HomeMy WebLinkAbout20130776.tiffRESOLUTION
RE: APPROVE CHILD PROTECTION AGREEMENT FOR SERVICES AND AUTHORIZE
CHAIR TO SIGN - NORTH COLORADO HEALTH ALLIANCE
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Child Protection Agreement for
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Human Services, and North
Colorado Health Alliance, commencing March 14, 2013, and ending December 31, 2013, with
further terms and conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Child Protection Agreement for Services between the County
of Weld, State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of the Department of Human Services, and North Colorado Health Alliance
be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 25th day of March, A.D., 2013, nunc pro tunc March 14, 2013.
BOARD OF COUNTY COMMISSIONERS
WEL0 ₹5, COLORADO
ATTEST: PA
Weld County Clerk to the Board
BY:
Deputy Clerk
APP' a ED A
Attorney
Date of signature ® 5 2013
William F. Garcia, Chair
Qptaa ,
Dougla4 Rademac r, Pro-Tem
4C' 0-5 L, \ic-
2013-0776
HR0084
MEMORANDUM
DATE: March 21, 2013
TO: William F. Garcia, Chair, Board of County Comn}issioners
FROM: Judy A. Griego, Director, Human
RE: Child Protection Agreement for Services between the
Weld County Department of Human Services and
North Colorado Health Alliance (NOCOHA)
Enclosed for Board approval is a Child Protection Agreement for Services between the
Department and North Colorado Health Alliance (NOCOHA). This Agreement was reviewed
under the Board's Pass -Around Memorandum dated January 23, 2012, and approved for
placement on the Board's Agenda.
The Agreement is necessary to meet the provisions of a court order that is case -specific and
requires nursing services during supervised visits with a medically fragile child. The major
provisions of this agreement are as follows:
No
Contractor/Term
Service Provided/
Funding Source
Rate
1
North Colorado Health Alliance
(NOCOHA)
March 14, 2013 — December 31, 2013
Nursing Services
CW Admin
$37.60/Hour (RN)
$40.46/Hour (Director of
Care Coordination -
Maximum of three (3)
hours for term of contract
unless otherwise approved
by the Department.)
If you have any questions, please give me a call at extension 6510.
2013-07710
PY-12-13-CPS -0131
CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN
THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AND NORTH COLORADO HEALTH ALLIANCE
This Agreement, made and entered into the day of Mach 2013, by and between the Board of
Weld County Commissioners, sitting as the Board of Human Services, on behalf of the Weld County Department of
Human Services, hereinafter referred to as the "Department" and North Colorado Health Alliance, hereinafter
referred to as the "Contractor".
WITNESSETH
WHEREAS, required approval, clearance, and coordination have been accomplished from and with
appropriate agencies; and
WHEREAS, the Colorado Department of Human Service has provided Child Welfare Adminstration to the
Department for Nursing Supervision and Education Services; and
NOW THEREFORE, in consideration of the premises, the parties hereto covenant and agree as follows:
1. Term
This Agreement shall become effective on March 14, 2013 upon proper execution of this Agreement and
shall expire December 31, 2013 unless sooner terminated as provided herein.
2. Scope of Services
Services shall be provided by the CONTRACTOR to any person(s) eligible for child protection services in
compliance with Exhibit A "Scope of Services," of which are attached hereto and incorporated herein by
reference
3. Referrals/Billing/Tracking
CONTRACTOR understands and will comply with all aspects of the referral authorization, billing and
tracking requirements as outlined in Exhibit D "Process Reference Guide", of which are attached hereto
and incorporated herein by reference.
4. Payment
Payment shall be made on the basis of Exhibit B "Payment Schedule," of which are attached hereto and
incorporated herein by reference.
"Payment Schedule" shall establish the maximum reimbursement which will be paid from
Child Welfare Administration funding during the duration of this Agreement.
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a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with criteria
established by the Department. CONTRACTOR shall submit all itemized monthly billings to the
Department by the 7th day of the month following the month the cost was incurred. Failure to submit
by the aforementioned deadline may result in forfeiture of payment.
b. Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof.
c. The Department shall not be billed for, and reimbursement shall not be made for time involved in
activities outside of those defined in Exhibit A and authorized by the Department. Work performed
prior to the execution of this Agreement and prior to an authorized referral shall not be reimbursed
or considered part of this Agreement.
S. Financial Management
At all times from the effective date of Agreement until completion of this Agreement, CONTRACTOR shall
comply with the administrative requirements, cost principles and other requirements set forth in the
Financial Management Manual adopted by the State of Colorado. The required annual audit of all funds
expended under this Agreement must confirm to the Single Audit Act of 1984 and OMB Circular A-133.
6. Payment Method
Unless otherwise provided in Exhibit A and Exhibit B:
a. CONTRACTOR shall provide proper monthly invoices and itemization of services preformed for costs
incurred in the performance of this Agreement.
b. The Department may withhold any payment if CONTRACTOR has failed to comply with the Financial
Management Requirements, program objectives, contractual terms, or reporting requirements. In
the vent of forfeiture of reimbursement, CONTRACTOR may appeal such circumstance to the Director
of Human Services. The decision of the Director of Human Services shall be final.
7. Compliance with Applicable Laws
CONTRACTOR shall abide by all applicable laws and regulations, including, but not limited to the following:
a. Compliance with Applicable Laws
At all times during the performance of this Agreement, CONTRACTOR shall strictly adhere to all
applicable Federal and State laws, orders, and all applicable standards, regulations, interpretations or
guidelines issued pursuant thereto. This includes the protection of the confidentiality of all
applicant/recipient records, papers, documents, tapes and any other materials have been or may
hereafter be established which relate to the Agreement. CONTRACTOR acknowledges that the
following laws are included:
• Title VI of the Civil Rights Act of 1964, 42 U.S.C. Sections 2000d-1 et. seq. and its implementing
regulation, 45 C.F.R. Part 80 et. seq.• and
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• All provisions of Civil Rights Act of 1986 so that no person shall, on the grounds of race, creed,
color, se, or national origin, be excluded from participation in, be denied the benefits of, or be
otherwise subjected to discrimination under the is approved Agreement.
• Section 504 of the Rehabilitation Act of 1973, 29 U.S.C. Section 794, and its implementing
regulations, 45 C.F.R. Part 84; and
• the Age Discrimination Act of 1975, 42 U.S.C. Sections 6101 et. seq. and its implementation
regulations, 45 C.F.R. Part 91; and
• Title VII of the Civil Rights Act of 1964; and
• the Age Discrimination in Employment Act of 1967; and
• the Equal Pay Act of 1963; and
• the Education Amendments of 1972; and
• Immigration Reform and Control Act of 1986, P.L. 99-603
• 42 C.F.R. Part 2; and all regulations applicable to these laws prohibiting discrimination because of
race, color, National origin, and sex, religion and handicap, including Acquire Immune Deficiency
Syndrome(AIDS) or AIDS related conditions covered under Section 504 of the Rehabilitation Act
of 1973, as amended, cited above. If necessary, CONTRACTOR and Department will resist in
judicial proceedings any efforts to obtain access to client records except as permitted by 42
C.F.R. Part 2. 45 C.F.R. Part 74, Appendix G 9, which requires that affirmative steps be taken to
assure that small and minority businesses are utilized, when possible, as sources of supplies,
equipment, construction and services. This assurance is given in consideration of and for the
purpose of obtaining any and all Federal and/or State financial assistance.
• Colorado Revised Statute (C.R.S.) 26-6-104, requiring criminal background record checks for all
employees, CONTRACTORS, and sub -contractors.
CONTRACTOR is further charged with the knowledge that any person who feels that s/he has
been discriminated against has the right to file a complaint either with the Colorado Department
of Human Services or with the U.S. Department of Health and Human Services, Office for Civil
Rights.
b. CONTRACTOR assures that it will fully comply with all other applicable federal and state laws which
may govern the ability of the Department to comply with the relevant funding requirements.
CONTRACTOR understands that the source of funds to be used under this Agreement is
Child Welfare Adminstration funds.
c. CONTRACTOR assures and certifies that it and its principals:
i. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transaction by a federal department or agency.
ii. Have not, within a three-year period preceding this Agreement, been convicted of or
had a civil judgment rendered against them for commission of fraud or a criminal
offense in connection with obtaining, attempting to obtain, or performing a public
(federal, state or local) transaction or contract under a public transaction; violation of
federal or state antitrust statues or commission of embezzlement, theft, forgery,
bribery, falsification or destruction of records, making false statements, or receiving
stolen property;
Hi. Are not presently indicted for other otherwise criminally or civilly charged by a
government entity (federal, state, or local) with commission of any of the offenses
enumerated in paragraph 12 of this certification; and
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iv. 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.
d. CONTRACTOR certifies that it shall comply with the provisions of Colorado Revised Statutes
(C.R.S.) 8-17.5-101, et. seq. CONTRACTOR shall not knowingly employ or contract with an illegal
alien to perform work under this Agreement or enter in to a contract with a subcontractor that
fails to certify to the CONTRACTOR that the subcontractor shall not knowingly employ or contract
with an illegal alien to perform work under this Agreement. CONTRACTOR represents, warrants,
and agrees that is (a) has verified that it does not employ any illegal aliens, through participation
in the Basic Pilot Employment Verification Program administered by the Social Security
Administration and Department of Homeland Security, and (b) otherwise will comply with the
requirements of C.R.S. 8-17.5-102(2)(b). CONTRACTOR shall comply with all reasonable requests
made in the course of an investigation under C.R.S. 8-17.5-102 by the Colorado Department of
Labor and Employment. If CONTRACTOR fails to comply with any requirements of this provision
or C.R.S. 8-17.5-101, et. seq., the Department may terminate this Agreement for breach and
CONTRACTOR shall be liable for actual and consequential damages to the Department.
Except where exempted by federal law and except as provided in C.R.S. 24-76.5-103(3), if
CONTRACTOR receives federal or state funds under this Agreement, CONTRACTOR must confirm
that any individual natural person eighteen (18) years of age or older is lawfully present in the
United States pursuant to C.R.S. 24-76.5-103(4) if such individual applies for public benefits
provided under this Agreement. If CONTRACTOR operates as a sole proprietor, it hereby sears or
affirms under penalty of perjury that is (a) is a citizen of the United State or is otherwise lawfully
present in the United States pursuant to federal law, (b) shall produce one of the forms of
identification required by C.R.S. 24-76.5-101, et seq., and (c) shall produce one of the forms of
identification required by C.R.S. 24-76.5-103 prior to the effective date of this Agreement.
8. Compliance with Child and Family Services Review
The Child and Family Services Review (CFSR) examines child welfare service outcomes in three areas;
Safety, Permanency and Well Being of families. For each outcome, data and performance indicators
measure each state's performance according to national standards and monitor progress over time.
Following the review, a Program Improvement Plan (PIP) will be implemented for the state to enhance
services to families.
Any CONTRACTOR providing services under this Agreement to families and children referred by the
Department will continually strive for positive outcomes in the areas of Safety, Permanency and Well
Being. Any CONTRACTOR providing services in the program area(s) identified by the Department is
required to comply with the standard assessment and reporting system set forth in Exhibit C which will
address the aforementioned three areas, unless otherwise determined by the Department.
9. Insurance
Weld County, the Board of County Commissioners of Weld County, its officers and employees, shall not be
held liable for injuries or damages caused by any negligent acts or omissions of CONTRACTOR, its
subcontractor, or their employees, volunteers, or agents while performing duties described in this
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Agreement. CONTRACTOR shall indemnify, defend, and hold harmless Weld County, the Board of County
Commissioners of Weld County, its employees, volunteers and agents.
Therefore, CONTRACTOR shall provide adequate liability (including professional liability insurances where
necessary) and worker's compensation insurances for all its employees, volunteer, and agents engaged in
the performance of the Agreement. Upon request, CONTRACTOR shall provide the Department with the
acceptable evidence that such coverage is in effect.
At a minimum, CONTRACTOR, shall procure, either personally or through its employer as applicable to the
CONTRACTOR'S business, at its own expense, and maintain for the duration of the work, the following
insurance coverage. Weld County, Colorado, by and through the Board of County Commissioners of Weld
County, its employees and agents, shall be named as additional named insured on the insurance, where
permissible by the insurance CONTRACTOR.
• Standard Workman's Compensation and Employer's Liability.
o As required by State statute including occupational disease, covering all employees at
work site.
• General Liability (PL and PD) (Minimum).
o Combined single limit - $500,000.00 written on an occurrence basis.
o Any aggregate limit will not be less than $1 million ($1,000,000.00).
o CONTRACTOR must purchase additional insurance if claims reduce the annual aggregate
below $500,000.00
o State of Colorado to be named as additional insured on each comprehensive general
liability policy.
o Certificate of Insurance to be provided to Weld County.
o Insurance shall include provision preventing cancellation without 60 days prior notice by
certified mail to Weld County.
• Automobile Liability (Minimum) for any CONTRACTOR transporting children or any party to
whom Department services are being provided.
Additional coverage may be required in specific program areas. For any insurances that are
required by this Agreement, a completed Standard Certificate of Insurance shall be provided to
the Department by the Contractor prior to the start of any Agreement.
10. Certification
CONTRACTOR certifies that, at the time of entering into this Agreement, it has currently in effect all
necessary licenses, approvals, insurance, etc., required to properly provide the services and/or supplies
covered by this Agreement. Copies of all necessary licenses shall be provided to the Department by the
Contractor prior to the start of any Agreement.
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11. Training
CONTRACTOR may be required to attend training at the request of the Department specific to services
provided under this Agreement. The Department will not compensate CONTRACTOR for said training in
the form of registration fees, time spent traveling to and from training, attending the training or any other
associated costs unless otherwise agreed to by the Department.
12. Subpoenas
CONTRACTOR will, on behalf of its employees and/or officers, accept any subpoena for testimony from
the Weld County Attorney's Office by facsimile and will return a waiver of service within 72 business
hours. If the Contractor receives a subpoena via facsimile but will only accept personal service, the
Contractor will contact the Weld County Attorney's Office immediately at 970-353-5215, x6503, and
advise that the subpoena must be personally served.
13. Monitoring and Evaluation
CONTRACTOR and the Department agree that monitoring and evaluation of the performance of this
Agreement shall be conducted by the Contractor and the Department. The results of the monitoring and
evaluation shall be provided to the Board of Weld County Commissioners, the Department and the
Contractor.
CONTRACTOR shall permit the Department, and any other duly authorized agent or governmental agency,
to monitor all activities conducted by Contractor pursuant to the terms of this Agreement. As the
monitoring agency may in its sole discretion deem necessary or appropriate, such program data, special
analyses, on -site checking, formal audit examinations, or any other reasonable procedures. All such
monitoring shall be performed in a manner that will not unduly interfere with work conducted under this
Agreement.
14. Modification of Agreement
All modifications to this Agreement shall be in writing and signed by both parties.
15. Remedies
The Director of Human Services or designee may exercise the following remedial actions should s/he find
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
Contractor. These remedial actions are as follows:
a. Withhold payment to Contractor until the necessary services or corrections in performance are
satisfactorily completed.
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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 Department. Denial of the amount of payment shall be
reasonably related to the amount of work or deliverables lost to the Department.
c. Incorrect payment to Contractor due to omission, error, fraud, and/or defalcation shall be recovered
from Contractor by deduction from subsequent payments under this Agreement or other agreements
between the Department and Contractor, or by the Department as a debt due to the Department or
otherwise as provided by law.
16. Representatives
For the purpose of this Agreement, the individuals identified below are hereby designated representatives
of the respective parties. Either party may from time to time designate in writing a new or substitute
representative(s):
For the Department:
Heather Walker
Name
For Contractor:
17. Notice
Administrator
Title
Vincent D. Atchity, Ph.D. Chief Operating Officer
Name Title
All notices required to be given by the parties hereunder shall be given by certified or registered mail to
the individuals at the addresses set forth below. Either party may from time to time designate in writing a
substitute person(s) or address to whom such notices shall be sent.
For Department:
Judy A. Griego, Director
P.O. Box A
Greeley. CO 80632
1970)352-1551
18. Litigation
For Contractor:
Vincent D. Atchitv, Chief Operating officer
293011`h Avenue
Evans, CO 80620
1303) 898-3405
CONTRACTOR shall promptly notify the Department in the event that Contractor learns of any actual
litigation in which it is a party defendant in a case that involves services provided under this Agreement.
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 Director of Human Services. The term "litigation" includes an assignment for the
benefit of creditors, and filings of bankruptcy, reorganization and/or foreclosure.
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19. Termination
This Agreement may be terminated at any time by either party giving thirty (30) days written notice to the
individuals identified in paragraph 18. No portion of this Agreement shall be deemed to create an
obligation on the part of the County of Weld, State of Colorado, to expend funds not otherwise
appropriated in each succeeding year, as this Agreement is subject to the availability of funding.
Therefore, the Department may terminate this Agreement at any time if the source of funding for the
services made available to the CONTRACTOR is not longer available to the Department. CONTRACTOR
reserves the right to suspend services to clients if funding is no longer available.
20. No Third Party Beneficiary Enforcement
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 and nothing 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 receiving services or benefits
under this Agreement shall be an incidental beneficiary only.
21. Governmental Immunity
No term or condition of this contract shall be construed or interpreted as a waiver, express or implied, of
any of the immunities, rights, benefits, protections or other provisions, of the Colorado Governmental
immunity Act §§24-10-101 et seq., as applicable now or hereafter amended.
22. Partial Invalidity of Agreement
If any section, subsection, paragraph, sentence, clause, or phrase of this Agreement is for any reason held
or decided to be unconstitutional, such decision shall not affect the validity of the remaining portions.
The parties hereto declare that they would have entered into this Agreement and each and every section,
subsection, paragraph, sentence, clause, and phrase thereof irrespective of the fact that any one or more
sections, subsections, paragraphs, sentences, clauses, or phrases might be declared to be unconstitutional
or invalid.
23. Improprieties
No officer, member or employee of Weld County and no member of their governing bodies shall have any
pecuniary interest, direct or indirect, in the approved Agreement or the proceeds thereof.
The Appearance of Conflict of Interest applies to the relationship of a CONTRACTOR with the Department
when the CONTRACTOR also maintains a relationship with a third party and the two relationships are in
opposition. In order to create the appearance of a conflict of interest, it is not necessary for the
CONTRACTOR to gain from knowledge of these opposing interests. It is only necessary that the
CONTRACTOR know that the two relationships are in opposition. During the term of the Agreement,
CONTRACTOR shall not enter any third party relationship that gives the appearance of creating a conflict of
interest. Upon learning of an existing appearance of a conflict of interest situation, CONTRACTOR shall
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submit to the Department, a full disclosure statement setting forth the details that create the appearance
of a conflict of interest. Failure to promptly submit a disclosure statement required by this paragraph shall
constitute grounds for the Department's termination, for cause, of its Agreement with CONTRACTOR.
CONTRACTOR certifies that federal appropriated funds have not been paid or will be paid, by or on behalf
of CONTRACTOR, to any person for influencing or attempting to influence an officer or employee of an
agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of
Congress in connection with the awarding of any Federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative agreement, and the extension,
continuation, renewal, amendment, or modification of any Federal contract, loan, grant, or cooperative
agreement.
24. Storage, Availability and Retention of Records
CONTRACTOR agrees that authorized local, federal, and state auditors and representatives shall, during
business hours, have access to inspect and copy records, and shall be allowed to monitor and review
through on -site visits, all activities related to this Agreement, supported with funds under this Agreement
to ensure compliance with the terms of this Agreement. Contracting parties agree that monitoring and
evaluation of the performance of the Agreement shall be conducted by appropriate funding sources. The
results of the monitoring and evaluation activities shall be provided to the appropriate and interested
parties.
All such records, documents, communications, and other materials created pursuant or related to this
Agreement shall be maintained by CONTRACTOR, in a central location and shall be made available to
Human Services upon its request, for a period of seven (7) years from the date of final payment under this
Agreement, or for such further period as may be necessary to resolve any matters which may be pending,
or until an audit has been completed with the following qualifications: If an audit by or on behalf of the
federal and/or state government has begun but is not completed at the end of the seven (7) year period, or
if audit findings have not been resolved after a seven (7) period, the materials shall be retained until the
resolution of the audit finding.
25. Confidentiality of Records
CONTRACTOR shall protect the confidentiality of all applicant records and other materials that are
maintained in accordance with this Agreement Except for purposes directly connected with the
administration of Child Protection, no information about or obtained from any applicant/recipient in
possession of CONTRACTOR shall be disclosed in a form identifiable with the applicant/recipient or a
minor's parent or guardian unless in accordance with CONTRACTOR's written policy governing access to,
duplication and dissemination of, all such information. CONTRACTOR shall advise its employees, agents,
and sub -contractor, if any, that they are subject to these confidentiality requirements. CONTRACTOR
shall provide its employees, agents, and sub -contractors, if any, with a copy or written explanation of
these confidentiality requirements before access to confidential data is permitted. CONTRACTOR shall
have its employees, agents, and subcontractors, if any, sign a written confidentiality agreement and shall
provide a copy of such agreement to the Department, if requested.
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26. Proprietary Information
Proprietary information for the purposes of this Agreement is information relating to a party's research,
development, trade secrets, business affairs, internal operations and management procedures and those
of its customers, clients or affiliates, but does not include information (1) lawfully obtained from third
parties, (2) that which is in the public domain, or (3) that which is developed independently. Neither
party shall use or disclose directly or indirectly without prior written authorization any proprietary
information concerning the other party obtained as a result of this Agreement. Any proprietary
information removed from the Department's site by CONTRACTOR in the course of providing services
under this Agreement will be accorded at least the same precautions as are employed by CONTRACTOR
for similar information in the course of its own business.
27. Independence of CONTRACTOR: Not Employee of Weld County
CONTRACTOR agrees it is an independent contractor and that its officers and employees do not become
employees of Weld County, nor are they entitled to any employee benefits as Weld County employees, as
the result of the execution of this Agreement.
28. Entire Agreement
This Agreement, together with all attachments hereto, constitutes the entire understanding between the
parties with respect to the subject matter hereof, and may not be changed or modified except as stated in
Paragraph 14 herein. This Agreement shall be binding upon the parties hereto, their successors, heirs,
legal representatives, and assigns. CONTRACTOR or the Department may not assign any of its rights or
obligations hereunder without the prior consent of both parties.
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IN WITNESS WHEREOF, the parties hereto have duly executed the Agreement as of the day, month, and
year first above written.
ATTEST:
Weld County Clerk to the Board
AP
Cs d my Attorney
WELD COUNTY DEPARTMENT
OF HUMAN SERVICES
By:
11
BOARD OF COUNTY COMMISSIONERS
WEL COUN "+COLORADO
iam F. Garcia, Chair
CONTRACTOR:
By:
MAR 252013
Mark Wallace, M.D.
Chief Executive Officer
026,/3 -O771n
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EXHIBIT A
SCOPE OF SERVICES
1. CONTRACTOR will employee a Registered Nurse, hereinafter referred to as the "R.N.", to provide nursing
supervision and education services as requested by the Department for C.M., a medically fragile child in
the Department's custody.
2. In preparation for services, the R.N. will participate in up to six (6) hours of training that will include the
foster parent, the biological parent and the CONTRACTOR'S Director of Care Coordination. The Director
of Care Coordination will participate as appropriate up to a maximum of three (3) hours. The purpose of
the training is to verify and document care orders, educate the R.N. on all aspects of C.M's care, review
the significant patient history, and ensure that adequate and appropriate care will be provided at all
times for the duration of services.
3. CONTRACTOR will ensure the R.N. maintains current and adequate licensure for the duration of the
agreement.
4. CONTRACTOR will ensure the R.N. is adequately covered under the insurance requirements of the
agreement and that said insurance is maintained for the duration of the agreement.
5. The R.N. will provide services in the paternal family home or at the Department's Parenting Education
Center (PEC), located at 710 11th Avenue, Suite 202, Greeley, CO 80631, as deemed appropriate by the
Department and will be flexible regarding the location.
6. C.M. will be transported by the foster parents to and from all service episodes. No other party, including
but not limited to, the CONTRACTOR and the R.N., are authorized to transport C.M., unless otherwise
approved by the Department.
7. Services will be provided on weekend days, for approximately three (3) hours, per the schedule set forth
by the Department. The Department, the CONTRACTOR, and the R.N. will maintain flexibility in
scheduling and length of visits to allow for illness, unexpected circumstances and the needs of C.M.
8. Services will include appropriate demonstration of basic daily care and skills to M.M., father of C.M., for
the purpose of furthering his knowledge and skills. M.M. is prohibited from providing any specialized
care or intervention that requires specialized training, until he can obtain the required training and has
the approval of the Department.
9. The CONTRACTOR will ensure the R.N. has all necessary items to meet the medical and general care
needs of C.M. These items include, but are not limited to, the following:
a. Oxygen (Required at all times.)
b. Adequate Clothing (Required for body temperature regulation.)
c. Medications
d. Therapy Aids
10. The CONTRACTOR will ensure the R.N. regularly inspects medical supplies used during the provision of
services to ensure they are in good working condition. Any equipment or supply needs will be
communicated promptly to the foster parents and the Department.
11. The CONTRACTOR will ensure the R.N. maintains C.M. in direct line of sight and sound at all times.
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12. The CONTRACTOR will ensure the R.N. promptly and appropriately responds to, and treats, any medical
issues that arise during the time services are provided.
13. The CONTRACTOR will ensure the R.N. has an appropriate and adequate plan for responding to any
medical emergency. This will include access at all times to a working phone for purposes of contacting
emergency medical personnel (911).
14. The CONTRACTOR will ensure the R.N. promptly reports to the foster parent(s) at the conclusion of each
episode of services regarding the following:
a. Any and all medical interventions required.
b. Any and all medications administered.
c. Disposition of C.M. during the interaction.
d. C.M.'s level of tolerance for the duration/length of interaction.
15. The CONTRACTOR will ensure the R.N. continually assesses parents regarding their capacity to
appropriately care for C.M.
16. The CONTRACTOR will ensure the R.N. documents in detail any and all observed or verbalized concerns
regarding C.M. Areas of concern may include, but are not limited to, any physical, emotional, educational
or behavioral issues. Areas of concern should be reported immediately.
17. Successful provision of these services will be demonstrated through the following:
a. Caseworker documentation will indicate consistent and regular communication with the R.N.
regarding the provision of services.
b. Caseworker will have current information regarding equipment and medications required for C.M. at
all times.
c. The Department will have access to all information regarding the services in order to appropriately
manage the case.
d. C.M.'s safety will be maintained at all times, and all medical needs will be addressed promptly and
adequately.
e. There will be no reports of inadequate or faulty equipment and/or supplies.
f. There will be no reports that C.M. was not within the direct line of sight and sound of L.B.
g. There will be no reports of inability to access emergency medical services (911) when necessary.
h. All parties will report a positive exchange of information regarding C.M.'s needs and care at all times.
i. Caseworker documentation will reflect accurate and detailed information regarding necessary
interventions within 24 hours of any service episode.
j. Reports from the R.N. and M.M. will indicate that M.M. is receiving appropriate and adequate
education and skills training in the care of C.M.
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EXHIBIT B
PAYMENT SCHEDULE
1. Funding and Method of Payment
The Department agrees to reimburse Contractor in consideration for the work and services
performed under this Agreement at the rate specified in Paragraph 2, below. The total amount to be
paid to Contractor during the term of this Agreement shall be reported by the Department in Trails
after May 31, 2013.
Expenses incurred by Contractor prior to the term of this agreement are not eligible Department
expenditures and shall not be reimbursed by the Department.
Payment pursuant to this Agreement, whether in whole or in part, is subject to and contingent upon
the continuing availability of said funds for the purposes hereof. In the event that said funds, or any
part thereof, become unavailable as determined by the Department, the Department may
immediately terminate the Agreement or amend it accordingly.
2. Fees for Services
$37.60/Hour (Registered Nurse - Includes up to six (6) hours of training.)
$40.46/Hour (Director of Care Coordination - Maximum of three (3) hours for term of contract unless
otherwise approved by the Department.)
CONTRACTOR may not attempt to collect co -pays and/or fees for services for which a Department
client is responsible, but which a particular client refuses or fails to pay.
CONTRACTOR will collect any applicable sliding scale co -pays and credit the Department for any
payment received on the monthly billing.
3. Submittal of Vouchers
CONTRACTOR shall prepare and submit monthly itemized voucher and certify that services
authorized were provide on the date(s) indicated and the charges made were pursuant to the terms
and conditions of Exhibit A and Exhibit D.
CONTRACTOR shall submit all itemized monthly billings to the Department by the 7th day of the
month following the month the cost was incurred. Failure to submit by the aforementioned deadline
may result in forfeiture of payment.
a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and
services provided pursuant to Exhibit A and Exhibit D of this Agreement in accordance with
criteria established by the Department.
b. For Monitored Sobriety services, proof of services rendered shall be a sign -in sheet with client
signatures or the test result.
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PY-12-13-CPS -0131
EXHIBIT C
CHILD and FAMILY SERVICES REVIEWS (CFSR)
The Child and Family Services Reviews (CFSR) examines child welfare service outcomes in three areas; Safety,
Permanency and Well Being of families. For each outcome, data and performance indicators measure each state's
performance according to national standards and monitors progress over time. Following the review, a
Performance Improvement Program (PIP) will be implemented for the state to enhance services to families.
Additionally, the review will assess statewide, systemic factors to determine if the systems necessary to achieve
positive outcomes for families are in place.
All agencies that contract to provide service to families and children in Weld County must continually strive for
positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued
progress in this area, the Department is requiring CONTRACTORS to comply with a standard assessment and
reporting system which will address these three areas.*
The Department is requesting that CONTRACTOR reports include observations and recommendations regarding
clients in a way that specifically addresses the areas of safety, permanency and well-being. Below are the specific
outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being, followed by specific
considerations and tasks which must be addressed by the Department contracted CONTRACTORs.
Safety Outcomes
CFSR Outcome Measures
Safety 1 Children are, first and foremost, protected from abuse and neglect.
Safety 2 Children are safely maintained in their homes whenever possible and appropriate.
Considerations for the Department's CONTRACTORs
• CONTRACTORs should always consider the following definitions regarding child safety when assessing
families.
o Children are considered safe when there are no present dangers or impending danger threats, or
the caregivers' protective capacities control existing threats.
o Children are considered unsafe when they are vulnerable to present or impending danger
threats, and caregivers are unable or unwilling to provide protection.
o Risk is the likelihood (chance, potential, prospect) for parenting behavior that is harmful and
destructive to a child's cognitive, social, emotional and/or physical development, and those with
parenting responsibility are unwilling or unable to behave differently.
• Monthly reports should continually document an assessment of risk and safety concerns and the
interventions that are being offered by the CONTRACTOR to ameliorate those concerns.
• Monthly reports should make recommendations regarding services and/or safety measures that the
CONTRACTOR believes should be implemented to insure safety of the child(ren).
• CONTRACTORs must specifically document efforts to engage families in services and to control for safety.
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PY-12-13-CPS -0131
Permanency Outcomes
CFSR Outcome Measures
Permanency 1 Children have permanency and stability in their living situations.
Permanency 2 The continuity of family relationships and connections is preserved for children.
Considerations for the Department's CONTRACTORs:
• CONTRACTOR reports should always note the primary permanency goal for the child and document how
interventions are working toward achieving that goal.
• CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make
specific recommendations regarding how the continuation of the service may assist in achieving the goal.
• CONTRACTORs should continually provide recommendations about whether any out -of -home placement
continues to be appropriate and should make recommendations regarding when changes in this area
should be made, in the CONTRACTORs' opinion.
• CONTRACTORs should continually assess family relationships (parent/child, sibling/sibling, extended
family/child, etc.) and should report any concerning relationship issues which may be a barrier to
achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or
make recommendations regarding additional services that may be required to address relationship issues.
• CONTRACTORs must document specific time frames when recommending ongoing services and/or
recommending changes to services and/or placements.
Child and Family Well -Being Outcomes
CFSR Outcome Measures
Well Being 1 Families have enhanced capacity to provide for their children's needs.
Well Being 2 Children receive appropriate services to meet their educational needs.
Well Being 3 Children receive adequate services to meet their physical and mental health needs.
Considerations for the Department's CONTRACTORS:
• CONTRACTORs must engage in ongoing assessments of the parents' capacity to appropriately care for
their children and whether or not the service being provided continues to be appropriate. This must be
clearly documented in monthly reports.
• CONTRACTORs should specifically detail areas of continued concern within the family and make
recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports
should also document what barriers may be impeding progress.
• CONTRACTORs should document any and all observed concerns regarding any child with whom the
CONTRACTOR is working. This should include concerns regarding physical, emotional, educational and
behavioral well-being of the child. When appropriate, CONTRACTORs should make recommendations
regarding evaluations and/or additional services that may address these concerns.
*Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the
Department's families unless otherwise noted.
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PY-12-13-CPS -0131
EXHIBIT D
PROCESS REFERENCE GUIDE FOR CONTRACTORS
Contracted Services
Referral/Tracking/Billing Procedures
The following procedures apply to all CONTRACTORs regardless of the service being provided, unless
otherwise directed by the Department. Failure to comply with these procedures may result in delay
of payment or denial of billed charges.
Referral:
1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and
Contracted Services Coordinator or Service Utilization Assistant.
2) Once received, carefully review the referral for service information, client contact
information and specific information regarding the start and end date of the referral.
a. Services provided prior to the start date or after the end date of an authorized referral
will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized
referral.
b. A verbal or written authorization from a caseworker or supervisor does not constitute
an authorized referral. If contacted by a caseworker or supervisor to start a service
please contact the Core and Contracted Services Coordinator for a referral.
3) Referrals for ongoing services (visitation, therapy, home -based, etc.) are reviewed by the
Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs
are asked to provide input regarding client status/progress. You will be notified in advance
via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone
if more convenient.
4) Any and all modifications to an authorized referral can only be approved by the Core and
Contracted Services Coordinator, the Service Utilization Manager or the Utilization Review
Team. A verbal or written authorization from a caseworker or supervisor does not
constitute authorization to modify a referral. If contacted by a caseworker or supervisor to
modify a referral please contact one of the abovementioned parties for proper
authorization.
Tracking:
1) Each client receiving face-to-face services must sign a Client Verification Form at the time of
service regardless of the service being provided unless otherwise directed by the
Department.
2) If multiple clients are receiving services together (ex. Family therapy), each member should
sign the same form at the time of service.
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PY-12-13-CPS -0131
3) If the client receives services over multiple dates, then the client must sign at the time of
service for each date (appointment).
4) If a child is receiving services and is unable to sign, then an appropriate person should sign
for the child and indicate their relationship to the child (ex. Jane Smith, foster mom, for
Jimmy Jones).
5) The Client Verification Form should track services for one calendar month only, should not
cross months, and must be submitted with that month's billing.
Billing:
1) All billing must be submitted by the 7th of the month following the month of service in order
to be processed for payment that month. Billing received after the 7th of the month may
result in forfeiture of payment as noted in the Agreement.
2) All payments are contingent upon receiving a complete and accurate billing. A complete
billing should include a 1) monthly progress report submitted online (if applicable to the
service provided), 2) the billing documents (Authorization for Contractual Services with
original signature and Request for Reimbursement), and 3) Client Verification Form(s) with
original signatures. A CONTRACTOR also may include their own invoice or other documents
they feel are applicable.
a. Monthly progress reports will be distributed to the appropriate caseworker once the
billing is processed.
b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the
Authorization for Contractual Services or Client Verification Form WILL NOT be
accepted.
3) All billings should be submitted to:
Tobi Vegter
Core and Contracted Services Coordinator
WCDHS/Service Utilization Unit
Mailing Address: P.O. Box A, Greeley, CO 80632
Physical Address: 315 A North 11th Avenue, Greeley, CO 80631
4) Final remittance will be provided by the Weld County Department of Human Services Fiscal
Office.
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WELD COUNTY DEPARTMENT OF HUMAN SERVICES
PY-12-13-CPS -0131
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PY-12-13-CPS -0131
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
AUTHORIZATION FOR CONTRACTUAL SERVICES
TO BE COMPLETED BY CONTRACTOR:
Date:
CONTRACTOR: Billing Contact:
Phone Number:
Address:
Description of Services (Program Area):
*Service Month / Year: Charges: $ _
*Month/Year services were provided.
I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE
MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF
HUMAN SERVICES.
Printed Name of Signer
CONTRACTOR Signature Date
AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
FOR COUNTY USE ONLY:
AMOUNT AUTHORIZED FOR PAYMENT: $
Approval:
Core & Service Contract Coordinator Date
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