HomeMy WebLinkAbout20133529.tiffMEMORANDUM
DATE: December 19, 2013
TO: William F. Garcia, Chair, Weld County Board of Con3issioflrs
FROM: Judy A. Griego, Director, Human Ser " P epart m
RE:
Agreements to Purchase Out -of -Home ° la ement Services
between the Weld County Department o uman 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 an amendment to the daily rate was reviewed under the Board's Pass -Around
Memorandum dated October 23, 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
C & M Group Home (9875)
October 1, 2013 — June 30, 2014
Group Home/Group Center Care
Greeley, Colorado
$60.82
2
Marie Alirez Group Home (70335)
October 1, 2013 — June 30, 2014
Group Home/Group Center Care
Greeley, Colorado
$60.82
If you have any questions, give me a call at extension 6510.
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2013-3529
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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 vatb2r , 20 L5 ,
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:
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SS -23A Revised 6/2013
I. TERM:
A. The term of this Agreement shall be from October 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
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SS -23A Revised 6/2013
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.
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.
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SS -23A Revised 6/2013
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.
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.
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SS -23A Revised 6/2013
(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
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.
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SS -23A Revised 6/2013
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
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
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SS -23A Revised 6/2013
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.
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
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SS -23A Revised 6/2013
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.
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.
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SS -23A Revised 6/2013
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.
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.
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SS -23A Revised 6/2013
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.
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.
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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, 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
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SS -23A Revised 6/2013
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.
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;
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SS -23A Revised 6/2013
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
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.
13
SS -23A Revised 6/2013
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.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
By:
Deputy ' lerk to th
Approval as to Substance.
WELD COUNTY DEPA
OF HUMAN SERVICES
By:
COUNTY:
The Board of County Commissioners of Weld
County, on behalf of the Weld County Department
of Human Services
Dougla
1ttQca: CAL. -12" --
Rademacher, Chair Pro-tem
NTRACTOR:
& M Group Home
920 81st Ave
Greeley, C9,80634
By:
Director's (or designee's) Signature
and Date
DEC 232013
SS -23A Revised 6/2013
14
O2&/.3 -a.5
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 $60.82, 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
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
❑ SHELTER CARE
❑ SUBSIDIZED ADOPTION
❑ TRANSITION/HOME BASED AFTER -CARE (RCCF)
❑ OTHER (DESCRIBE):
THIS AGREEMENT is made and entered into this \ day of 0 cL o'o r , 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 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:
1
SS -23A Revised 6/2013
ao«- .gip
I. TERM:
A. The term of this Agreement shall be from October 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
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
2
SS -23A Revised 6/2013
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.
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.
3
SS -23A Revised 6/2013
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.
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.
4
SS -23A Revised 6/2013
(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
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.
5
SS -23A Revised 6/2013
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
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
6
SS -23A Revised 6/2013
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.
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
7
SS -23A Revised 6/2013
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.
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.
8
SS -23A Revised 6/2013
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.
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.
9
SS -23A Revised 6/2013
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.
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, 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
11
SS -23A Revised 6/2013
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.
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;
12
SS -23A Revised 6/2013
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
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.
13
SS -23A Revised 6/2013
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.
WHEREFORE, the parties have herein set their hands and affixed their seals the day and
date first written above.
•
ATTEST'`
Deputy i erk to
i861
Approval as to Substance:.
WELD COUNTY DEPAR
OF HUMAN SERVICES
By:
COUNTY:
The Board of County Commissioners of Weld
County, on behalf of the Weld County Department
of Human Services
CK-15/02 7
ouglaa— ademach r, Chair Pro-tem
NTRACTOR:
arie Alirez Group Home
1405 26th Street
Greeley, CO 80631
DEC 232013
By: C e \CLX.A R/ \'`'"`kjr
Director's (or designee's) Sigitatre
and Date
SS -23A Revised 6/2013
14
O7%9- 35072
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 $60.82, 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
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