HomeMy WebLinkAbout20130182.tiffMEMORANDUM
DATE: January 10, 2013
TO: �/ n/
FROM: Judy A. Griego, Director, Human Servic epart'iCent J
RE: Weld County Addendum to Purchase Out -of -Home
Placement Services for Child Placement Agency Services
between the Weld County Department of Human Services
and Ariel Child Placement Agency to be Placed on the
Consent Agenda
William F. Garcia, Chair, Weld County Board of Commissioners
Enclosed for Board approval is a Weld County Addendum to Purchase Out -of -Home Placement
Services for Child Placement Agency Services between the Department and Ariel Child Placement
Agency.
Below are the major provisions of the attached Agreement:
No.
Facility Name/Term
Type of Facility/Location
Daily Rate
1
Ariel Child Placement Agency (90205)
Child Placement Agency
$16.32 -
July 1, 2012 — June 30, 2013
Wheat Ridge, Colorado
$40.11
If you have any questions, give me a call at extension 6510.
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2013-0182
WELD COUNTY ADDENDUM
To that certain Agreement to Purchase Child Placement Agency Services
(the "Agreement") between Ariel Child Placement Agency and Weld County
Department of Human Services for the period from
July 1, 2012 through June 30, 2013.
The following provisions, made this / 5 day of idcw0.,6,- , 2012, are added to the referenced
Agreement. Except as modified hereby, all terms of the Agreement remain unchanged.
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. 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.
4. Section I, Paragraph 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 Department Administrator
before payment will be release to provider.
5. Section I, Paragraph 4. 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.
6. Add Paragraph 6 to Section I. 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.
7. Add Paragraph 7 to Section I. 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.
8. Add Paragraph 5 to Section II. Contact by the Contractor with the 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, the
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
Weld County SS -23A Addendum
authorization. During non -regular work hours, weekends and holidays, the Contractor
will contact the Emergency Duty Worker at the pager number (970) 304-2749.
9. Section III, Paragraph 5. Contractor additionally agrees to have appropriate personnel
available for staffing current placements with the Service Utilization Unit. Contractor
shall be notified by County staff of the date and time of the review.
10. Add Paragraph 15 to Section IV. Cooperate with any vendors hired by Weld County
Department of Social Services to shorten the duration of placement.
11. Add Paragraph 16 to Section IV. 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.
12. Add Paragraph 17 to Section IV. 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.
13. Add Paragraph 18 to Section IV. Assure and certify that it and its principals:
A. Are not presently debarred, suspended, proposed for debarment, and declared
ineligible or voluntarily excluded from covered transactions by a federal
department or agency.
B. 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;
C. 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.
D. 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.
14. Section V, Paragraph 5. 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.
15. Add Paragraph 7 to Section VI. 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
2 Weld County 55-23A Addendum
parties or their assignees receiving services or benefits under this Agreement shall be an
incidental beneficiary only.
16. Add Paragraph 8 to Section VI. No portion of this Agreement shall be deemed to
constitute a waiver of any immunity the parties or their officers or employees may
posses, 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.
17. Add Paragraph 9 to Section VI. The Director of Human Services or designee may
exercise the following remedial actions should s/he find the Contractor substantially
failed to satisfy the scope of work found in this Agreement. 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 are as follows:
A. Withhold payment to the Contractor until the necessary services or corrections in
performance are satisfactorily completed;
B. Deny payment or recover reimbursement for those services or deliverables which
have not been performed and which due to circumstances caused by the
Contractor cannot be performed or if performed would be of no value to the
Human Services. Denial of the amount of payment shall be reasonably related to
the amount of work or deliverables lost to Human Services;
C. Recover from the Contractor any incorrect payment to the Contractor due to
omission, error, fraud, and/or defalcation by deducting from subsequent payments
under this Agreement or other agreements between Social Services and the
Contractor, or by Human Services as a debt to Human Services or otherwise as
provided by law.
18. Add Paragraph 10 to Section VI. The contractor shall promptly notify Human Services
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 Human Services' Director. The term "litigation" includes an
assignment for the benefit of creditors, and filings in bankruptcy, reorganizations and/or
foreclosure.
19. Add Section VII - EXHIBITS:
3
Weld County SS -23A Addendum
(Exhibit B)
WELD COUNTY DRS
NEEDS BASED CARE ASSESSMENT
IDENTIFYING INFORMATION
CHILD'S NAME
WORKER COMPLETING ASSESSMENT
AGENCY NAME
PROVIDER NAME
STATE ID#
SEX 'TRAILS CASE ID jDOB
M F I I
jHHN jDATE OF ASSESSMENT
PROVIDER TRAILS ID
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 provider 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
❑I) One round trip a week ❑1'h) 2 round trips a week
021/2) 5 round trips a week 03) 6 round trips a week
P 2. How often is the foster care provider required to participate in child's therapy or counseling sessions?
❑ Basic Maint.) No participation required
❑2) Three times a month
❑ 3%) Three times a week or more
❑ 1) Once a month ❑1'/:) Two times month
02%) Once a week 03) Two times a week
P 3. How much time is the provider 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
❑ 1) Less than a '/2 hour per day ❑ 1%) '/z hour a day
02 '''A) 11/2-2 hours per day 03)21/2-3 hours per day
P 4. How often does the child require special and extensive involvement by the provider in scheduling and monitoring of time
and/or activities and/or crisis management?
❑ Basic Maint.) No special involvement needed ❑t) Less than 5 hours per week ❑1'/) 5 to 7 hours per week
❑2) 8 to 10 hours per week 02%) II to 14 hours per week
❑ 3) Constant basis during awake hours ❑3'/a) Nighttime hours
P 5. How much time is the provider required to assist the child because of impairments beyond age appropriate needs with feedin
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
❑2) 8 to 10 hours per week ❑2'/) 11 to 15 hours per week ❑3) 16 to 20 per week
❑ 3'/:) 21 or more hours 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.)
DI) Face-to-face contact one time per month with child and minimal crisis intervention.
❑1'/z) 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.
❑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 provider.
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)
02) 4-8 hours per month
4
DI) Less than 4 hours per month
❑3) 9-12 hours per month
Weld County SS -23A Addends
Aggression/Cruelty to
Animals
(Exhibit B)
WELD COUNTY DHS
NEEDS BASED CARE
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
tf#ng of Conditions
box for oath ca
Verbal or Physical
Threatening
❑ 0
Destructive of
Property/Fire Setting
Stealing
Self -injurious Behavior
Substance Abuse
Presence of Psychiatric
Symptoms/Conditions
Enuresis/Encopresis
Runaway
0
0
0
0
0 ❑
0 ❑
Sexual Offenses
5
Weld County SS -23A Addend
(Exhibit B)
WELD COUNTY DHS
NEEDS BASED CARE
BEHAVIOR ASSESSMENT CONTINUED
Please rate the behavior/intensity of conditions which create the need for services that appI' to this child.
..Sa:Yia?'S.S_ili
Inappropriate Sexual
Behavior
O ❑
Disruptive Behavior
Delinquent Behavior
O ❑
Depressive -like Behavior
O 0
Medical Needs
(If 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'/ ❑ 3 ❑ 31/2
6
Weld C unty SS -23A Addendu
(Exhibit C)
WELD COUNTY' DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
County
Basic
Maint.
1
1 112
2
2 1/2
Age 0-10...$16.32
($496)
Age 11-14...$18.05
($549)
Age 15-21...$19.27
($586)
+ $.66 Respite Care
($20)
$19.73
+$.66 Respite Care
($20.39 day/$620 mo)
$23.01
+$.66 Respite Care
($23.67 day/$720 mo)
$26.30
+$.66 Respite Care
($26.96 day/$820 mo)
Basic Maint $4.93 day/$150mo
No crisis intervention, Minimal CPA
involvement, one face-to-face visit
with child per month.
Level 1 $8.22 day/$250 mo
Minimal crisis intervention as needed,
one face-to-face visit per month with
child,
2-3 contacts per month
Level 1 1/2... $9.86 day/$300 mo
Level 2 $11.51 day/$350 mo
Occasional crisis intervention as needed,
two face-to-face visits with child,
2-3 contacts per month
$29.59
+$.66 Respite Care Level 2 1/2 $13.15 day/$400 mo
($30.25 day/$920 mo) ;..
LevelO $0
Therapy not needed or provided
by
another source, i.e. mental health.
Level 1 $4.93/$150 mo
Regularly scheduled therapy,
up to 4 hours/month.
Level 2 $9.86/$300 mo
Weekly scheduled therapy,
5-8 hours a month with 4 hours of
group therapy.
Level 0...$0
(None)
Level 1 ...$2.99
Level 2..$4.47
3
3 112
$32.88
+$.66 Respite Care
($33.54day/$1020 mo)
$36.16
+$.66 Respite Care
($36.82 day/$1,120 mo) -..
Level 3 $14.79 day/$450 mo
Ongoing crisis intervention as needed,
weekly face-to-face visits with child,
and intensive coordination of
multiple services.
Level 3 1/2 $16.44 day/$500 mo
Level 3 $14.79/$450 mo
Regularly scheduled weekly
multiple sessions, can include
more
than 1 person, i.e. family therapy,
for 9-12 hours/monthly.
Level 3..$6.02
4
TRCCF
Drop Down
Assess/
Emergency
Level
Rate
$39.45
+$.66 Respite Care
($40.11 day/$1220 mo)
Admin. Overhead Rate:
As of 7/01/08
$30.25 day/$920 mo
(Includes Respite)
Level 4 $18.08 day/$550 mo
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 •er week minimum.
$13.15 day/$400 mo
Level 4 $14.79/$450 mo
Regularly scheduled weekly
multiple sessions, can include
more
than 1 person, i.e. family therapy,
for 9-12 hours/monthly.
Level 4.... Neg.
$6.91 day/$210.00 month
7
Weld County SS -23A Addend,
IN WITNESS WHEREOF, the parties hereto have duly executed the Addendum as of the day,
month, and year first above written.
ATTEST: Weld County Clerk to the Board
By:
Depu r Clerk to the Bo
Approval as to Substance:
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
LL
natureY ) ate
WELD COUNTY BOARD OF
SOCIAL SERVICES, ON BEHALF
OF THE WELD COUNTY
DEPARTMENT OF HUMAN
SERVICES
By:
i
Chab: Signature
CONTRACTOR
Ariel Child Placement Agency
4660 Wadsworth Blvd
Wheat Ridge, CO 80033
By:
JAN 1 4 2013
ontractor's Signature/Date
8
Weld County SS -23A Addendum
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