binder. 7. Contractor agrees to meet with the Department of Human Services Group Home Coordinator for a minimum of two hours weekly (7.709.21). 8. Contractor agrees to work collaboratively with Department staff, mental health Exhibit "A" to the SS23A 1 Revised 6/2013 • professionals, GAL's, CASA volunteers, and other service providers in arranging times that Contractor's home is open to professional visits. Contractor also understands that the County Department Caseworker and GAL have the right to make unannounced home visits to check the child's safety, needs, and environment. 9. Contractor agrees to ensure that hired staff are completing training specific to the children they service, and are current on all trainings and other requirements as mandated by CDHS Volume 7 Policy and Procedure Manual section 7.700. 10. Contractor agrees to accompany key professionals to school conferences, IEP meetings, school -related staffings, Foster Care Reviews and Court Hearings. 11. Contractor agrees to immediately report any significant issue, regarding the youth, to the youth's assigned caseworker. Issues may be medical, behavioral, legal/ criminal, or educational in nature. If a youth becomes a threat to him/herself or others, appropriate "critical incident" documentation must be prepared by the specialized group home parent according to State guidelines (7.701.52), in addition to notification to the caseworker. While specialized group home parent attempts to maintain the youth at the group home level of care, the specialized group home parent will be familiar with Weld County's continuum of care and understand when a child needs to be forwarded or regressed through the continuum. 12. Contractor agrees to immediately report to the County and/or local law enforcement any known or suspected child abuse or neglect as set forth in Section 19-3-304, C.R.S. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 013 day of 20 13, by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Mount St Vincents Home, whose address is 4159 Lowell Blvd, Denver, CO 80211, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 02013-302d B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Depaitnient of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: Deputy Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES By: C The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: Will m F. Garcia, Chairman NTRACTOR: unt St Vincents Home 59 Lowell Blvd enver, CO 80211 OCT 3 0 2013 By: ;/ Ji/ 473 Direcor's or designee's) Signature and Date SS -23A Revised 6/2013 14 ,202S-SD7O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Mount St Vincents Home, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45174, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06=11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) El RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION El TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this / day of , 20 /3, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley Hospital, whose address is 4601 Corbett DR, Fort Collins, CO, 80528, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible children) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan, Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitionallafter-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis, 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only, Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from infortation provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of thew financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organi7,ttions including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CFIRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. hicorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: I. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the children) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the children) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screwier of any emergency medical, surgical or dental issues prior to granting authorization, During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/20)3 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if hi State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. 1. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature, L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section 1., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be deemed to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits trader this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: By: Deputy C ' k to t Approval as to Substanc WELD COUNTY DEP OF HUMAN SERVICES By: SS -23A Revised 6/2013 1O1 4 -Pk 4 The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: NTRACTOR: Garcia, Chairman 0CT 3 0 2013 untain Crest Poudre Valley Health Care Inc. '111 /B/A Poudre Valley Hospital ��.... 4601 Corbett DR Fort Collins, CO, 80528 By: 10S FLuA. g 2(-- 3 Director's Or designee's) Signature and Date 14 62,19/.6 �Q EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Mountain Crest Poudre Valley Health Care Inc. D/B/A Poudre Valley Hospital, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#42261, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $160.00 per day for children placed within the Residential Child Care Facility Emancipation Program. c. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child Exhibit "A" to the SS23A 1 Revised 6/2013 care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a frill evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 013 day of // s" , 20 Al , by and between the Board of County Commissioners of Weld County, on be of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and New Start Youth Services LLC, whose address is PO Box 1392, Pueblo, CO 81002, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 6702.- Se,) JO B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. 11 SS -23A Revised 6/2013 G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 12 SS -23A Revised 6/2013 N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: The Board of County Commissioners of Weld County, on behalf of the Weld County Department ATTEST: 6�n. s P� ., �9��(!. of Human Services Deputy e to Approval as to Substanc X961 WELD COUNTY DEPA OF HUMAN SERVICE. By: /� William F. Garcia, Chairman OCT 3 0 2013 ONTRACTOR: ew Start Youth Services LLC PO Box 1392 Pueblo, CO 81002 Director's (or designee's) Signature and Date SS -23A Revised 6/2013 14 axis' 3&70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and New Start Youth Services LLC, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#1528224. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHAP) waiver eligible children. County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week ❑2) 3-4 round trips a week. O3%) 7 round trips or more Comments: ❑I) One round trip a week ❑1/) 2 round trips a week O2%) 5 round trips a week O3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required O2) Three times a month O3%) Three times a week or more Comments: O1) Once a month ❑1%) Two times month O2%) Once a week O3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? O Basic Maint.) No educational requirements O2) 1 hour a day O3%) More that 3 hours per day Comments: ❑1) Less than a'' /z hour per day 01%) %z hour a day O2 %) 1'/z-2 hours per day O3) 2%-3 hours per day P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed DI) Less than 5 hours per week 01%) 5 to 7 hours per week O2) 8 to 10 hours per week O2%) 11 to 14 hours per week ❑ 3) Constant basis during awake hours ❑3%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week O2) 8 to 10 hours per week O3%) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1%) 5 to 7 hours per week O2%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑1) Face-to-face contact one time per month with child and minimal crisis intervention. ❑1/) Face-to-face contact one time per month with child and occasional crisis intervention. O2) Face-to-face contact two times per month with child and occasional crisis intervention. ❑TA) Face-to-face contact three times per month with child and occasional crisis intervention. O3) Face-to-face contact weekly with child and occasional crisis intervention. O3%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) O2) 4-8 hours per month Exhibit "B" to the SS23A ❑l) Less than 4 hours per month O3) 9-12 hours per month 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areas None 0•1 Mild mild/ Moderate Moderate' tiiah tli�Oh/ sa Comments: �k ,'.tloderate. ltigh Severe 1 112 2 2 1/2 3 3 112 I, Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ ❑ Verbal or Physical Threatening ❑ O ❑ ❑ ❑ ❑ Destructive of Property/Fire Setting ❑ ❑ O ❑ ❑ ■ • Stealing ❑ ❑•❑ ❑ ■ • Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ ■ Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ❑ ■ Enuresis/Encopresis ❑ O ❑ ❑ ❑ ❑ ■ Runaway ❑ ❑ ❑ ❑ ❑ ❑ • Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ❑ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areas None Mild it & �toderate - ttodernter High Mgt/ Severe Comments: Moderate. Highs 0 1 1 1/2 A 2 2 1/2 3 31(2 Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ ❑ ❑ ■ Disruptive Behavior ❑ ❑ ❑ ❑ ❑ • ■ Delinquent Behavior ❑ ❑ ❑ ❑ ❑ ■ • Depressive -like Behavior O ❑ O ❑ ■ ■ ■ Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ . ■ Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ❑ Eating Problems ❑ ❑ ❑ ❑ ❑ ❑ • Boundary Issues ❑ ❑ ❑ O ❑ O ■ Requires Night Care ❑ ❑ ❑ ❑ ❑ ❑ ❑ Education ❑ ❑ ❑ ❑ ❑ ❑ ■ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ■ ■ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 1'/z ❑ 2 ❑ 2''/ 3'/z ■ 3 ❑ Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE :�"x.� r�'a p, �jt.� et�::tvt iM 4� li, b -��`df.Ei�x:x x• s �i �— ��• :, t �t� ��: .n...+�-�.�i,.`"...""-v`, �";. �j+�, .,d. kn Lx � "5µm^, �� - , � �, i� 5. i .{ � :i.. '"a � :k,, ci �s i � .b�� i -- +S �.,}� 4L.�St'��' �.''.��r_.t. ... ? ��dt4,llrt„.7se��: �f�":�F•'u'vi �5,�- ki r ��xx r - , i 1 ♦ -�r -�: � . �'� �-�'C.��.,� io � y,':�[j i� 1rt i .: •� .. '' �.- County Basic Maint. .-, �k; Gs�3t:'C- Y*f Age 0-10 $16.32/day y( Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care $' y p " $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. a t4i ; $0.00 Not needed or provided by another source, i.e. mental health. 11r : a 1 4-* $19.73' +$.66 Respite Care $15.13/day* ny crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month M 3 g:,a $4.93/day Regularly scheduled therapy,($20.39/day)';, 9 Y pY� up to 4 hours/month. �.. $2.99/day 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) $16.77/day* 2 4 W $26.30 ; +$.66 Respite Care ($26.96/day) $18.42/day* "" Occasional crisis intervention as needed,. ` two face-to-face visits with child, 2-3 contacts per month r:k $9.86/day Weekly scheduled therapy,$4.47/day 5-8 hours a month with 4 hours of group therapy. 21/2 $29.59 +$.66 Respite ($30.25/day) $20.06/day*:. 3 msµ), W=5'_ $32.88 � +$.66 Respite Care ($33.54/day) $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. rah $14.79/day Regularly scheduled weekly, u .- multiple sessions, can include �more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $6.02/day 3 1/2 $36.16 :*'0:? +$.66 Respite Care ($36.82/day) $23.35/day* z_s 4 RCCF Step Down aa'y is $39.45 +$.66 Respite Care ($40.11/day) } $24.99/day* 'la,R Ongoing crisis intervention as needed, --'"; which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face>t�:.,--. contacts per week minimum. ;G 3Rs: I nv xvar Negotiated Assess/ Emergency Level Rate x._.. s, $29.59 .,. +$.66 Respite Care ($30.25/day) ? .. $20.06/day* "7 Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 V. AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ® CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ P• SYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ R• ESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of arid , 20 ,(3, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Quality Life Services LLC, whose address is 11975 Reed Street, Broomfield, CO 80020, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 0?E/8 se7e s B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) maybe placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 r 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. I1 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: By: Deputy '"erk to the B Approval as to Substance: WELD COUNTY DEBAR OF HUMAN SERVICES By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: 14/ TRACTOR: ty Life Services LLC 75 Reed Street roomfield<tO 80020 By: ianf�F. Garcia, Chairman OCT 302013 Director's (or designee's) Signature and Date c70 3 Quality Life Service / // 11975 Reed Shea8 Suke 1 Broomfield, CO 80020 SS -23A Revised 6/2013 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Quality Life Services LLC, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#32066. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P I. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week ❑2) 3-4 round trips a week. ❑3%:) 7 round trips or more Comments: 01) One round trip a week ❑1'/z) 2 round trips a week 02%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month 03%) Three times a week or more Comments: ❑1) Once a month ❑1%:) Two times month 02%) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑1) Less than a'/: hour per day O1%) %: hour a day 02) 1 hour a day 02 %) 11/2-2 hours per day 03) 2'%-3 hours per day 03%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? 0 Basic Maint.) No special involvement needed 02) 8 to 10 hours per week 0 3) Constant basis during awake hours Comments: 01) Less than 5 hours per week 02%) 11 to 14 hours per week 03%) Nighttime hours 01%) 5 to 7 hours per week P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? 0 Basic Maint.) 0-2 hours per week 02) 8 to 10 hours per week 03%) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week 01%) 5 to 7 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ['Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑1) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) 01) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. 72ating of Conditions '.: itV: (Check one box for each categorvi Assessment Areas None Mild Mild/ Moderate Moderate/ Ili ,h Hhl Severe Comments. i`Tp' Moderate. Hiefi 21/2 0 1 11/2 2 3 31/2 `l Aggression/Cruelty to Animals o D 0 ❑ ❑ ❑ ■ Verbal or Physical Threatening D ❑ 0 ❑ ❑ ❑ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ❑ Stealing ❑ ❑ ❑ ❑ D ❑ ❑ Self -injurious Behavior ❑ ❑ ❑ 0 ❑ ❑ ■ Substance Abuse ❑ ❑ 0 D ■ ■ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ■ Enuresis/Encopresis D ❑ ■ ■ ■ • ■ Runaway ❑ ❑ 0 D ■ ■ ■ Sexual Offenses ❑ ❑ 0 ❑ D • • Exhibit "B" to the SS23A 3 Revised 6/2013 }• EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. �3'hE C• t ". :. S .. '•... _ ,• •�.a FF: .. .,.:� s t� ��..::.... . :......_.....r..... ...;,_��_r•::;.. E. -.x..... ......... • ... .. ...:.. .. _......-... ! , i '.: t _ �:..'° .»�.�_��atlil .... •._ 3s .- ._ate. 11 i .t .: ' .. _..»_ !.. .. ��.Er• _ __.__ ...-. `. ! 4u !' �('F.xi i '1 ! ... LtinlT 1 .. S f .... .. ... :{ ..- FF R o .. O _ .-]i.E •; Check one Qry:.::::�:,. _.__,. . box for. each Cate _�..•.: J t :�:n� m� ��ii4'.i . 4.411 4-` 1 3•L•....o ... ? .cFs':'rs J �EEElf :SEE •• . "F�.:.._t x r &:ir — , ,.,*�.r ry ,._:., t s . --.:ry ze y`v.„, i.vyi.;gl,. ilS ;...: , -iu. '}: i: ' E -r::Y• V `;•• .,ia,._ i Ei• ., ae :x.....:..:. -c ..........:.�...:.:.._. �a .:.......�..,..,........::ajrC- .E "l ..:. ... .. ....� s ...... ..-:fird. -....... ..: ..:-,, y........ �': :... ....._�s...... �>.r �... .•: _., ..::iii::-::.., r;:• :. • . * _- y �. .. ., n.r" S n_� ... .., .. .e. ..a. : _ .:;-'ai . ' .!S ._s'� t t :. r�:e:.; .�.:... .. . � .. a+msalx• su s; .' . •! ..1:_.r•F '•.,: 4 , .•!,_... ;s .>f..a r. .....! . •i �.� ::�• t h,tirk !' ,, y,l, ... t 1F R. �':' ,r.- ;.:3 .. R F.:. w' � .� .._ 5 � tr Gir E �'t .6 F'9� a.-. - FS 'f.. .iF".:d. f& �� .,:3i:_r: FF3ii!FIf I , } t +x ,N lFr. 'r ti .. .F .$l� a �Ji'.D: - _.i ,.:{ �-;' 'iii:y€:•? .i•' {Elie 2i: %•.F.., "ic,..-. _ 7 i Nt - p-,�1F .: 'I' , :t^. . •'xt j F. j R 5•., -�n:..^1 E• �a " 1•R �:•xu. 1:n..., •ks.'"„ii":i�i':..F 1: ;��a.:s ::[ r... 3 .::.t _ a..�.� .m! " xe::Eii::En:i.._.,.,F iit t. 'i!:. � !}�_: .'. `� i �,�n�:ti. FEEE.d4• 2'fll' • _�.. ,: ..._ r. ... �e .:_.:..... .::...............».. - 4 ,� Inappropriate Sexual Behavior ❑ ❑ 0 ❑ ❑ ■ ■ Disruptive Behavior ❑ ❑ 0 ❑• ■ ■ Delinquent Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Depressive -like Behavior ❑ ❑ ❑ 0 ❑ ■ ■ Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ■ Eating Problems ❑ ❑ ❑ ❑ ❑ ■ ■ Boundary Issues ❑ 0 0 ❑ ❑ • • Requires Night Care ❑ ❑ ❑ 0 ❑ ❑ ❑ Education ❑ ❑ ❑ ■ ■ ■ ■ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ❑ ■ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 11/2 ❑ 2 ❑ 2%2 ❑ 3 ❑ 3y2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE ` 4 �1'a b GEG�iM�•`t-f °�sNs 43mt f �µCy..''w ...a",�NF �i �`I`' �'' �! �yi'.,. .'''ij tt Fy4 etc £q 3 .w>>� t�R��l _.__ " •. �-r� text f`•i`,a: .. w��N� j ` Mf rs; N �r'3 ,may YAL f $� �aE`�'f'i" 3lVF' 9, rt t n e!" s: mx d= iM-ir � '3 e"" i Y e '!� SMLs 3 eu y ��^-v^ •ars I .� :? County Basic Maint. x fi : ;;'.tal, Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day $.66/day Respite Care y p 'a a eh° $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. r- aR $0.00 Not needed or provided by another source, i.e. mental health. 1L=L; s;Aaw >E" l.,�• 3 $19.73 +$.66 Respite Care ($20.39/day) x $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month rib , $4.93/day Regularly scheduled therapy, up to 4 hours/month. 5 $2.99/day 1 1/2 X311 3+e"= $23.01 +$.66 Respite Care fir $16.77/day*($23.67/day) 3Ni4 r 2 '-" e„?u $26.30 +$.66 Respite Care p ($26.96/day) ''>:x '`'_ $18.42/day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month ' ' asp $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. ; 3'a ms's= $4.47/day 2 1/2 �:iS 7 $29.59 +$.66 Respite Care ($30.25/day) vEE $20.06/day* S 3 $32.88 +$.66 Respite Care ($33.54/day) €5 $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. may; s a( $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $6.02/day 3 112 mxR $36.16 +$.66 Respite Care ($36.82/day) $23.35/day* 4 RCCF Step Down 1`ft'p"r i�lSF• ni�i $39.45 +$.66 Respite Care ($40.11/day) $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. Negotiated Assess/ Emergency Level Rate n= $29.59 +$.66 Respite Care ($30.25/day) ' i $20.06/day* Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this ,..23 day of 20 /3, by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Reflections For Youth, Inc., whose address is 1000 S Lincoln Ave, Ste 200, Loveland, CO 80537-6357, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 07d/3- SO 2O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services deteiiuined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social firnctioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess, of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Departme it of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is tenninated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: By: Deputy C rk to the Approval as to Substance 56i WELD COUNTY DEPAI4.T OF HUMAN SERVICES Bv: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: William . Garcia, Chairman NTRACTOR: OCT 3 0 2013 flections For Youth, Inc. 000 S Lincoln Ave, Ste 200 Lovelan' JI80537-6357 D'. ector s (or designee's) Signature an vs 3 SS -23A Revised 6/2013 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Reflections For Youth, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1530130, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $164.67 per day for children placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $132.00 per day for children placed within the Residential Child Care Facility Emancipation Program. c. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child Exhibit "A" to the SS23A 1 Revised 6/2013 care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this . /1 day of . , 20)3 ,, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Regents of the University of Colorado, a body corporate, for and on behalf of the UCDenver, whose address is 3738 W Princeton Cir, Denver, CO 80236, hereinafter referred to as, "Contractor" This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: 1 SS -23A Revised 6/2013 /,� --8070 A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/20(3 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. 1. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CFIRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. £. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatmentlfamily services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. I SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: Bv: 44 )444,16k Deputy C rk to the Board Approval as to Substan WELD COUNTY DEP OF HUMAN SERVICE By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: William F. Garcia, Chairman OCT 302013 gents of the University of Colorado, ody corporate, for and on behalf the University Colorado Denver 3738 W Princeton Cir Denver, CO 80236 Director's (or designee's) Signature and Date Shaun A McMullin, Deputy Controller i4 SS -23A Revised 6/2013 cZ:9 . 070 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Regents of the University of Colorado, a body corporate, for and on behalf of the UCDenver, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#49488, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $171.15 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A 1 Revised 6/2013 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed LEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of / , 20 )3 , by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Rocky Mountain Kids, whose address is 2210 E. LaSalle Street, #219, Colorado Springs, CO 80909, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 &C/.a-322O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the teiin of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/20 I3 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. 11 SS -23A Revised 6/2013 G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 12 SS -23A Revised 6/2013 N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A, and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: B The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services Deputy C rk to th �: a b'i t �.? '.,, William F. Garcia, Chairman OCT 3 0 2013 Approval as to Substance WELD COUNTY DEPA OF HUMAN SERVICES NTRACTOR: cky Mountain Kids 210 E. LaSalle Street, #219 Colorado Springs, CO 8 J! 09 By: Direc or's (or des _nee's) Signature and Date 131 is SS -23A Revised 6/2013 14 &&(7,& . c2 ) EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $93.67, per day for children placed within the Group Home/Group Center identified as Provider ID #1599808. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Rocky Mountain Kids, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $100.00, per day for children placed within the Group Home/Group Center identified as Provider ID #1599810. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ® CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of , 20 /, 7 , by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Roundup Fellowship, whose address is 2250 S Oneida, Suite 201, Denver, CO, 80224, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 070,0 -So 26 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court 8 SS -23A Revised 6/2013 hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining finds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibits A and B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement and Exhibits A and B in writing, if agreed to by both parties. This Agreement and Exhibits A and B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perfoiin any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTESTewwQwQ�•••9, t\JL.. By: Deputy C 'rk toh Approval as to Substance: WELD COUNTY DEPAR OF HUMAN SERVICES The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services Iliam F. Garc'., Chairman NTRACTOR: undup Fellowship 250 S Oneida, Suite 201 Denver, CO, 80224 OCT 302013 By: 1/U9 DirPrtor's (or designee's) Signat re U SS -23A Revised 6/2013 14 o'DL3 - 3c7D EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Roundup Fellowship, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45105, agrees to provide: A. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $159.32 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP). If the child is deemed CHRP eligible, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). Exhibit "A" to the SS23A 1 Revised 6/2013 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Roundup Fellowship, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45201, agrees to provide: A. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $159.32 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP). If the child is deemed CHRP eligible, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). Exhibit "A" to the SS23A 1 Revised 6/2013 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Roundup Fellowship, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45211, agrees to provide: A. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $159.32 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP). If the child is deemed CHRP eligible, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). Exhibit "A" to the SS23A 1 Revised 6/2013 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). a Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Roundup Fellowship, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45212, agrees to provide: A. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $159.32 per day for children placed within the Residential Child Care Facility unless the child is eligible for the Children's Habilitation Residential Program (CHRP). If the child is deemed CHRP eligible, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). Exhibit "A" to the SS23A L 1 Revised 6/2013 b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of , 20 /3 , by and between the Board of County Commissioners of Weld County, on b half of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Savio House, whose address is 325 King St, Denver, CO 80219, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 o?D/.3 - 3D 2O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST rn"'ta ' . By: Deputy C lliam F. Garcia, Chairman Approval as to Substanc WELD COUNTY DEPA, OF HUMAN SERVICES By: C The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: NTRACTOR: OCT 3 0 2013 vio House 25 King St Denver, CO 80219 1 / 1-'1;13 Director's (or designee' ) Signature and Date SS -23A Revised 6/2013 14 O O/. -36) 7c EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Savio House, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#48170, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this day of / , 20 /1, by and between the Board of County Commissioners of Weld County, on be If of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Shiloh House, Inc., whose address is 6400 W Coal Mine Ave, Littleton, CO 80123, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 I B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (I), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: Deputy Co th m , e�_ _&) ?� William F. Garcia, Chairman NTRACTOR: OCT 3 0 2013 Approval as to Substanc WELD COUNTY DEPA OF HUMAN SERVICES By: C S iloh House, Inc. 6400 W Coal Mine Ave Littleton, CO 80123 IC 1 Di ector's or ; •sign=s) gnature and Date SS -23A Revised 6/2013 14 aDi-4 -.30 20 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#20335, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23 A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#54169, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#62291, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A I Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#70967, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1528492, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules andregulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1539982, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.45 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Shiloh House, Inc., hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1588986, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.98 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 • j a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ® CHILD PLACEMENT AGENCY SERVICES (CPA) ® CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ® GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 07,3 day of� M 20 /3, by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Smith Agency, whose address is 14394 E. Evans Ave, Aurora, CO 80014, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 c2tJ/i.., S22O B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court 8 SS -23A Revised 6/2013 hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibits A and B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement and Exhibits A and B in writing, if agreedto by both parties. This Agreement and Exhibits A and B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. 11 SS -23A Revised 6/2013 G. Time is of the essence in each and all of the provisions of this Agreement. H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. 12 SS -23A Revised 6/2013 N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST�'----`3-9'^ Deputy C Approval as to Substance: WELD COUNTY DEPA OF HUMAN SERVICES By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: p_ Wi tam Garcia, hC airman NTRACTOR: mith Agency 14394 E. Evans Ave Aurora, CO 80014 OCT 302013 By: ))....A.2-0). Directors (or designee's) Signature and Date SS -23A Revised 6/20O 14 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Smith Agency Inc., hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#44882. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week 02) 3-4 round trips a week. 03%) 7 round trips or more Comments: 01) One round trip a week ❑1'/) 2 round trips a week 02%) 5 round trips a week 03) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month ❑3%) Three times a week or more Comments: 01) Once a month 01%) Two times month 02%) Once a week 03) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? 0 Basic Maint.) No educational requirements 01) Less than a '/2 hour per day 011/2) 1/2 hour a day ❑2) 1 hour a day 02 %) 11/2-2 hours per day 03) 21/2-3 hours per day 03%) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? 0 Basic Maint.) No special involvement needed 01) Less than 5 hours per week ❑1'/) 5 to 7 hours per week ❑2) 8 to 10 hours per week 02%) 11 to 14 hours per week 0 3) Constant basis during awake hours ❑3%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week 02) 8 to 10 hours per week 03%) 21 or more hours per week Comments: 01) 3 to 4 hours per week 01%) 5 to 7 hours per week 02%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑1) Face-to-face contact one time per month with child and minimal crisis intervention. 011/2) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. "Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? 00) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month 02) 4-8 hours per month 03) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. r is .:c3'"Wi:. �k ... �.{-r �'t =i'�'�. �.}r`n'•.' c der ...�.._� , l3:".a: :: . t, Sao i'.k..... .::........:.[.o..»�«_...iG't':� ^s: S i �1. b, "-:.t, ..,4 :rt b: �.., r. k 4 z`T_.....i .. 1 he_ sTf o„Tr�in1111tIY e�� v_i ... • .<,. ,.. a, ..., t v'..�:.. ..:.: ::. : v {� ..�. f S ._ .. l�uar cae'�Ct�' u$�ti.3 ,. ij �`� .i.. .:{ :1 J,..ttc .. 4. x ��i., ..�i, S r -}�i '1 �."2itnuiw2Y;2• ::vr,, :•.� ,;,: ;Si2:2SL'�C,'^.:Z:i^Rs'a riflvs:FB_ r. .._ - y :: 1 MUd/ r Moderate - Moderate/ h r Hi ht omm ent? - __... :..�...,..... r ., _F Modentte Ili h _ e ..... 1;1/2 . , 2 2 112- ,3 3- ,. Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ • • Verbal or Physical Threatening ❑ ❑ ❑ ❑ 0 ❑ • Destructive of Property/Fire Setting ❑ ❑ 0 ❑ ❑ ❑ ■ Stealing 0 ❑ ❑ 0 ❑ • • Self -injurious Behavior ❑ ❑ 0 0 ❑ ❑ I Substance Abuse ❑ ❑ ❑ 0 ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions 0 ❑ ❑ ❑ 0 ❑ • Enuresis/Encopresis ❑ ❑ ❑ ❑ ❑ ❑ ❑ Runaway ❑ ❑ ❑ ❑ ❑ ❑ ❑ Sexual Offenses ❑ ❑ ❑ ❑ ❑ ❑ ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. x L,tiir�5si:. i :.Q-}� : 3" p < b L YY I t retz : } �s u: » . ° v3?.a'�.._ ... _. ..mi' S .,�• Z li`Ailf)[I � 4 t ( �I�G 01P494f _ . -4... i —�t^ t ''tr ':: 1 y . cft 11(1M " r =: .. : _ ! y.n�^,cti �AC�I � ..... ,' ,. _ 1 r•.::.-:. 9? i , , .., l tt, f _r..._ r ..ill . . . ,? .i _ •�' •� R .: __ii` ;i;L •:irkr',{.-r w ': yam._; 7 : ii �1. • ."r't�i 1 1 'Tn '13�YJ�. .. ' € � ;� r.:c�'f 1.+_•:: i .: .....L;...�..N�....,•:t: +mot.' I. L 2 t . ' . fi ess�tt0iu ` ` l None lltlid M�IdI oderate hioderatef Hteh f 1 ri 3 i�f.,, w :,,, Conant $, , Moderate.. High`- Severn 0 1 1`1/2 2 21/2=: ;'3 3 Inappropriate Sexual Behavior ❑ ❑ ❑ ❑ ❑ ❑ ❑ Disruptive Behavior ❑ ❑ ❑•❑ ❑ ■ Delinquent Behavior ❑ ❑ 0 ❑ ❑ • ■ Depressive -like Behavior ❑ ❑ 0 ❑ ❑ ❑ ■ Medical Needs (If condition is rated "severe". please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Emancipation ❑ ❑ ❑ ❑ ❑ 0 • Eating Problems ❑ ❑ ❑ ❑ ❑ ❑ ❑ Boundary Issues ❑ 0 ❑ ❑ ❑ ❑ ■ Requires Night Care ❑ ❑ ❑ ❑ ❑ ❑ ■ Education ❑ ❑ ❑ ❑ ❑ ❑ ❑ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ❑ ■ CHILD'S OVERALL LEVEL OF (check level of need) ❑ 0 F11 NEED FROM BEHAVIOR ASSESSMENT: ❑ 2 ❑ 2'/2 ❑ 3 3V2 • 11/4 II Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE i-r.,.. fi"y .y.�..+;: i„ ERVICE' �+ P... :t,; , �Ss�;.r "r'^ t'�,... c" •• 6....14 �. �ii�WLV�If11111��LIEiJ PROVIDER ELATES -P1 - P5 c> e �i, � +.:� :.—; ++ ck::-::�. :. ,Iii- ;SSr: ; t•. d l ,{r;:. iii-- ei' _.,i,'i. 1 .: - ••. FFr {+1 " F EGOMMENInE AGENCY RATE i' ; _ .< ." Al 'lx $• ' ur - t : '..:.. d - i ,j d ; ,arm 4 v-i; ,.x a } r .. �: , THER7�T�I( i �''� d: , t +. ai .}'. i.'+ci� .c ice•?' . A 1_ i3 Level w Child; Maintenance - i mimstra#iv n e Ad a Mainte anc Case Management -Adrnin, Overhead)..,..: } } Administrative_Services' + +? :.. (Therapy/Misc;'y tS eS) . E County Basic Maint. ; Age 0 10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care p " $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. v = $0.00 Not needed or provided by another source, i.e. mental health. , 1 1. r Ei. $19.73 +$.66 Respite Care ($20.39/day) , i } d€ °: . $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month `_ $4.93/day Regularly scheduled therapy up to 4 hours/month. $2.99/day 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) $16.77/day* --- --_-_--- 2 • $26.30 +$.66 Respite Care ($26.96/day) 'n F., $18.42/day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month t" ag, tie :-:'s $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. $4.47/day 2 1/2 $29.59 +$.66 Respite Care ($30.25/day) $20.06/day* --------- 3 $32.88 +$.66 Respite Care ($33.54/day) lip $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $6.02/day 3 1/2 ,, s• $36.16 +$.66 Respite Care ($36.82/day) 4,,1 $23.35/day* . .,. �n'" �:� � 4 RCCF Step Down $39.45 +$.66 Respite Care ($40.11/day) _ ? ' •.-'• $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. W c-' ' -;; -------_-_---_--_--- Negotiated f�r4"X27 '.k �.:='• �. '"}iA:A'+1 1-___ - ¢ ( �g�_-gyp y �(��(p,".. A+J r -'td tt iigilEStSM, ?S ES, '£� J •5" MIN hi'r; i lie-e�.+c'?i}?rt�r 4, ,' ice `' . ,ss �. } Assess/ Emergency Level Rate $29,59 +$.66 Respite Care ($30.25/day) $20.06/day* +,, ----- Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Smith Agency, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $155.30, per day for children placed within the Group Home/Group Center identified as Provider ID #1540493. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. Exhibit "A" to the SS23A 1 Revised 6/2013 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Smith Agency, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#6566, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $155.30 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A t Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Smith Agency, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#96482, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $155.30 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this a3 day of / 20 by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Special Kids Special Families, whose address is 424 W Pikes Peak Ave, Colorado Springs, CO 80905, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State taws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Govermnental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: By: Deputy C rk to the B Approval as to Substance. WELD COUNTY DEPAF, OF HUMAN SERVICES;. By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: NTRACTOR: ecial Kids Special Families 4 W Pikes Peak Ave Colorado Springs, CO 80905 William F. Garcia, Chairman 0CT 302013 Erect is (o designe-'s) Si yjture and Date 07/ SS -23A Revised 6/2013 14 e2/J.. 3O217 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Special Kids Special Families, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#43184. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writine will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A I Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ['Basic Maint.) Less than one round trip a week ❑2) 3-4 round trips a week. ❑3%z) 7 round trips or more Comments: ❑ 1) One round trip a week ❑ I %z) 2 round trips a week ❑2'/z) 5 round trips a week ❑3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required ❑2) Three times a month ❑3'/z) Three times a week or more Comments: ❑1) Once a month ❑1'/z) Two times month ❑2'/z) Once a week ❑3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements ❑1) Less than a'' /z hour per day 011/2) IA hour a day ❑2) 1 hour a day ❑2 %z) 1'/z-2 hours per day ❑3) 2'%-3 hours per day ❑3%z) More that 3 hours per day Comments: P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? ❑ Basic Maint.) No special involvement needed ❑1) Less than 5 hours per week ❑1'/z) 5 to 7 hours per week ❑2) 8 to 10 hours per week ❑2%z) I 1 to 14 hours per week ❑ 3) Constant basis during awake hours ❑3'/z) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week ❑2) 8 to 10 hours per week ❑3'/z) 21 or more hours per week Comments: ❑1) 3 to 4 hours per week ❑1'/) 5 to 7 hours per week ❑2%) 11 to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) ❑1) Face-to-face contact one time per month with child and minimal crisis intervention. El 11/2) Face-to-face contact one time per month with child and occasional crisis intervention. ❑2) Face-to-face contact two times per month with child and occasional crisis intervention. ❑2'/z) Face-to-face contact three timesper month with child and occasional crisis intervention. ❑3) Face-to-face contact weekly with child and occasional crisis intervention. ❑3'%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? 00)Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month 02)4-8 hours per month ❑3) 9-12 hours per month Exhibit"B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category) Assessment Areaas None Mild Mild/ Moderate Moderate/ 11^._igh 2"1/2 High Hi h? _ Severe 3 -1/2 Comments: mss, K - Moderate. 0 1 1.1/2 2 3 Aggression/Cruelty to Animals ❑ ❑ a a a , , Verbal or Physical Threatening ❑ a a ❑ ❑ ■ ■ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ■ ■ 1 Stealing ❑ ❑ ❑ • ■ ■ ■ Self -injurious Behavior ❑ ❑ 0 ❑ ❑ ❑ 0 Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ❑ Presence of Psychiatric Symptoms/Conditions a a a a a a 0 Enuresis/Encopresis a ❑ ❑ 0 • ■ ■ Runaway ❑ ❑ ❑ ❑ ❑ a a Sexual Offenses ❑ ❑ ❑ a ❑ ❑ ❑ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Inappropriate Sexual Behavior Disruptive Behavior El Delinquent Behavior 111 Depressive -like Behavior Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) ❑ Emancipation Eating Problems Boundary Issues CI O El Requires Night Care El Education CI CI CI Involvement with Child's Family o CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 1Y2 ❑ 2 ❑ 2'/z 0 3 0 3'/z Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE ft' 1[EL SE ICE i r-; '� r�}1 ",Ni4, r Y'v 't L",'�-� ,4RECEDED .:r PROWDER RATE �" : Pt' 5:~ v e..�` L+. {, if-� :t4 a R`'�i : t a s .... ..:r 7 +tY' ! ,C� "is COMMENDED AGENfiE a Al , s .,y + E' t :ti-z.71"� �zy .. s.z x¢f t �.�{L fi1iERAPY't3ATF Tli� '' ' _ 7:::E.N:.O.5,:l2T .,.7 ,., a't'a # ii. r i sn 1 d L l_ .N .il 'l; � '• ' 3u: i E! � + ..R : `s {I - . Chiid httaitif Kance A> `i ..f E 'i' f s'' i.„ iert rit c �.s 1.� -,..W wri t: ,. rj?x, -dtnini`strat v� a Maaritenance r #� !�. _M i 3y Case Managernerct& Admen Overhead} _;1 �'- "Wn.4r#F.,3 "� t-,..., r ,-.t 4l : LL .:Tr: - J.. " k m n sttati a ervices ; n T herapylMisc l ervices) 3r i . 3[ ii i ,Level County Basic Maint. nE u' s,uQF Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care ,, ,c $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. 41 id $0.00 Not needed or provided by another source, i.e. mental health. 3' sy' 'e 1 - 5 1z $19.73 +$.66 Respite Care ($20.39/day)_ 'a?;- T - £ =- $15.13/day" Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month bra ' . T., $4.93/day py, Regularly scheduled thera up to 4 hours/month. ,!':. z ` 'i $2.99/day 1 1/2 s $23.01 +$.66 Respite Care ($23.67/day) 3 $16.77/day* a gie ,x� — f 2 � w $26.30 +$.66 Respite Care ($26.96/day) ,. }S, $18.42/day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month i * '- :; $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. :> $4.47/day 2112 r $29.59 + 66 Respite Care ($30.25/day) s' $20.06/day* ue-, ' --------------------- - --------- 3 . $32.88 +$.66 Respite Care ($33.54/day) a ' , $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. z k. =- $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. , r3; "`° , .,: ,, $6.02/day 3 1/2 $36.16 +$.66 Respite Care ($36.82/day)� ., 2; $23.35/day* `. ------------ 4 RCCF Step Down `= $39.45 +$.66 Respite Care ($40.11/day) -; `_ -= 4 $24.99/day" Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. .1. ., '' ____ _ —__ _ _ _--_ -- 1 Negotiated �7 , .,. ',=�-� �a <<-"�:.�x. yr' .._--=a�.-� ., �.... ..v.,."�� -.-�. _.-- .� ...=� ��. .. X29: ^; � _ -r �'` �� TM�'..��. ;,``�3.sy�:.' ��: ,y� ,.''.: .�s zs,?. .,i,"-`'>'�'� � .., ..-�xar�.w.=: n ..��k.-,.._.-,-a.. Assess/ Emergency Level Rate $29.59 +$.66 Respite Care` ($30-25/day) �4 �: $20.06/day* r :`. — Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) Z GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 3 day of 20 13, by and between the Board of County Commissioners of Weld County, on b alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Strong Foundations, LLC, whose address is 1702 68th Ave, Greeley, CO 80634, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 aO43 .3°76 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while perfoiruing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The auditedfinancial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 6 SS -23A Revised 6/2013 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: By: Deputy Cl Approval as to Substanc WELD COUNTY DEP' OF HUMAN SERVICE By: The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services `Garcia Chairman ONTRACTOR: rong Foundations, LLC 1702 68th Ave Greeley, CO 80634 OCT 302013 Directo,'s (or de ignee's) Signature and Da SS -23A Revised 6/2013 14 9&/ -z3D2O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Strong Foundations, LLC, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#1594056. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week O2) 3-4 round trips a week. O3%) 7 round trips or more Comments: 01) One round trip a week ❑1'/:) 2 round trips a week ❑2'/) 5 round trips a week O3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required O2) Three times a month O3%) Three times a week or more Comments: ❑1) Once a month ❑1%:) Two times month ❑2%:) Once a week O3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? ❑ Basic Maint.) No educational requirements O2) 1 hour a day O3%) More that 3 hours per day Comments: ❑1) Less than a''/3 hour per day ❑1%)'% hour a day O2 %) 1'/z-2 hours per day O3) 2'/-3 hours per day P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? 0 Basic Maint.) No special involvement needed ❑l) Less than 5 hours per week 01%) 5 to 7 hours per week O2) 8 to 10 hours per week ❑2'/) 11 to 14 hours per week 0 3) Constant basis during awake hours ❑3'/) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week O2) 8 to 10 hours per week ❑3%) 21 or more hours per week Comments: ❑ 1) 3 to 4 hours per week 01%) 5 to 7 hours per week ❑2'/) I l to 15 hours per week ❑3) 16 to 20 per week A 1. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. O2) Face-to-face contact two times per month with child and occasional crisis intervention. O2%) Face-to-face contact three times per month with child and occasional crisis intervention. O3) Face-to-face contact weekly with child and occasional crisis intervention. O3%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T 1. How often are therapy services needed to address child's individual needs per NBC assessment? O0) Not needed or provided by another source (i.e. Medicaid) ❑1) Less than 4 hours per month O2) 4-8 hours per month O3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. � ,Ad �i,.( It °, ;.31 f ..�:. ..`F � ,i i� n; [� � t r '§' _ 4 6-a s yt ° t r ^ ucLa f.�°•:-::mi:-ti. k sq �� ,, s..3 ti ar ) r .: t . _ 1'k. ri- 6L s ` ti€n'' � ''t � t.- j L f��]p 4.0 (�t}t{ ` ' +tl ..4. . ^;t�.r�.:u N..�}, :. { .- G�t?t' Z r- },, 4�nUltIa `.'" . !I ,� ��11,�,, P."d.�li t�'i �' `r { .. a� } � _."u}.'av:.r� vi? etil�'` �. . i a ,?-' i" a� :- "- y , n �-t'�' �.: �G.a{L .c c._ "'ti7 ,�'{ ii_. t�':i, �f r ,mo tC`u` :.4'i°i :.aIi-'� L t }id {.�" - 'g._� p.c- t i , j5 �jE ,, ' , ::1�',: `L ; .� �' �-� C'� fiat .csf°li n ti .x;• �. C..l.....1. � •..: — o >rt. V+FIn �.,. 6-0111 IQ1 .. ,�-=Mltd :1 .�'tll(� i 'bioderaie t9 �.�ModerAle� Nigh 4j* H,-, r 1 T i 4 , COmm efltS. :. Moderate , nig_ = Severe 0 1 1/2 : .2 21/2 3 31Z yy Aggression/Cruelty to Animals ❑ ❑ ❑ ❑ ❑ ❑ • Verbal or Physical Threatening ❑ ❑ O ❑ ❑ ❑ ■ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ■ Stealing ❑ ❑ ❑ ❑ ❑ O ■ Self -injurious Behavior O ❑ ❑ O ❑ ■ ■ Substance Abuse ❑ ❑ ❑ ❑ ■ ■ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ • • Enuresis/Encopresis ❑ ❑ O ❑ ❑ ❑ ■ Runaway ❑ ❑ ❑ ❑ ❑ ■ ■ Sexual Offenses ❑ O ❑ ❑ ❑ ❑ ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions, (Check one box for each category Assessment Areas Banc Mild Ntildr Modcrate Moderate/ Hiatt High/ Comments: .;≥ 4toderxtc. High � Severe 0 1 11/2 2 2 1/2 3 3 1,2 Inappropriate Sexual Behavior ❑ ❑•❑ ❑ ❑ ❑ Disruptive Behavior ❑ ❑ ❑ o 0 ■ ■ Delinquent Behavior ❑ ❑ ❑ ❑ ❑• ❑ Depressive -like Behavior ❑ 0 ❑ ❑ ❑ ❑ ❑ Medical Needs (if condition is rated "severe", please complete the Medically fragile NBC) ❑ ❑ ❑ ❑ ❑ ❑ ❑ Emancipation ❑ ❑ ❑ ❑ ❑ ❑ ■ Eating Problems ❑ ❑ ❑ 0 0 ❑ ■ Boundary Issues ❑ ❑ ❑ ❑ ❑ ■ ■ Requires Night Care ❑ ❑ ❑ ❑ ❑ ❑ ❑ Education ❑ ❑ ❑ ❑ ❑ ■ ■ Involvement with Child's Family ❑ ❑ ❑ ❑ ❑ ❑ ■ CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑ 1 ❑ 1'/2 ❑ 2 ❑ 2'/2 ❑ 3 ❑ 3'/2 Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE LEVEL. y ..:: VI�� .. ... r!i ^� -..: vv` M1 RECOMMENDED PR �I�Ar F :}�'ti � ':»in r �� li' It' ..} I .(1• ., f 1 P S Fs = -, P5 : , rare. i RECQMMENDED AG€N&Y RATE , , 2 9 � i+ t e,: t:i.,f n:.fe �ll�. � _.. �1�, t: r i I ��'� .�:1 � t� � :.I. -0lL.t ! .:i.. }� iL. t' f �. t n x' t . �u1C�'9iiS yiktu�i .' Al ,,.,,, F _��, r }��,., THERAPY RATE :��.. f t ,�i ij 1.., .S_y, " .t,••6eili"ce:�;{�.} .5� ,i2, �.r i S'4"�° � ;" t ,�.^5#-..44]...� y �$'i. �i M LCAL ,r +': Level: Chil�lt�aintenance. .:� !{dmrnistrative Maintenance` - _ - (Case Management &Admnn Overhead) ;, AdmtmstrativeServices. , (Therapy/Misc: Services)." County Basic lVlaint. Age 0-10 $16.32/day4 Age 11-14...$18.05/day Age 15 21...$19.27/day + $.66/day Respite Care $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. $0.00 Not needed or provided by another source, i.e. mental health. 1 !is $19.73 +$.66 Respite Care ($20.39/day) ry _ '' $15.13/day* crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $4.93/day Regularly scheduled therapy, up to 4 hours/month. $2.99/day 1 1/2 � $23.01 +$.66 Respite Care ($23.67/day) .�. *'" _ $16.77/day* �ruru trv�w iv= — ------ 2 t i $26.30 +$.66 Respite Care ($26.96/day) Iti t $18.42/day* Occasional crisis intervention as needed, two face-to-face visits with child, 2-3 contacts per month : .' ' $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. $4.47/day 2 1/2 k ,- $29.59 +$.66 Respite Care ($30.25/day) $20.06/da * y ` y=? ---------- 3 $32.88 +$.66 Respite Care ($33.54/day) } r .; '? $21.70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. �z € js` $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. ;- $6.02/day 3 1/2 '` $36.16 +$.66 Respite Care ($36.82/day) _ •s $23.35/day* niwn 4 RCCF Step Down t $39.45 +$.66 Respite Care ($40.11 /day) = `i ii't $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. • - }' 3, Negotiated 35' �'?r. .n� r 3., s .. .., .-v,-/-4, 'h'! , d.,�:�ii� � .a�,ix� i:'t}.' c , .i .:v..,;;tk'.^-s � �, . .. _ .r i . '+lima" .. , ...l,?.,�.la^�ai� t ._w. ti _.�aP.gi.:'r 3r1 �Y-� � !, 1ca5-�`-S.� ,: 'i _fi'"t Jr .�, )e:'3 -E. ;3 -ffoo'S4i 1�T... 5I•�.. -.- . ay a'Ft Lf 7� -["�: S {'fk Assess/ Emergency Level Rate � , `' $29.59 +$-66 Respite Care ($30.25/day) 1 $20.06/day* ,� ; _—_• —------------- y ----- Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Group Home/Group Center Care Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Strong Foundations, LLC, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement at a rate of $71.74, per day for children placed within the Group Home/Group Center identified as Provider ID #54150. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County and Contractor agree that for Children's Habilitation Residential Program (CHRP) waiver eligible children, the County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. 4. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished under this contract for facilities that provide sex offender treatment. 5. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 6. The services purchased under this Agreement for Group Home/Center services may include, but are not limited to: Basic 24 -hour care and child maintenance (food, shelter, clothing, educational supplies and allowance), direct child care, transportation, administrative overhead, support overhead, service delivery staff, which may include but are not limited to: Parent training for teens, independent living training, and mentor/advocate services. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. Exhibit "A" to the SS23A 1 Revised 6/2013 8. Contractor agrees to actively participate in achieving the child's Permanency Goal and cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): S THIS AGREEMENT is made and entered into this day of _u_, 20 /3, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Tennyson Center for Children, whose address is 2950 Tennyson St, Denver, CO 80212-3029, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 DX)23- 76 B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall infoim each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perfo,ui any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTESTT`sv $' .°'9;)rS"'k^- The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services c._ By: viii.< � _� : r��.�F�!t�.�� By: Deputy Cl to 1961 Approval as to Substance: WELD COUNTY DEPAR OF HUMAN SERVICES By: William F. Garcia, Chairman NTRACTOR: OCT 3 0 2013 ennyson Center for Children 2950 Tennyson St Denver, CO 80212-3029 By: irector's41CLA Y143 r designee's) Signature and Date SS -23A Revised 6/2013 14 &&3 e)7C) EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Tennyson Center for Children, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1529814, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $181.64 per day for children placed within the Residential Child Care Facility. b. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $300.00 per day for children placed within the Residential Child Care Facility Special Services Unit. c. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, basedon the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for Exhibit "A" to the SS23A 1 Revised 6/2013 teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 • AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ® RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this 5- day of u..� , 2003 by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Third Way Center, whose address is PO Box 61385, Denver, CO 80206, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. 1 SS -23A Revised 6/2013 aoij -3026 2 , B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2 SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTEST: B Deputy C Approval as to Substance: WELD COUNTY DEPART OF HUMAN SERVICES The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services William F. Garcia, Chairman CTOR: ay Center ox 61385 enver, CO 80206 By: Director's (or .esignee's) Signature and Date deozd OCT 3 0 2013 SS -23A Revised 6/2013 14 07043- So 2O EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#49487, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $180.12 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#65346, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $180.12 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A I Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#77810, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $180.12 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1507881, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $180.12 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A 1 Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Third Way Center, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1547437, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $176.57 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as outlined in Section VI of this contract: Exhibit "A" to the SS23A I Revised 6/2013 a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A ❑ CHILD PLACEMENT AGENCY SERVICES (CPA) ❑ CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this O13 day of , 20 1J, by and between the Board of County Commissioners of Weld County, on be alf of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Turning Point Center for Youth, whose address is 1644 South College Ave, Fort Collins, CO 80525, hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. I SS -23A Revised 6/2013 ae B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. SS -23A Revised 6/2013 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and 3 SS -23A Revised 6/2013 Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the 4 SS -23A Revised 6/2013 full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 5 SS -23A Revised 6/2013 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal 6 SS -23A Revised 6/2013 Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in 7 SS -23A Revised 6/2013 accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. 8 SS -23A Revised 6/2013 D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A and the SS23B as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, and the SS23B in writing, if agreed to by both parties. This Agreement, Exhibit A, and the SS23B are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. 11 SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. J. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: I. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find 12 SS -23A Revised 6/2013 and determine that Contractor has substantially failed to satisfy the scope of work found in this Agreement, Exhibit A and the SS23B. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: ATTESTW ,_ By: eputy Cl'rk to th Approval as to Substance: WELD COUNTY DEPART OF HUMAN SERVICES TRACTOR: urning Point Center for Youth 1644 South College Ave Fort Collins, CO 80525 The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services V William F. Garcia, Chairman OCT 3 0 2013 e's) Signature S - Co- t3 SS -23A Revised 6/2013 14 opey.9-SO '70 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#45179, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $178.89 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A 1 Revised 6/2013 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Residential Child Care Facility Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Turning Point Center for Youth, hereinafter referred to as, "Contractor." 1. County agrees to purchase and Contractor, ID#1616504, agrees to provide: a. Child Maintenance, Administrative Maintenance and Services, which are listed in this Agreement at a rate of $178.89 per day for children placed within the Residential Child Care Facility. b. Additional services not covered by Medicaid or considered within the above vendor rate. These additional services/rates may be negotiated on a child by child basis, based on the needs of the child and in accordance with the Colorado Department of Human Services Agency Letter CW-06-11-I dated June 8, 2006. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 2. County considers the agreed upon rate, outlined in the Weld County Addendum to this contract, to be all inclusive and shall not pay for additional treatment fees; i.e. Drug/Alcohol and Sex Offender services. 3. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from the Department Administrator before payment will be release to provider. Reimbursement rates for bed hold days may not exceed the state standard rate for administrative maintenance and administrative services or may be a reduced rate that is mutually agreed upon. 4. The services purchased under this Agreement as Child Maintenance, Administrative Maintenance and Services for Residential Child Care Facilities include, but are not limited to: Food, shelter, clothing, personal needs and allowance, administration, administrative overhead, support staff, support overhead, sleep -over staff, direct child care, transportation, therapeutic recreation, service delivery staff, parent training for teens, independent living training, mentor/advocate, supervised visitation and all other services as outlined in the Child Specific Addendum. The anticipated minimum percentage for each item is as follows and will be subject to County monitoring as Exhibit "A" to the SS23A Revised 6/2013 outlined in Section VI of this contract: a. Food, including meals and snacks (25%). b. Clothing (3%). c. Shelter, including utilities and use of household furnishing and equipment and daily supervision, including those activities that a parent would normally carry out to assure protection, emotional support and care of the child (30%). d. Personal items and grooming care for the child, such as toothpaste, toothbrushes, soap, combs, haircuts, and other essentials (2%). e. Other/miscellaneous items considered usual in the care and supervision of the child, include, but are not limited to, transportation, recreation and overhead (40%). 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, that is not provided within the vendor rate or attached Scope of Service, will need be negotiated and authorized, in writing by the County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Provider shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by Weld County Department of Human Services to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to the County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor will complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Human Services Policy and Procedure Manual. Exhibit "A" to the SS23A 2 Revised 6/2013 AGREEMENT TO PURCHASE OUT -OF -HOME PLACEMENT SERVICES SS23A • CHILD PLACEMENT AGENCY SERVICES (CPA) Eg CHILD RESIDENTIAL HABILITATION PROGRAM (CHRP) ❑ GROUP HOME/GROUP CENTER CARE ❑ INDEPENDENT LIVING ❑ PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) ❑ RESIDENTIAL CHILD CARE FACILITY (RCCF) ❑ RESIDENTIAL DRUG/ALCOHOL PROGRAM ❑ SHELTER CARE ❑ SUBSIDIZED ADOPTION ❑ TRANSITION/HOME BASED AFTER -CARE (RCCF) ❑ OTHER (DESCRIBE): THIS AGREEMENT is made and entered into this o?3 day of , 20 /3 , by and between the Board of County Commissioners of Weld County, on be if of the Weld County Department of Human Services, whose address is P.O. Box 758, hereinafter referred to as, "County," and Whimspire CPA, whose address is o hereinafter referred to as, "Contractor." This Agreement covers all children placed by County with Contractor. WITNESSETH: WHEREAS, the Colorado State Department of Human Services, hereinafter referred to as, "State Department," is authorized to provide human services to individuals and families through county departments of human services, and WHEREAS, County is authorized to purchase certain services for eligible children under State Department rules, and WHEREAS, County wishes to provide these services by purchasing them from Contractor, and WHEREAS, Contractor is licensed as a Child Placement Agency, Residential Child Care Facility, certified Psychiatric Residential Treatment Facility, or meets the requirements for other licensed service types. NOW, THEREFORE, in consideration of the mutual promises and covenants made herein, County and Contractor agree as follows: I. TERM: A. The term of this Agreement shall be from July 1, 2013, to and until June 30, 2014. I SS -23A Revised 6/2013 cQ2/ ae�� B. Each party shall have the right to terminate this Agreement by giving the other party written notice received at least thirty (30) days prior to the intended date of termination. If notice is so given, this Agreement shall terminate upon the expiration of thirty (30) days, or until the eligible child(ren) may be placed elsewhere, whichever occurs first, and the liability of the parties hereunder for further performance of the terms of this Agreement shall thereupon cease; however, the parties shall not be released from the duty to perform their obligations up to the date of termination. II. SERVICES TO BE PROVIDED BY AND REQUIREMENTS OF CONTRACTOR: A. Services to be provided by Contractor are detailed herein in the document entitled, "Additional Provisions," which is attached hereto and referred to herein as "Exhibit A." B. County and Contractor agree and understand that the reasons for referral, which necessitate purchasing services for children, are specified in the Child Specific Addendum (SS23B) and Family Services Plan. Any other relevant information concerning these children that does not necessitate purchasing services is also included in the Child Specific Addendum (SS23B). C. County and Contractor shall develop an Initial Individual Plan of Care that addresses the immediate and/or emergency needs of the child within 72 hours of admission for children in RCCFs or group homes, except PRTF. County and Contractor shall formulate an Individual Plan of Care within 14 calendar days after admission for children in RCCFs or group homes, except PRTF. The placement date is that date noted in Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. D. County and Contractor shall formulate an Initial Individual Plan of Care for children in PRTFs within 72 hours. For children in a PRTF, a comprehensive Individual Plan of Care must be completed by the multidisciplinary team within 14 calendar days from the placement date. The placement date is that date noted in the Child Specific Addendum (SS23B). Modifications to the Individual Plan of Care must be agreed to in writing. E. The Individual Plan of Care shall be goal oriented and time -limited and shall: 1. Address all areas listed in Section 7.714.4, C, 2, (12 CCR 2509-8) together with clinical and other needs including the child's presenting problems, physical health, emotional status, behavior, support system in the community, available resources, and discharge plan. 2. Include specific goals and measurable objectives, expected dates of achievement, specific discharge and transitional/after-care and follow up services criteria to be met for termination of treatment. 2 SS -23A Revised 6/2013 3. Specify the type, frequency, and duration of clinical therapy services, rehabilitation services, medication management, emergency services, initial assessment, documented treatment modifications, and other services determined to be necessary to meet the child's specific goals. 4. Specify that all therapeutic services are necessary to meet the needs of the child and to treat the child's current diagnosis. 5. Identify the provision of, or the referral for, services other than RCCF services and shall document any court ordered treatment including identifying the agency responsible for providing the court ordered treatment. 6. Specify the anticipated living arrangement for the child at the date of discharge. 7. Specify the anticipated educational arrangement for the child at the time of discharge. 8. Specify the anticipated date for discharge from treatment purchased for the child. 9. Specify a permanency goal for the child. F. Monthly, Child Placement Agencies, RCCFs and all other Contractors, other than PRTF, shall conduct a monthly review of each Individual Plan of Care to evaluate whether the short-term and long-term goals have been achieved or not achieved. These Contractors shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the treatment plan. Further, Contractor agrees to sequence reports to be received by County fifteen (15) calendar days prior to judicial or administrative hearings or reviews when provided with thirty (30) calendar days advance notice of such review dates by County. G. Every fourteen (14) days, PRTFs shall provide County with written reports which address changes to the child's physical condition, psychological and social functioning, changes in the child's family situation, educational progress, significant incidents or disciplinary actions, and progress made to achieve goals specified in the Individual Plan of Care. H. Contractor shall: 1. Conform with and abide by all rules and regulations of the Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing (if appropriate), the State of Colorado and any applicable federal laws and regulations, as such, which may be amended from time to time, and shall be binding on Contractor and control any disputes in this Agreement. 3 SS -23A Revised 6/2013 2. Maintain a current license and maintain license requirements as specified under State law and rule. 3. Not charge any fees to children or families of children referred by county for any services provided under this Agreement. 4. Not assign the obligations under this Agreement nor enter into any sub - Agreement without the express written approval of the Director of the County Department or his/her appointed designee. 5. Abide by all applicable provisions of Title VI and VII of the Federal Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title XX of the Social Security Act of 1975 as revised, and provide confidentiality of information concerning the child in compliance with the Health Insurance Portability and Accountability Act (HIPAA). 6. Maintain at all times during the term of this Agreement a liability insurance policy of at least $25,000 for CPAs ($400,000 for PRTFs and RCCFs) for property damage liability, $150,000 for injury and/or damage to any one person, and $600,000 for total injuries arising from any one accident. Contractor shall provide a certificate of insurance provided by its insurer upon request by County. 7. Maintain during the terms of this Agreement a fidelity bond of at least $25,000 or two (2) months gross receipts, whichever is greater, covering the activities of any of its officers, agents or employees responsible for the implementation and/or administration of this Agreement in order to make reparations for any wrongful acts, omissions, or any other defalcations of Contractor. 8. Indemnify County, the Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, and the State of Colorado, against any and loss against all claims and actions based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this Agreement or by conditions created thereby, or based upon any violations of any statute, ordinance, or regulation and the defense of any such claims or actions. (Paragraphs 6, 7 and 8 do not apply to agreements between County and the University of Colorado.) 9. In regards to University of Colorado Contractors only, Contractor shall be responsible for its own wrongful or negligent acts or omissions or those of its officers, agents, or employees while performing their professional duties to the full extent allowed by law. Notwithstanding the foregoing, nothing in this Agreement is a limitation or waiver of the application of the Colorado Governmental Immunity Act set forth in §24-10-101 to §24-10-120, C.R.S., any 4 SS -23A Revised 6/2013 claims resulting from the performance of the University of Colorado, its employees or agents under this Agreement. 10. Maintain service program records, fiscal records, documentation and other records, which will sufficiently and properly reflect all direct and indirect costs of any nature incurred in the performance of this Agreement. The above shall be subject at all reasonable times to inspection, review or audit by federal, Colorado Department of Human Services, Colorado Department of Health Care Policy & Financing, or county personnel, and other persons authorized in writing by the Executive Director of the Colorado Department of Human Services. 11. In any instance of a potential adoption by a foster parent, provide the initial home study, the SAFE study update, annual certification updates and related materials when requested by the County within fourteen working days of the request. At all other times Contractor shall make home studies and related materials available to the County for review, at a location agreed upon by the County and Contractor, during regular business hours. 12. Invoice the County for services rendered, using the required form. This form is to be mailed to the County by the last day of the month of care. Billings for PRTFs shall be made to the MMIS System only. Billings for RCCF fee -for -service and CHRP shall be made to either the MMIS System or the County. Billings for RCCFs daily rate, CPAs and other Contractor types shall be made to the County only. Contractor will not be paid by the county when billing is not received by the County within thirty (30) calendar days following the billing due date. 13. Attend and participate in Administrative Reviews for children in placement with Contractor pursuant to two (2) weeks written notice by the County. Contractor shall encourage children over the age of twelve to attend their Administrative Reviews. Participation may be in person or by teleconference. 14. Contractor shall pay the foster parent the amount agreed upon with the county as the child maintenance or room and board. Any payment to the foster parent in excess of the child maintenance or room and board amount shall be treated as income to the foster parent. I. Audit and financial requirements. The purpose of these requirements is to provide minimum assurance that Contractor has adequate accounting and budgeting information available to allow management to maintain a financially viable enterprise and to demonstrate financial accountability to County and to the State of Colorado Department of Human Services for the use of public funds. 1. Contractor must have in place a double entry accounting system and all financial transactions must be posted to this system. Financial statements, prepared from information provided by this system, shall be presented in conformity with U.S. generally accepted accounting principles (GAAP). Contractor must also have 5 SS -23A Revised 6/2013 adequate time keeping and cost allocation systems to allocate salary cost and indirect cost to appropriate cost centers. Books and records of Contractor shall be subject, at any reasonable time, to inspection, audit or copying by appropriate Federal, State or county personnel, or such independent auditors or accountants as may be designated by these personnel. 2. All billing by Contractor must be in a format approved by the fiscal agent or county. Contractors must bill the fiscal agent and county at least once a month. Contractors may bill twice a month, on the 15th and last day of the month, for services rendered. Bills will be returned unpaid if the bills do not conform to the approved format or the documentation is inadequate. 3. All Contractors whose total annual expenditures are $100,000 or more shall submit an annual audit of their financial statements by an independent certified public accountant. Contractors with total annual expenditures less than $100,000 may submit an audit as described above or may submit compiled or reviewed financial statements, prepared in accordance with generally accepted accounting principles. If Contractor is a government agency that has an independent audit done by another agency of that government, its audited financial statements, prepared in accordance with generally accepted accounting principles for state and local governments meet this requirement. The audited, compiled or reviewed financial statements of PRTFs, RCCFs, and CPAs must be completed and a copy provided to the Colorado Department of Human Services (Attn: Administrator for PRTFs, and RCCFs and Attn: Audit Division Director for CPAs) within 180 days after Contractor's fiscal year end. The audited financial statements and supplementary information defined in regulation for various agencies shall be presented as described in Section VI, B (1), above and must contain sufficient detail to provide evidence of financial accountability under the terms of this Agreement and controlling state regulations. Contractors that are a subsidiary of a parent organization must submit separate financial statements for the subsidiary that detail each of Contractor's facilities and/or programs that provide services for the Colorado Department of Human Services and also must provide a reconciliation of these financial statements to the consolidated financial statements of the organization as a whole. When applicable, Contractor must comply with the audit requirements found in the Single Audit Act of 1984 and the Single Audit Act Amendments of 1996 and U. S. Office of Management and Budget (OMB) Circular A-133, Audits of States, Local Governments, and Non - Profit Organizations including subsequent revisions, and appropriate audit and financial reporting requirements as defined in State laws, rules, and regulations. 4. If Contractor does not submit their annual audit or refuse to disclose financial information regarding the operation of the program in a timely manner, the Fiscal Agent may withhold payment until the audit and/or requested information is submitted. If Contractor is a CPA, then sanctions of Contractor may occur for failure to submit. SS -23A Revised 6/2013 6 5. In cases where documentation does not exist to support audit information or services provided, Contractor will be required to repay all funds received for which documentation does not exist. 6. In cases where audit deficiencies are noted, a plan of corrective action shall be submitted to the State Department's Audit Division for approval within four (4) months of the date of the audit. 7. Failure to comply with any of these requirements, including items on the addendum is justification for the County to impose possible fiscal sanctions, penalties, or cancel the Agreement. III. PAYMENT TO CONTRACTOR: A. The total rate of payment for care and services under this Agreement shall not exceed: the established rate for the PRTF; for CPA placements, the negotiated rate or the approved vendor rate; for RCCF placements, the established Fee -for -Service rate and the negotiated rate or the approved vendor rate; and, for CHRP placements, the agreed upon service proposal rate. The total rate of payment for care and services for other service types will be as negotiated between the County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. Any child may be removed from the facility prior to the end of the term by County. The amount paid for purchased care and services for less than a full month will be based upon the daily rate. B. Payment for a child's temporary absence from the facility, including absence due to hospitalization, will be made in accordance with State Department rules in Staff Manual Volume VII, 7.406.1, F (12 CCR 2509-5). C. All invoices from contractor shall be submitted to and approved by the appropriate County staff. Payment for placement services shall be paid from the date of admission up to, but not including, the day of discharge. Medicaid payments for PRTF and CHRP placements are permitted on the day of discharge in compliance with regulations promulgated by the Colorado Department of Health Care Policy and Finance. Fee for Service will be reimbursed as per Medicaid regulations. Medicaid funds shall not be limited to funds encumbered in this Agreement and shall also include Medicaid funds for PRTF and RCCF therapeutic services and CHRP services paid by the Department of Health Care Policy and Financing. Payment for placement services will not be provided for clients on "runaway" status unless the County has previously approved it. Invoices for therapy costs for clients enrolled in PRTF, RCCF, and CHRP programs shall be submitted to the Medicaid Fiscal Agent in accordance with instructions provided by such Fiscal Agent. Contractor shall forward copies of such billings to the County on a monthly basis. D. In the event that a Contractor receives payment for a per diem discharge day, regardless of funding source, Contractor shall refund those dollars forthwith. 7 SS -23A Revised 6/2013 E. In the event this Agreement is terminated, final payment to Contractor may be withheld at the discretion of the County until final audit. Incorrect payments to Contractor due to omission, error, fraud, or misuse of funds shall be recovered from Contractor either by deduction from subsequent payments under this Agreement or other Agreements between the County and Contractor or by the County, as a debt due to both the State of Colorado, the Colorado Department of Human Services and the County. The waiver of any violation shall not be construed as a waiver of any other or subsequent violation of this Agreement or appropriate statutes and regulations. F. If this Agreement covers an initial placement for a child, Contractor may receive a clothing allowance in accordance with State Department rules. G. Reimbursement rates that are negotiated between the County and Contractor shall be for allowable costs in one or more of four primary components: child maintenance, administrative services, administrative maintenance, and treatment. Contractor type will determine which of these four components will be included in the reimbursement rate. IV. TRANSPORTATION: A. Transportation shall be furnished by County between the child's residence and Contractor's facility for the initial placement and return after the treatment plan is completed. If the child runs away from Contractor's facility, County shall provide transportation to either return the child to the facility or to other care as arranged by County. County has responsibility for the decision to return the child to the facility, with input from Contractor. B. All other transportation associated with Contractor's proposed services shall be provided by Contractor. Any transportation costs not covered or contemplated in the original treatment plan must be negotiated between County and Contractor and are not subject to reimbursement under this Agreement. However, provisions for payment of other transportation may be provided for in the Family Service Plan / Individual Plan of Care. C. Any transportation costs to be incurred on behalf of a child in placement, which are to be borne by persons, or agencies, which are not a party to this Agreement, shall be specified in the treatment/service plan, and those persons shall acknowledge their responsibility by signing the treatment/service plan. D. Transportation may include, but is not limited to; visitation with family members, medical/dental or mental health appointments, extracurricular activities, court hearings or other specialized programming. Transportation expectations will be documented on the Child Specific Addendum, SS23B. 8 SS -23A Revised 6/2013 V. LEGAL STATUS AND AUTHORIZATIONS: 1. Such permission as is held by the County is hereby granted to Contractor to authorize routine or emergency medical and dental treatment, except that: a. Medical or dental care shall be provided by personnel duly licensed by law as required by the State of Colorado. b. It is mutually understood hereto that hospital expenses, surgery, ophthalmology services, eyeglasses, orthodontia or other unusual expenses are not included in the monthly rate. c. The cost of any items not covered by Medicaid will be negotiated between County and Contractor. Medicaid rules shall govern activities to be covered in the daily rate paid to PRTFs. 2. County and Contractor shall insure that the child(ren) is enrolled in the Early and Periodic Screening, Diagnosis and Treatment Program. 3. It is agreed and permission is granted for the child(ren) to participate in planned recreational and social activities of Contractor, including supervised off grounds excursions and extended trips within the State, provided that Contractor has written permission from County and legal guardian for any trips out of Colorado for any reason and any planned absence from the facility of over seven (7) days within a consecutive 30 -day period. Such written permission may be in the treatment/service plan. Further, Contractor and County will also secure, where possible, permission from parents or guardians of the child placed with Contractor. Any planned absence of more than 24 hours for children placed in a PRTF is not Medicaid reimbursable. 4. County and Contractor shall inform each other and the local school district of any changes in parental residence affecting educational status which comes to their attention. 5. Contact by Contractor with County regarding emergency medical, surgical or dental care will be made in person -to -person communication, not through phone mail messages. During regular work hours, Contractor will make every effort to notify the assigned caseworker, supervisor, or intake screener of any emergency medical, surgical or dental issues prior to granting authorization. During non -regular work hours, weekends and holidays, Contractor will contact the Emergency Duty Worker at the pager number (970) 304-2749. 9 SS -23A Revised 6/2013 VI. RESPONSIBILITIES OF COUNTY: A. County shall: 1. Determine eligibility of the children under this Agreement for placement and medical coverage. Medicaid rules and regulations shall govern determination of Medicaid eligibility. 2. Assess and collect fees in accordance with the rules and regulations of the Colorado Department of Human Services. 3. Reimburse Contractor by the 15th of the following month in accordance with fiscal system time frames for services purchased under this Agreement in accordance with the established rate when billing is submitted as described in Section IV, Number 10 (above). 4. Abide by all the rules and regulations of the Colorado Department of Human Services, federal rules and regulations and the laws of the State of Colorado, any of which may be amended from time to time. 5. Monitor children's progress in accordance with the treatment/family services plan and the requirements of Colorado Department of Human Services rules and provide consultation to Contractor in relation to the services purchased under this Agreement. 6. Invite Contractor to administrative reviews at least two (2) weeks prior to the scheduled review. 7. Involve Contractor in planning for the child and give Contractor a copy of the Family Services Plan at time of placement or as soon as completed and when updated or revised. 8. Seek recovery from the RCCF, CPA or other Contractor type for any non - Medicaid payment amounts that have been misused as defined in rules. The County may withhold subsequent payments to recover any funds misused by the RCCF, CPA or other Contractor type. The County shall seek recovery of any remaining funds as a debt due the County for the benefit of the state. The RCCF or CPA may appeal the decision to recover or withhold subsequent payments as defined in rules. 9. Identify the amount agreed upon with Contractor to be paid to the foster parent for the child's room and board. Such amount will be the same as shown in Trails for the child's maintenance. 10 SS -23A Revised 6/2013 VII. GENERAL PROVISIONS: A. Contractor agrees that Contractor is an independent contractor and that neither Contractor nor Contractor's agents or employees are, or shall be deemed to be, agents or employees of the County for any purpose. Contractor shall have no authorization, express or implied, to bind the County to any agreement, liability, or understanding. The parties agree that Contractor will not become an employee of County, nor is Contractor entitled to any employee benefits from County as a result of the execution of this Agreement. Contractor shall be solely and entirely responsible for its acts or of any agent, employee, servants and sub -contractors during the performance of this Agreement. B. Payment pursuant to this Agreement, if in State of Colorado, county, or federal funds, whether in whole or in part, is subject to and contingent upon the continuing availability of State of Colorado, county, and federal funds for the purpose thereof. C. It is agreed that if, after investigation, it is shown that reasonable care was given to guard and protect personal items brought to Contractor by the children, Contractor shall be released from responsibility for loss or damage to such personal items. D. This Agreement is intended to be applied in conjunction with Exhibit A, the SS23B, and the Needs Based Care Addendum as the complete integration of all understandings between the parties. No prior or contemporaneous addition, deletion or other amendment hereto shall have any force or affect whatsoever, unless embodied herein in writing. No subsequent notation, renewal, addition, deletion, or other amendment hereto shall have any force or effect unless embodied as a part of this written Agreement. This section shall not be construed as prohibiting the periodic amending of this Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum in writing, if agreed to by both parties. This Agreement, Exhibit A, the SS23B and the Needs Based Care Addendum are intended to be in lieu of and supersedes all prior agreements between the parties hereto and relating to the care and services herein described. E. The State of Colorado Department of Human Services shall be and hereby is permitted to monitor service program, fiscal and other records sufficiently to assure the purchase of services in this Agreement are carried out for the benefit of the aforementioned client. Monitoring may occur through review of program reports, on -site visits where applicable and other Agreements as deemed necessary. Contractor understands that the State Department may provide consultation to Contractor to assure satisfactory performance in the provision of purchased services under this Agreement. F. County shall have access to Contractor's financial records as they relate to this Agreement for purposes of audit. Such records shall be complete and available for audit 90 days after final payment hereunder and shall be retained and available for audit purposes for at least five years after final payment hereunder. G. Time is of the essence in each and all of the provisions of this Agreement. II SS -23A Revised 6/2013 H. Neither party to this Agreement shall be liable to the other for delays in delivery or failure to deliver or otherwise to perform any obligation under this Agreement, where such failure is due to any cause beyond its reasonable control, including but not limited to Acts of God, fires, strikes, war, flood, earthquakes or Governmental actions. I. Any notice required to be given under this Agreement shall be in writing and shall be mailed or delivered to the other party at that party's address as stated above. 3. This Agreement and the provision of services hereunder shall be subject to the laws of Colorado and be in accordance with the policies, procedures, and practices of County. K. This Agreement is nonexclusive and County may engage or use other contractors or persons to perform services of the same or similar nature. L. Contractor certifies that Contractor is not an illegal immigrant, and further, Contractor represents, warrants, and agrees that it has verified that Contractor does not employ any illegal aliens. If it is discovered that Contractor is an illegal immigrant, employs illegal aliens or subcontracts with illegal aliens, County can terminate this Agreement and Contractor may be held liable for damages. M. Contractor assures and certifies that it and its principals: 1. Are not presently debarred, suspended, proposed for debarment, and declared ineligible or voluntarily excluded from covered transactions by a federal department or agency. 2. Have not, within a three-year period of 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; 3. Are not presently indicted for or otherwise criminally or civilly charged by a government entity (federal, state, or local) with commission of any of the offenses enumerated in paragraph (B) above. 4. Have not within a three-year period preceding this Agreement, had one or more public transactions (federal, state, and local) terminated for cause or default. N. In addition to terminating this Agreement, in accordance with the provisions of Section I., above, County may exercise the following remedial actions County find and determine that Contractor has substantially failed to satisfy the scope of work 12 SS -23A Revised 6/2013 found in this Agreement, Exhibit A, the SS23B, and the Needs Based Care Addendum. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by the Contractor. These remedial actions include, but are not limited to, any one or more of the following: 1. Withhold payment to Contractor until the necessary services or corrections in performance are satisfactorily completed. 2. Deny payment or recover reimbursement for those services or deliverables which have not been performed and which due to circumstances caused by Contractor cannot be performed or if performed would be of no value to County. Denial of the amount of payment shall be reasonably related to the amount of work or deliverables lost to County. 3. Recover from Contractor any incorrect payment to Contractor due to omission, error, fraud, and/or defalcation by deducting from subsequent payments under this Agreement, or other agreements between County and Contractor, or as a debt to County, or otherwise as provided by law. O. It is expressly understood and agreed that the enforcement of the terms and conditions of this Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to the undersigned parties or their assignees, and nothing contained in this Agreement shall give or allow any claim or right of action whatsoever by any other person not included in this Agreement. It is the express intention of the undersigned parties that any entity other than the undersigned parties or their assignees receiving services or benefits under this Agreement shall be an incidental beneficiary only. P. No portion of this Agreement shall be deemed to constitute a waiver of any immunity the parties or their officers or employees may possess, nor shall any portion of this Agreement be deemed to have created a duty of care that did not previously exist with respect to any person not a party to this Agreement. The parties hereto acknowledge and agree that no part of this Agreement is intended to circumvent or replace such immunities. Q. Contractor shall promptly notify County in the event in which it is a party defendant or respondent in a case, which involves services provided under the agreement. The Contractor, within five (5) calendar days after being served with a summons, complaint, or other pleading which has been filed in any federal or state court or administrative agency, shall deliver copies of such document(s) to the County Director. The term "litigation" includes an assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or foreclosure. 13 SS -23A Revised 6/2013 WHEREFORE, the parties have herein set their hands and affixed their seals the day and date first written above. COUNTY: F' O 1/42 uty Cl ! to the Board Approval as to Substance: WELD COUNTY DEPARTMENT OF HUMAN SERVICES By: ty Director ture and D = to SS -23A Revised 6/2013 The Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services By: Ili• F. Garcia, Chairman 0CT 302013 CONTRACTOR: Whimspire CPA � X .540 E. Jewe 1t Ave. E;,lugud.—SpLings, CO 80915-275C° Derwy, CO e., sitolt 3 Director's (or designee's) Signature and Date 14 &P2.41 EXHIBIT "A" Additional Provisions for the Agreement to Purchase Out -of -Home Placement Services SS23A For the Purchase of Child Placement Agency Services The following additional provisions apply to the agreement entitled, "Agreement to Purchase Out -of -Home Placement Services SS23A, by and between the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Human Services," hereinafter referred to as, "County," and Whimspire CPA, hereinafter referred to as, "Contractor." 1. County and Contractor agree that a child specific Needs Based Care Assessment, designated as Exhibit B, shall be used to determine levels of care for each child placed with Contractor. 2. County agrees to purchase and Contractor agrees to provide the care and services, which are listed in this Agreement, based on the Needs Based Care Assessment levels determined. The specific rate of payment will be paid for each level of service, as indicated by the Needs Based Care Rate Table, designated as Exhibit C, for children placed within the CPA identified as Provider ID#19562. These services will be for children who have been deemed eligible for social services under the statutes, rules and regulations of the State of Colorado. 3. For Children's Habilitation Residential Program (CHRP) waiver eligible children, County agrees to pay the federal SSI rate to Contractor and all other service costs will be billable under the CHRP program. 4. All bed hold authorizations and payments are subject to a 3 day maximum for a child's temporary absence from a facility, including hospitalization. Bed hold requests must have prior written authorization from County's Department Administrator before payment will be release to provider. 5. A minimum of one polygraph test per Colorado fiscal year, if needed by the child, will be furnished by the Contractor under this contract for facilities that provide sex offender treatment. 6. Any additional costs for specialized services, which include, but are not limited to; polygraph tests, plethysmographs, and urinalysis screens, which are not provided within the negotiated provider rate, will need to be authorized, in writing by County, prior to the service being performed. Any payment for specialized services not authorized in writing will be denied. 7. Contractor agrees to have appropriate personnel available to attend or participate in family engagement or team decision making meetings. Contractor shall be notified by County staff of the dates and times attendance is requested. 8. Contractor agrees to cooperate with any vendors hired by County to shorten the duration of placement. 9. Contractor agrees to have physical examinations completed within 14 days and dental examinations completed within 8 weeks of the child being placed with Contractor. All documentation of these examinations shall be forward to County. 10. Contractor agrees to arrange a full evaluation of an Individualized Educational Plan (IEP) for youth designated as a Special Education Student every 3 years and coordinate reviews every year. If the IEP is due while the child is in placement, the Contractor shall complete or obtain a completed IEP. A copy will then be forwarded to the County. 11. Children in Psychiatric Residential Treatment Facilities, Residential Child Care Facilities and Child Placement Agencies are not eligible to receive clothing allowances as outlined in the Weld County Department of Social Services Policy and Procedure Manual. Exhibit "A" to the SS23A 1 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE ASSESSMENT ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE PAYMENT • For each question below, please select the response which most closely applies to this child. THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE: P 1. How often does the child require transportation by the foster care Contractor for the following: Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc., as outlined in the treatment plan? ❑Basic Maint.) Less than one round trip a week ❑2) 3-4 round trips a week. 03'A) 7 round trips or more Comments: ❑ 1) One round trip a week O1%) 2 round trips a week ❑2%) 5 round trips a week ❑3) 6 round trips a week P 2. How often is the foster care Contractor required to participate in child's therapy or counseling sessions? ❑ Basic Maint.) No participation required 02) Three times a month 03%) Three times a week or more Comments: _ 01) Once a month ❑1'/) Two times month ❑2%) Once a week ❑3) Two times a week P 3. How much time is the Contractor required to intervene at home and/or at school with the child in conjunction with a regular or special education plan? O Basic Maint.) No educational requirements 92) 1 hour a day ❑3%) More that 3 hours per day Comments: ❑l) Less than a'/z hour per day 011/2) 1/2 hour a day 02 %) 1'/2-2 hours per day 03) 2'h-3 hours per day P 4. How often does the child require special and extensive involvement by the Contractor in scheduling and monitoring of time and/or activities and/or crisis management? O Basic Maint.) No special involvement needed 01) Less than 5 hours per week 01%) 5 to 7 hours per week ❑2) 8 to 10 hours per week 02%) II to 14 hours per week O 3) Constant basis during awake hours 03%) Nighttime hours Comments: P 5. How much time is the Contractor required to assist the child because of impairments beyond age appropriate needs with feeding, bathing, grooming, physical, and/or occupational therapy? ❑ Basic Maint.) 0-2 hours per week ❑2) 8 to 10 hours per week 03%) 21 or more hours per week Comments: _ ❑1) 3 to 4 hours per week 01%) 5 to 7 hours per week ❑2'/:) II to 15 hours per week ❑3) 16 to 20 per week A I. How often is CPA/County case management required? (Does not include therapy) ❑Basic Maint.) Face-to-face contact one time per month with child and no crisis intervention. (i.e. mutual care placements.) 01) Face-to-face contact one time per month with child and minimal crisis intervention. 01%) Face-to-face contact one time per month with child and occasional crisis intervention. 02) Face-to-face contact two times per month with child and occasional crisis intervention. 02%) Face-to-face contact three times per month with child and occasional crisis intervention. 03) Face-to-face contact weekly with child and occasional crisis intervention. 03%) Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive coordination of multiple services. **Please Note: The Case Management level may be assessed on a combined basis if a sibling group, or more than one County foster child is with the same Contractor. T I. How often are therapy services needed to address child's individual needs per NBC assessment? ❑0) Not needed or provided by another source (i.e. Medicaid) 01) Less than 4 hours per month ❑2) 4-8 hours per month ❑3) 9-12 hours per month Exhibit "B" to the SS23A 2 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Rating of Conditions (Check one box for each category Assessment Areas None Mild Mild/ Moderate Moderate/ High High/ Continents: Moderate. High 21/2 Severe 0 1 11/2 2 3 31/2 Aggression/Cruelty to Animals ❑ ❑ ❑ ❑III II l Verbal or Physical Threatening ❑ ❑ ❑ ❑ ❑ ❑ ❑ Destructive of Property/Fire Setting ❑ ❑ ❑ ❑ ❑ ❑ ■ Stealing ❑ ❑ ❑ ❑ ❑ ❑ I Self -injurious Behavior ❑ ❑ ❑ ❑ ❑ ❑ in Substance Abuse ❑ ❑ ❑ ❑ ❑ ❑ ■ Presence of Psychiatric Symptoms/Conditions ❑ ❑ ❑ ❑ ❑ ■ ■ Enuresis/Encopresis ❑ ❑ ■ ■ ■ ■ is Runaway ❑ ❑ ❑ ❑ ■ ■ is Sexual Offenses O ❑•❑ ❑ • ■ Exhibit "B" to the SS23A 3 Revised 6/2013 EXHIBIT "B" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE BEHAVIOR ASSESSMENT CONTINUED Please rate the behavior/intensity of conditions which create the need for services that apply to this child. Inappropriate Sexual Behavior Disruptive Behavior Delinquent Behavior Depressive -like Behavior Medical Needs (If condition is rated "severe", please complete the Medically fragile NBC) Emancipation Eating Problems Boundary Issues Requires Night Care Education Involvement with Child's Family CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT: (check level of need) ❑ 0 ❑1 ❑ 1'h 2 ❑ 2%z ❑ 3 ❑ 3'h Exhibit "B" to the SS23A 4 Revised 6/2013 EXHIBIT "C" WELD COUNTY DEPARTMENT OF HUMAN SERVICES NEEDS BASED CARE RATE TABLE LEVEL • OF SERVICE RECOMMENDED PROVIDER RATE P1 - P5 - RECOMMENDED AGENCY RATE Al THERAPY RATE Ti MEDICAL NEEDS ADDENDUM . Level • dyE.G nil i._ Child Maintenance • ;:•xr. ,_ - - Administrative Maintenance (Case Management 8, Admin. Overhead) Administrative Services (Therapy/Misc. Services) Level '_; ; County Basic Maint. Age 0-10 $16.32/day Age 11-14...$18.05/day Age 15-21...$19.27/day + $.66/day Respite Care $11.84/day* No crisis intervention, Minimal CPA involvement, one face-to-face visit with child per month. $0.00 Not needed or provided by another source, i.e. mental health. 1 $19.73 4.66 Respite Care ($2Q.39/day) $15.13/day* Minimal crisis intervention as needed, one face-to-face visit per month with child, 2-3 contacts per month $4.93/day Regularly scheduled therapy, up to 4 hours/month. $2.99/day 1 1/2 $23.01 +$.66 Respite Care ($23.67/day) $16.77/day* '' L 'L�ry% 2 $26.30 +$.66 Respite Care ($26.96/day) $18.42/day* Occasional crisis intervention as needed. two face-to-face visits with child, 2-3 contacts per month $9.86/day Weekly scheduled therapy, 5-8 hours a month with 4 hours of group therapy. 1. s,14 $4.47/day _. di 2 1/2 $29.59 4.66 Respite Care ($30.25/day) $20.06/day" 3 $32.88 4.66 Respite Care ($33.54/day) $21 ,70/day* Ongoing crisis intervention as needed, weekly face-to-face visits with child, and intensive coordination of multiple services. $14.79/day Regularly scheduled weekly, multiple sessions, can include more than 1 person, i.e. family therapy, for 9-12 hours/monthly. $6.02/day E, • •k 31/2 $36.16 +$.66 Respite Care ($36.82/day) $23.35/day* 4 RCCF Step Down $39.45 4.66 Respite Care ($40.11/day) $24.99/day* Ongoing crisis intervention as needed, which includes high level of case management and CPA involvement with child and provider and 2-3 face-to-face contacts per week minimum. --------- ---------- •s Negotiated 4. Assess! Emergency Level Rate t= ki. $29.59 Respite +$.66 Respite Care ($30.25/day) $20.06/day* -- ---- — — -- '� Effective 7/01/08 * Includes an additional $6.91/day for Admin. Overhead Exhibit "C" to the SS23A 5 Revised 6/2013 Hello