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Home My WebLink About20121884.tiff RESOLUTION RE: APPROVE THIRTEEN (13)CHILD PROTECTION AGREEMENTS FOR SERVICES WITH VARIOUS PROVIDERS AND AUTHORIZE CHAIR TO SIGN 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 thirteen (13) Child Protection Agreements 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 the providers listed within Exhibit"A", commencing June 1, 2012, and ending May 31, 2013 with further terms and conditions being as stated in said agreements, and WHEREAS,after review, the Board deems it advisable to approve said agreements, copies of which are attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the thirteen (13) Child Protection Agreements 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 the providers listed within Exhibit"A", be, and hereby are, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said agreements. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 23rd day of July, A.D., 2012, nunc pro tunc June 1, 2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: C Sean P. Conway Chair Weld County Clerk to the Board , - t E La it F. Garcia, Pro-T m BY:1/411/1),, rk t the Boa �' Deputy erk t� the Boar. j 1861 t O -ice=tea Kirkmeyer r j APP' • • A ►i "�- %f C c� '2ai � - s:vid E. Long un Attorney j 03 Douglas ademacher Date of signature: 5 s / -/a µSS 2012-1884 �" a' la HR0083 ,861 MEMORANDUM t►I T = LrI � DATE: July 19, 2012 a 0 N T Z71/ TO: Sean P. Conway, Chair, Board of County Commissioners FROM: Judy A. Griego, Director, Human Se ices 1 ' o SUBJECT: Child Protection Agreements for Services between the Weld County Department of Human Services and Various Providers Enclosed for Board approval are Child Protection Agreements for Services between the Department and Various Providers. These Agreements were reviewed under the Board's Pass-Around Memorandum dated May 7, 2012, and approved for placement on the Board's Agenda. There are a total of 52 agreements with various providers; the following represent the next 13 agreements received leaving 30 agreements needing to be signed by the Board Chair. The major provisions of these Agreements are as follows: Program Area/ No. Provider Funding Source PY12-13 Rate(s) 1 Leahy Neurofeedback Center, Mental Health Services Rate determined by number of clients LLC (dba Denver (Neurofeedback) completing services on any one day. Neurofeedback) Minimum of$400.00/day; maximum of 14 Core clients/day. 06/01/12-05/31/13 $100.00/Client(4 Clients) $80.00/Client (5 Clients) $66.67/Client(6 Clients) $57.14/Client(7 Clients) $50.00/Client(8 Clients) $44.44/Client(9 Clients) $40.00/Client( 10 Clients) $36.36/Client(11 Clients) $33.33/Client(12 Clients) $30.77/Client(13 Clients) $28.57/Client(14 Clients) 2 Lutheran Family Services Home Based Intensive $105.00/hr(Home-Based Intensive Services) Rocky Mountains Services $75.00/hr(Court Staffing/Facilitation) 06/01/12-05/31/13 Core 3 Lutheran Family Services Home Studies $1,000.00 (Full Home Study- English) Rocky Mountains $1,600.00 (Full Home Study- Bilingual or CW Admin Monolingual Spanish) 06/01/12-05/31/13 $250.00 (Partial Home Study) $100.00 (Rate per additional person beyond primary client and four others.) $75.00/hr(Court Staffing/Facilitation) 2012-1884 4 Lutheran Family Services Life Skills $80.00/hr(Interactional Visitation) Rocky Mountains $70.00/hr(Supervised Visitation) Core $45.00/hr(Monitored Visitation/Safe 06/01/12—05/31/13 Exchange) $105.00/hr(Therapeutic Visitation - Level 4) $95.00/hr(Therapeutic Visitation - Levels 3 & 2, Home Based Parent Coach) $75.00/hr(Therapeutic Visitation - Level 1) $75.00/hr(Court Staffing/Facilitation) 5 Poudre Health Care, Inc. Home Based Intensive $1,700.00/Month DBA Poudre Valley Hospital Services $56.50/Day(Partial Services) 06/01/12 —05/31/13 Core 6 Reflections for Youth, Inc. Home Based Intensive $307.00/Week(HB/Behavioral Coaching- Services 10 Hours/Week without Therapy) 06/01/12—05/31/13 $543/Week(HB/Behavioral Coaching- 10 Core Hours/Week with Therapy) $495.00/Week (HB/Behavioral Coaching- 20 Hours/Week without Therapy) $763.00/Week (HB/Behavioral Coaching- 20 Hours/Week with Therapy) $1,010.00/Week (HB/Behavioral Coaching- 30 Hours/Week with Therapy) 7 Reflections for Youth, Inc. Day Treatment Services $111.25/day (Regular Day Treatment) $135.25/day (Enhanced Day Treatment, or 06/01/12-05/31/13 Core Enhanced Day Treatment Doubled) $155.25/day (Enhanced Day Treatment-2 Enhancements) $171.25 (Enhanced Day Treatment-3 Enhancements) 8 Strong Foundations, LLC Foster Parent $40.00/hr(Phone Crisis Foster Parent Consultation Consultation) 06/01/12—05/31/13 Core $100.00/hr(Foster Parent Consultation) 9 Strong Foundations, LLC Foster Parent Training $150.00/Person (Foster Parent Training- 12 Hours) 06/01/12—05/31/13 CW Admin $200.00/Person(Foster Parent Training- 15 Hours) $250.00/Person (Foster Parent Training- 27 Hours) $100.00/hr/cpl or ind (Foster Parent Training - 2 Hours) $810.00 (Foster Parent Training. Flat rate for interpreter.) 10 Strong Foundations, LLC Home Based Intensive $50.00/hr(Home-Based Intensive Services) Services 06/01/12—05/31/13 Core 11 Strong Foundations, LLC Home Studies/ $950.00(Full Home Study) Relinquishment $425.00 (Home Study Update) 06/01/12-05/31/13 Counseling $250.00 (Additional Adult) $225.00 (Study cancelled after 3.5 hours CW Admin direct service.) $300.00 (Flat rate for interpretive services/family home study) $150.00 (Flat rate for interpretive services/individual home study) $110.00/hr(Relinquishment Counseling) 12 Transitions Psychology Life Skills $110.00/hr(Therapeutic Visitation) Group, LLC $125.00/hr(In-Home Therapeutic Visitation Core or Life Skills) 06/01/12—05/31/13 $95.00/hr(Individual or Family Therapy, Play Therapy, or EMDR) $180.00/hr(Co-Therapy) $110.00/hr(In-Home Therapy) $95.00/hr(Court Facilitation/Staffing) 13 Transitions Psychology Mental Health Services $95.00/hr(Individual or Family Therapy, Group, LLC Play Therapy, or EMDR) Core $180.00/hr(Co-Therapy) 06/01/12—05/31/13 $110.00/hr(In-Home Therapy) $95.00/hr(Court Facilitation/Staffing) If you have any questions, give me a call at extension 6510. PV-12-13-CORE-0215 600 0-. °' CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN c te- THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LEAHY NEUROFEEDBACK CENTER,LLC ski d This Agreement,made and entered into the / day of vti< , 2012, 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 Leahy Neurofeedback Center, LLC, 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 Core Services to the Department for Mental Health Services(Neurofeedback);and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012, upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 PY-12-13-CORE-0215 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. 5. 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 2 PY-12-13-CORE-0215 • 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 Core Services 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; iii. 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 3 4 PY-12-13-CORE-0215 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 4 PY-12-13-CORE-0215 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. 5 PY-12-13-CORE-0215 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. 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. 6 PY-12-13-CORE-0215 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 Administrator Name Title For Contractor: Susan Leahy Owner Name Title 17. Notice 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: For Contractor: Judy A.Griego, Director Susan Leahy,Owner P.O. Box A 6640 South Yukon Way Greeley,CO 80632 Littleton,CO 80123 1970)352-1551 1303)862-6863 18. Litigation 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. 7 //I/ PY-12-13-CORE-0215 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 8 PY-12-13-CORE-0215 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. 9 PY-12-13-CORE-0215 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. 10 PY-12-13-CORE-0215 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: BOARD OF COUNTY COMMISSIONERS ,r,^-y 't ff_ , WELD COUNTY,COLORADO Weld County Clerk to the Board isq,cr ,,, isil _i < 3 0 1461qr. .,„2Sean P. Conway, Chair JUL 2 3 2012 By: Deputy Clerk t e Board APP AS TO F Co Sy-Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES ,41-1.40-m--• O1-'e-41-4-8-- CCJJ J d A.Gri o, Direc r Contractor Title 11 2'.&--APS PY-12-13-CORE-0215 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Neurofeedback Training to foster children referred by the Department. 2. Services will occur at the Parent Education Center,a leased facility of the Department, in Greeley,CO. 3. The Department will provide"office space", located in the Weld County Department of Human Services' Parent Education Center located at 710 North 11th Avenue, Greeley,Colorado, hereinafter referred as"the Premises",as follows: a. Department will provide one work space to the CONTRACTOR,as the Lessee,which will be located at the Premises. b. In consideration of leasing of the aforesaid,the parties covenant and agree as follow: i. The Department will charge no rent to the CONTRACTOR for use of the Premises; ii. CONTRACTOR agrees to use ordinary care when using the Premises; iii. CONTRACTOR may not sublet any part of the Premises; iv. CONTRACTOR may not use the Premises for any purpose other than conducting the business and duties under the Agreement; v. CONTRACTOR shall keep the Premises clean and in sanitary condition; vi. CONTRACTOR shall allow Human Services any reasonable hour of the day to enter into or upon the Premises. 4. Services will be provided by Susan Leahy,OMC Certified Neurotherapist. 5. Services will be provided by appointment only. CONTRACTOR will operate one day per week(Saturday),8:30 a.m.-4:30 p.m., unless otherwise agreed to by the Department and Contractor. CONTRACTOR will notify the Department in advance of any breaks in service due to holidays or personal time off. 6. CONTRACTOR will give priority to clients referred by the Department but services will be made available to post-adoptive families and general public with Department and Contractor approval if space is available. 7. CONTRACTOR will accommodate up to fourteen(14)clients per day,utilizing at least two(2)work stations for a maximum of seven(7) hours per day. CONTRACTOR is permitted a one-hour lunch break and may elect to use that time for private pay clients as approved by the Department. 8. CONTRACTOR will solely determine charges to be paid by the Department by the total number of clients served per day of service. The total number of clients will be calculated based on the number of clients,both Department referrals and private pay,who complete services on any one day. 9. CONTRACTOR will only request reimbursement from the Department for those clients referred by the Department and authorized under Department funding as evidenced by an authorized referral form. 10. CONTRACTOR is solely responsible for collecting fees from private pay clients. For the purposes of this agreement,"private pay"clients are defined as clients not referred by the Department or authorized under Department funding. The Department will not be held liable for Contractor's inability to collect fees and such inability will not impact or change charges to the Department. 11. CONTRACTOR will provide scheduling by phone. CONTRACTOR will provide the Department a final schedule following each day of service that shows all clients scheduled for services and the status of their services for that day; "Completed"or"Failed to Attend". 12 ,/v PY-12-13-CORE-0215 12. CONTRACTOR will make at least three(3)attempts to contact caregiver for the referred client and set up services. The first attempt will occur within 72 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 13. CONTRACTOR will conduct a phone conference with the referring caseworker and caregiver prior to the start of any new referral when possible. If a referral arrives within the same week as the client's first appointment, contact with the caseworker and/or caregiver may occur the day of the first appointment or following the first appointment. 14. CONTRACTOR will assess each referred client prior to the start of Neurofeedback training utilizing the"QIK" Test. The test measures an individual's continuous performance under low versus high demand"tasks". For purposes of the Neurofeedback training,it will provide an objective measurement to establish client baseline performance. CONTRACTOR will reassess each client at the conclusion of training(usually after approximately 20 sessions). 15. CONTRACTOR will require the caseworker and/or foster parent to complete a Symptom Behavior Checklist weekly for each referred client. The checklist utilizes a Likert scale and takes approximately three minutes to complete. Additionally, a brief list will be provided to the caregiver for daily completion between sessions. 16. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 17. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 18. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 19. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0215 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, and shall not exceed $400.00 per day. 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 $100.00/Session/Client(4 Clients/Day) $80.00/Session/Client(5 Clients/Day) $66.67/Session/Client(6 Clients/Day) $57.14/Session/Client(7 Clients/Day) $50.00/Session/Client(8 Clients/Day) $44.44/Session/Client(9 Clients/Day) $40.00/Session/Client(10 Clients/Day) $36.36/Session/Client(11 Clients/Day) $33.33/Session/Client(12 Clients/Day) $30.77/Session/Client(13 Clients/Day) $28.57/Session/Client(14 Clients/Day) $30.00/Episode(O1K Test) 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. 14 PV-12-13-CORE-0215 CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h 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. 15 PY-12-13-CORE-0215 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. 16 i t"�i PY-12-13-CORE-0215 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. 17 PY-12-13-CORE-0215 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. 18 i L- PV-12-13-CORE-0215 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. 19 p 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 AAAMAAAAAMMAAAMAAAAAAMAMAAAAAAAAAAAAAAAAMAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core &Service Contract Coordinator Date 20 K— . - \ N) . Oi> � � 2 < cID E - k 0 - 1 m § f co — 2 [ 2 % a z t E c ° w u - = O Q O $ � 0fq � w > - " 9 E ® k k / CO 2 . . . . . 2k e o � � Et o >. R D �kk / / 2 � coCO � o zvE R R = � ceE / � �� \ � 2 6 8 / l- 3fa0 �El, M (-) 2 q q $ @ j f (N CCaIoD ° 2 2 aIP • 96 _ m _ / .g / i< I o @ a) \ U % . I- 7 � S / co 2 eG@ E % Oomoo 3 O % E a) -o o c a H \ / § \ / / / \ H fa a� 6 & (=> a) / 2 $ ¢w �\ m m in -- -- . . c = m , I \ > m \ m % \kkk < o 46O5 \ z . . . - I- < -O $ -j 5 / a) ± E3 \ X = E @ G E z \ = z 2 I co O $ 0 .§ / / \ n \ $ 2 \ & Uw • < « k { / G � / — � t I-17 CI) \ Cu \ < ---- - { t / o .E / w \ > - , , Oo2 z 03 12 / c/ 0 0 � Cl) / 0 ® ± < E c 4-) / 7 / 0c � % R 2 / O) c k -- - \ J � \ 0 / cc / / ] o ! o E \ 2 I \ \ i - in to- i -0f Z o _�u ill 110 ti E _� EL ( ) ~ 2 t § § ; | ; ; 2 | $ ) ! ; -ro ■ - - t 0I-® ta. ) CO ) - ! Da ul § § ? : - I ® CC W 13: ! ) - .0 C. j } § CO M 1 - § t a 2 - o tia � ■ 8 cc } } O. Ci- - ! a � o \ \ 2 g f ` a - '0 74 ` E Si CV 01, 7 / E ! { / _ )-- ii Ln ri J } ! 7 ! \ / - , a_ 8 eo | \ ` a . E \ \ \\ 2 | 7 rti \ \ / \ k 'g2 a ! : a » : . z ) ! a _e� 1 PY-12-13-CORE-0187 a •C:7A7A CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the day of 2012, 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 Lutheran Family Services Rocky Mountains, 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 Core Services to the Department for Home Based Intensive 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 June 1, 2012, upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 PY-12-13-CORE-0187 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. 5. 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 2 PY-12-13-CORE-0187 • 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 Core Services 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 3 PY-12-13-CORE-0187 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 4 PY-12-13-CORE-0187 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. 5 PY-12-13-CORE-O187 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. 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. 6 PY-12-13-CORE-O187 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 Administrator Name Title For Contractor: James Barclay President/Chief Executive Officer Name Title 17. Notice 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: For Contractor: Judy A.Griego, Director James Barclay, President/Chief Executive Officer P.O. Box A 363 South Harlan Street,Suite 200 Greeley, CO 80632 Lakewood, CO 80226 (970) 352-1551 303)217-5830 18. Litigation 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. 7 PY-12-13-CORE-0187 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 8 PY-12-13-CORE-0187 interest. Upon learning of an existing appearance of a conflict of interest situation,CONTRACTOR shall 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. 9 PY-12-13-CORE-0187 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. 10 • PY-12-13CORE)187 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: `"." BOARD OF COUNTY COMMISSIONERS '` ;� WELD COUNTY, COLORADO i r V P Weld County Clerk to the Board C. "+ `kh 5 qr° ! ° ; Sean P.Conway,Chair ii'' ;p By: JUL 2 3 2012 Deputy Clerk t e Board AEP 0 D AS TO • Co ty Attorney WELD COUNTY DEPARTMENT CONTRACTO • OF HUMAN SERVICES By: k By: Judy Griego, irector Contractor ,�rs 6:el.G 4Y Title 11 &//? —ac5 PY-12-13-CORE-0187 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services to families referred by the Department. 2. Services are designed for families with children at risk of out-of-home placement or whose children have recently transitioned home. Services promote the safety and well being of children and their family members by reducing the risk of child maltreatment in the home. 3. CONTRACTOR will provide services utilizing flexible, individualized service modalities based upon the family's strengths and needs. The goal of services is to help parents improve their parenting abilities, identify parental and familial strengths,identify and link families to community resources and source of support,and support parents in appropriately caring for their children. 4. Services are: a. Short Term (Average of 10 weeks of service.) b. Intensive(Maximum of 20 hours of direct service,averaging two hours of direct service per week.) c. Home-Based (Service is provided in the clients natural environment.) d. Individualized(Treatment focuses on the family's strengths and needs.) e. Solution-Focused (Services focus on the areas of greatest need.) f. Strength-Oriented (Interventions build upon behavioral strengths in the family.) g. Approached as a partnership between the clinician and the family. 5. Families must be receptive to services; however, CONTRACTOR will accept referrals for non-receptive families when the courts have ordered participation. 6. CONTRACTOR can provide bilingual services(Spanish). 7. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving and accepting the referral (excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3) attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 8. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 10. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 11. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 12 PY-12-13-CORE-O187 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 $105.00/Hour(Home Based Intensive Services) $75.00/Hour(Court Staffing or Court Facilitation) 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. 13 PY-12-13-CORE-0187 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. 14 PY-12-13-CORE-0187 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. 15 PY-12-13-CORE-0187 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. 16 PY-12-13-CORE-0187 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 7`h 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. 17 PY-12-13-CORE-0187 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. 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PY-12-13-HS-0114 is ..1/71e,� HI CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN �/�( THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the day of , 2012, 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 Lutheran Family Services Rocky Mountains, 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 Home Studies;and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 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. 1 a O/c>2—/SS PY-12-13-HS-0114 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. 5. 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 2 PY-12-13-HS-0114 • 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; iii. 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 3 PY-12-13-HS-0114 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 4 PY-12-13-HS-0114 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. 5 PV-12-13-HS-0114 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. 6 PY-12-13-HS-0114 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 Administrator Name Title For Contractor: James Barclay President/Chief Executive Officer Name Title 17. Notice 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: For Contractor: Judy A. Griego, Director James Barclay, President/Chief Executive Officer P.O. Box A 363 South Harlan Street, Suite 200 Greeley, CO 80632 Lakewood,CO 80226 (970) 352-1551 (303) 217-5830 18. Litigation 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. 7 PY-12-13-HS-O114 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 8 PY-12-13-HS-0114 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. 9 PY-12-13-HS-0114 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. 10 PY-12-13- HS 0114 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. 4.1 ATTEST: 'CS '•.A, BOARD OF COUNTY COMMISSIONERS • -_ F = aN WELD COUNTY,COLORADO y Weld County Clerk to the Board V., 1,r �^ , a • (�a k Sean P.Conway,Chair By. Zit JUL 2 32012 Deputy Clerk to e Board APP AS TO FO . Co Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By. By: d A. Grieg , Direct r Contrraac,,tdd /�/�jp/e-/ /Si e /'t, c e.F/ Title 11 C/o2 i �' PY-12-13-HS-0114 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide home study services for families referred by the Department. 2. CONTRACTOR utilizes the Structured Analysis Family Evaluation(SAFE)tool developed by the Consortium of Children. All staff completing studies under this contract are SAFE certified and appear on the State's approved home study vendor list. 3. CONTRACTOR will ensure that all staff conducting studies under this contract attend SAFE Refresher training during the term of the contract. 4. CONTRACTOR will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudy.org. 5. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department, unless otherwise directed by the Department. 6. CONTRACTOR will notify the Department within three days of receipt of a referral if the referral will be accepted and acted upon. 7. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information, SAFE questionnaires completed by the applicants, references and all other original documents submitted by the home study applicant. 8. CONTRACTOR can provide services in Spanish. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any specific Weld County home. Areas of concern may include, but are not limited to,any physical, emotional, educational or behavioral issues. Child abuse must be reported immediately per law. 12 PY-12-13-HS-0114 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 $1,000.00/Episode(Full Home Study- English) $1,600.00/Episode(Full Home Study-Spanish) $100.00/Person (Additional rate per person beyond primary client and four others.) $250.00/Episode(Partial Home Study-English or Spanish. Charge applies after three attempts to schedule or completion of one interview.) $75.00/Hour(Court Staffing or Court Facilitation) 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. 13 PY-12-13-HS-0114 b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 14 PY-12-13-HS-0114 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. 15 PY-12-13-HS-0114 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. 16 PY-12-13-HS-0114 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. 17 PY-12-13-HS-0114 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. 18 PY-12-13-HS-0114 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 19 ai - 4— § \ , 0 0 4 t. . a . 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F.E § / �• � CU � \ \ = 2 S { _ � | 'Cr tEd ` E ` 8 b ) til g ! . `141 _E ' § ; \ { f 2 }\ re ` % ) Z▪ ; \ z / ( ) _ | ! PY-12-13-CORE-0202 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND LUTHERAN FAMILY SERVICES ROCKY MOUNTAINS This Agreement, made and entered into the day of , 2012, 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 Lutheran Family Services Rocky Mountains, 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 Core Services to the Department for Life Skills(Visitation, Parent Coach);and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1, 2012 upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 —/Op q7�/o7c.f PY-12-13-CORE-0202 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 7`h 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. 5. 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 2 PY-12-13-CORE-0202 • 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.5.) 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0202 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 4 PY-12-13-CORE-0202 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. 5 PY-12-13-CORE-0202 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. 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 6 PY-12-13-CORE-O2O2 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 Administrator Name Title For Contractor: James Barclay President/Chief Executive Officer Name Title 17. Notice 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: For Contractor: Judy A. Griego, Director James Barclay, President/Chief Executive Officer P.O. Box A 363 South Harlan Street, Suite 200 Greeley, CO 80632 Lakewood,CO 80226 {970)352-1551 {303)217-5830 18. Litigation 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. 7 PY-12-13-CORE-0202 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 8 PY-12-13-CORE-0202 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. 9 PY-12-13-CORE-0202 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. 10 PY-12-13 CORE)202 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. r.4 ATTEST.TESS . ' `�i6 BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO Weld County Clerk to the Board 861, 6 ~� c w � a Sean P.Conway,Chair JUL 2 3 2012 By. ' Deputy Clerk to a Board OV A • unty/Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: A. Gri go Director Contractor c%?r5 e ..eGer /4too-Asigan T"is a) Title 11 020/2—/SJ9 PY-12-13-CORE-0202 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide the following Life Skills services to families referred by the Department: a. Parent Coach (in-home). CONTRACTOR will serve families who are either at risk of having children placed out-of-home or whose children have transitioned home. Services are provided utilizing flexible, individualized service modalities based upon the family's strengths and needs. Services are designed to assist families in creating a safe,stable and nurturing family environment; promote the safety and well-being of children and families; maintain and build upon family connections and supportive resources; reduce isolation; assist parents in developing appropriate parenting techniques;improve household management skills;prevent, reduce or eliminate behaviors that may place a child or family at risk; and prevent unnecessary out-of-home placements. Families appropriate for this program demonstrate a fundamental lack of knowledge of parenting skills, basic life skills and community resources. This program is not intended to address marital issues outside the parenting context, domestic violence, or chronic mental health issues. b. Therapeutic Visitation. CONTRACTOR will actively monitor, assess and assist in the overall adult/child interaction between parent/relative/caregiver and child (ren). Services are intended to improve the quality of the relationship,to expedite and/or maintain the reunification. Services levels are as follows: 1. Level 4(Family Therapy Level): Intensive services that utilize various techniques from different therapy theories, including but not limited to, narrative and solution focused,to assist family members in increasing emotional regulation, improving family communication patterns and repairing parent/child relationships. Services will assist the referred family to identify dysfunctional family relationships, cross-generational patterns and trauma experiences that affect individual family members and the family unit. Level 4 will also include all Level 3 services. 2. Level 3: Assessment of future intervention needs for continuing visitation and providing protection, both emotionally and physically,for children and/or youth in out-of-home placement. 3. Level 2: Step down from Level 3 if deemed appropriate to assist in the maintaining stability and consistency within the family. 4. Level 1: Maintenance level that will be considered on a case-by-case basis if CONTRACTOR has available staff. Services will occur at the Lutheran Family Services Therapy Center in Greeley, CO;the Lutheran Family Services office in Fort Collins,CO;or at careHouse in Evans, CO. Services may also occur in appropriate community settings or in the family home if deemed appropriate,and approved by the Department. All services will be provided by Master's, or higher, level therapists. CONTRACTOR has bilingual (Spanish/English)staff. 12 PY-12-13-CORE-0202 c. Lower-level Visitation and Safe Exchange. Services are available as follows: 1. Interactional Supervised Visitation: Utilizing the Nurturing Skills for Families Curriculum, CONTRACTOR will work with referred families to develop a specific, customized competency based plan to meet the family's needs. Lessons focus on the five parenting constructs of the curriculum: - Inappropriate Expectations Lack of Empathy Belief in Corporal Punishment Family Role Reversal Suppressing Power and Independence CONTRACTOR is physically present with the family at all times, allowing for immediate intervention,coaching and role modeling. Families are encouraged to practice new skills during the visits with the goal of improving positive family relationships. Some of the parent feedback/education occurs prior to,or just after,the actual visit. 2. Supervised Visitation: CONTRACTOR is physically present with the family at all times ensuring the safety and well being of the child(ren). 3. Monitored Visitation: CONTRACTOR is present in the facility and within earshot of the visit but not physically present with the family at all times. CONTRACTOR will intervene as necessary. 4. Safe Exchanges: CONTRACTOR is present during the exchange of children for the purpose of parenting time in situations that do not allow for face-to-face contact by the parents. Services will occur at careHouse in Evans,CO. Services may also occur in appropriate community settings or in the family home if deemed appropriate, and approved by the Department. 2. CONTRACTOR can provide bilingual services(Spanish) in the areas of Parent Coach and Therapeutic Visitation. 3. CONTRACTOR will make at least three(3) attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving and accepting the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 4. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 5. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical, emotional, educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 6. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 7. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT) and are not considered billable hours. 13 PY-12-13-CORE-0202 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 $80.00/Hour(Interactional Visitation) $70.00/Hour(Supervised Visitation) $45.00/Hour(Monitored Visitation, Safe Exchange) $105.00/Hour(Therapeutic Visitation -Level 4) $95.00/Hour(Therapeutic Visitation- Level 2 or 3, Parent Coach) $75.00/Hour(Therapeutic Visitation-Level 1) $75.00/Hour(Court Staffing or Court Facilitation) 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. 14 PY-12-13-CORE-0202 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. 15 PY-12-13-CORE-0202 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. 16 PY-12-13-CORE-0202 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. 17 PY-12-13-CORE-0202 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. 18 PY-12-13-CORE-0202 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 11`h Avenue,Greeley, CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0202 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. 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Z = vdi a` = in Z s 1 r 19 PY-12-13-CORE-0174 ` Oifi � rci �j 7 CHILD PROTECTION AGREEMENT FOR SERVICES BEIIWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND POUDRE HEALTH CARE,INC.,DBA POUDRE VALLEY HOSPITAL This Agreement, made and entered into the day of 2012,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 Poudre Health Care, Inc.,dba Poudre Valley Hospital, hereinafter referred to as the"Contractor". CONTRACTOR operates Mountain Crest Behavioral Healthcare Center,a licensed behavioral health care facility located at 4601 Corbett Drive, Fort Collins,CO 80528. Mountain Crest offers Aftercare Wraparound Services. 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 Core Services to the Department for Home Based Intensive Services(Aftercare Wraparound 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 June 1, 2012 upon proper execution of this Agreement and shall expire May 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. 1 a9ia—4'(f PY-12-13-CORE-0174 "Payment Schedule"shall establish the maximum reimbursement which will be paid from Core Services funding during the duration of this Agreement. 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. 5. 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 2 PY-12-13-CORE-0174 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 • 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.5.)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 Core Services 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. H. 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, 3 PY-12-13-CORE-0174 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 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. 4 PY-12-13-CORE-0174 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 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 5 PY-12-13-CORE-0174 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. 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. 6 • PY-12-13-CORE-0174 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 Administrator Name Title For Contractor: Shari Simmons Manager of Residential Name Title 17. Notice 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: For Contractor: Judy A.Griego, Director Shari Simmons, Manager of Residential P.O.Box A 4601 Corbett Drive Greeley,CO 80632 Fort Collins,CO 80528 (970)352-1551 (970)207-4867 18. Litigation 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. 7 • PY-12-13-CORE-0174 19. Termination This Agreement may be terminated at any time by either party giving thirty(3)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 4424-10-101 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 8 • PY-12-13-CORE-0174 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. 9 • PY-12-13-CORE-0174 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. 10 PY-12-13-CORE-0174 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST:_ y„ t.,-� BOARD OF COUNTY COMMISSIONERS J' � t 1 , jy WELD COUNTY,COLORADO Weld County Clerk to the Board an P.Conway,Chair By: ' JUL 2 3 2012 Deputy Clerk to e Board ' `+\''.,",j -42 OVE ST Co "Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: = By: rh"ft4QoDQ Contractor Clue.I Title pry J.,, l aipp,_ (46+161 11 cC/o? - /f8 PY-12-13-CORE-0174 EXHIBIT A SCOPE OF SERVICES 1. The goal of the Wraparound Aftercare Services Program is to bring the residential program to the youth's home and community by providing needed support and services that the Wraparound team has agreed upon. The intent of the"Wraparound Aftercare Services" is to solidify the work begun in residential placement and empower families to implement what is needed for their own unique circumstances, ultimately allowing for self-sufficiency. 2. The CONTRACTOR will provide the following in the home/community to those clients referred by the Department: a. Team development—Support team for the family consisting of both professional and non- professional members. b. Monthly team meetings. c. Practice of the Crisis/Safety Plan. d. Facilitation of both formal and informal resources to address the family's unique needs. e. On-call availability. f. Weekly face-to-face contact with the family by the Wraparound Facilitator. g. Individual and family therapy if needed by the same therapist the family worked with in residential placement. h. Attendance at court appointments and staffings as needed. i. Required documentation for High Fidelity Wraparound,the Department and the court. 3. Timeline for Wraparound Services: a. Upon Intake:Preliminary Intake Assessment b. Within 24-72 Hours: Evaluation and Comprehensive Assessment; Initial Risk Assessment; Psychiatric Assessment;and Health/Physical Assessment c. Within One Week: First Family Interview, First Individual Interview; Basic Strengths, Needs,Cultural Discovery(SNCD); Basic Functional Assessment(FA);Safety/Crisis Plan (CP);Basic Wrap Team Development;and Psychosocial d. Within 10 Days: Initial Team Meeting-Care Plan Development;Case manager begins working with youth on goals e. Within 30 Days: Comprehensive Team Meeting f. Within 30-45 Days: Decision on Wraparound Aftercare made by team(Intensive Wrap or Basic Wrap). 4. Under Intensive Wrap,CONTRACTOR will provide the following: a. Comprehensive SNCD b. Comprehensive FA c. Comprehensive CP d. Monthly Team Meetings e. Identified needs coming out of assessments/recommendations are; new techniques are practiced and strengths built upon. f. Wrap Facilitator works with the family building team development in their community. g. Wrap Facilitator teaches the family how to build natural supports in their community. h. Wrap team meetings are held in the family's community to assist the team in practicing treatment plan recommendations. i. Pass check-ins. j. Wrap will go to the home and practice in-home techniques that are being identified in therapy. k. Available via telephone for crisis assistance. 12 PY-12-13-CORE-0174 5. Under Basic Wrap, CONTRACTOR will provide the following: a. Monthly team meetings b. Assessments and recommendations are given to the caseworker for community referrals. c. Wrap will make recommendations to assist the family in developing a team of natural supports. d. Pass check-ins once every two weeks. 6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include, but are not limited to, any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team (URT)and are not considered billable hours. 13 PY-12-13-CORE-0174 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 $1,700.00/Month (Aftercare Wraparound) $56.50/Day(Aftercare Wraparound -Partial Services) 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 7f°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. 14 PY-12-13-CORE-0174 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. a 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. 15 PY-12-13-CORE-0174 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. 16 PY-12-13-CORE-0174 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. 17 PY-12-13-CORE-0174 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 7`h of the month following the month of service in order to be processed for payment that month. Billing received after the 7`h 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 11`h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0174 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: 7/4 2,0i CONTRACTOR: Billing Contact: ,f� Phone Number: 207 - ¢ S(,7 Address: 41001 CIr bc-ff ht , Poet Cr: ('_(.) .17 W Description of Services (Program Area): (,1�2a..Y� AP orVOL-,� �� 1 2`eed_I*h. ; Opt.L: *Service Month/Year. 20 i2. - 20I Charges: $ I ) 1OO.nnhytO *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 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA W AAAMMAAAAAAAMMAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 N aJ • O Q co • v E co V 9 Q N c▪ c .L. a) CO W c E m E r co co N3 $ z E ' E a7 3 C O Q N c y N _ Z O 0 O ❑ 4.)Ur N x T I J i U OO C O el LL m r T O d O aJ U .+ m a Oco O T JO O T . > NV ccom- r._ 1 tcE q 0 4 U 7 0 c , d.aJ °.O LL O co O O .O COI- U > xaC —cc) 2Ucarom aJ 15 « N 2 ax O D w U c- r` _ ( N. 12 C > O a U O = O m `o o ax C.12 a_ H U o a w v R a a ` N Z 0 0 0 F Z 0 O O (n O co �E O U `m m ..;o o O w o r LU co co a co N Q. N Z ...-C ® a c N N M J{p 2 U) a W` a .J -- COo u W TO o m U CO > a m o CO J O N -J C �N U < coo 2 co a z H a -O LU J O LO al o u U 'D a C co W L D m m in .. Z CO xzam _ aJ rn x oo a m w a c o co v U O m mco @ d m(I) aJ J N N N -o E D w an d � � v W a N > J I- ri .- a 4 a Ey w aJCO LL U m Jco d H K• >. a) 0 aJ Z a m W oll U ? O O W N W L o yJ E07 Z oa o • U as m c d -) o_ m a¢ o n JP- Q o n. CY -°_- a0 5 cc (no r 4 j - 0 16 \ j 15 V. 7 E J 2 6 . f ) -u as ,% 01 $ %ni ) . 0 } E 2ia • 2 , . n § 0 X 0 X / � : . k § E- 0 § I a \ 8 § § % . E \ 0 aL o J o w \ 0 , ) f \ § & § „ § - 7° § e ) k \ 2 - f $ § § E = ■ } Z n - § |° D i- ) J - m - al 2 B 13 § / \ 3 » • , § 7 ( k & E ■ _ a 2 f lN 0.Li \ \ j o.rn, fa\ 1 ° 2 a_ as a § § 0 / o � \ 9 B \ to — Ta § $ A a. I § 0 " � V ` � 2 E k f o E 52 § % � § } 1Elj k u , = Eas 2 � « k ] � \ 5 qj { X • — • Ln Yr 13 . ) iii ( k \ .7c CU 1. 1 ' <0.j U / E • )• ) c � .3 e _ V \] # \ / $ k .6 f tu 2 - E ! § % 3 28 . - q\ k / a . - { \ & 2 § k - '} E O_ z § O. f «Z . '! ) PY-12-13-CORE-0206 CHILDECTION AGREEMENT FOR ERVICES BETWEEN lir,HE WELD TC COUNTY DEPARTMENT OFSHUMAN SERVICES Lin i Jill 12 4 q: 41 AND REFLECTIONS FOR YOUTH,INC. This Agreement,made and entered into the day of ,2012,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 Reflections for Youth, Inc.,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 Core Services to the Department for Home-Based Intensive 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 June 1,2012 upon proper execution of this Agreement and shall expire May 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 E"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 Core Services funding during the duration of this Agreement. 1 a PY-12-13-CORE-0206 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E 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. 5. 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 2 PY-12-13-CORE-0206 • 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 Core Services 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 3 PY-12-13-CORE-0206 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 D 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 4 PY-12-13-CORE-0206 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. 5 PY-12-13-CORE-02O6 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. 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 6 PY-12-13-CORE-0206 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 Administrator Name Title For Contractor: Jeffery Johnson Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Griego, Director Jeffery Johnson,Executive Director P.O. Box A P.O.Box 1860 Greeley,CO 80632 Berthoud,CO 80513 (970)352-1551 (970)344-1380,x202 18. Litigation 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. 7 PY-12-13-CORE-0206 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 8 PY-12-13-CORE-0206 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. 9 PY-12-13-CORE-0206 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. 10 • PY-12-13-CORE-0206 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. �T. ATTEST: ro BOARD OF COUNTY COMMISSIONERS "N `„ ,„'+„ r WELD COUNTY,COLORADO Weld County Clerk to the Board vim ‘1) :h Sean P.Conway,Chair v' JUL 2 3 2012 By: Deputy Clerk t he Board AP V AS T C my Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES ��1 40 Vt. By: L By: J d A.Grie , Direct Contr ,,,AiitgRaot Titl 11 c21/a —/fl PY-12-13-CORE-0206 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide intensive home and community based behavioral coaching services to youth 10 years of age or older,and their caregiver(s),as referred by the Department,except when any of the following exist: a. The referred youth has an IQ below 55. b. There is active sexual abuse is occurring in the home. c. There is recent or current domestic violence. d. A high lethality suicide attempt has occurred within the last 30 days(from the start date of the referral). e. There are felony assault charges by youth or family member within the last 30 days(from the start date of the referral). f. The youth or another participating family member is actively psychotic. g. There are any legal or behavioral patterns that present significant issues of danger to staff providing services. h. The youth identified for services is younger than six(6)years of age. 2. Services will include treatment and support to the youth and their caregiver(s)to prevent out-of-home placement or an increase in placement level. Family therapy can also be included. Services are available as follows: a. With therapy: i. Support Level= 10 hours/week. ii. Stabilization Level=20 hours/week. iii. Safety Level=30 hours/week. b. Without therapy: i. Support Level=10 hours/week. ii. Stabilization Level=20 hours/week. 3. The program is designed to be offered in three(3)phases over the course of 12-20 weeks based upon the needs of the referred youth. The phases are identified as: a. Assessment and Treatment Planning: This phase encompasses the first two(2)weeks of programming.The purpose of this phase is to set up behavioral and support plans for the family that outline the treatment process and recommendations. This phase includes up to six(6)hours of clinical involvement and in-home support time. All assessments are scientifically validated and include the SASSI-A2, FACES IV,and DAP. b. Ongoing Treatment: Implementation of treatment plans. 12 PY-12-13-CORE-0206 c. Discharge Phase: Treatment hours are reduced to prepare family and youth for end of services. Discharge assessments and Aftercare Agreement will be completed during this phase,which will include an agreed upon plan for reduction of hours and phase out of services. 4. The goal of services is primarily to prevent out-of-home placement or transition child(ren)home. Additional goals include the following: a. Providing the lowest level of in-home intervention to meet the need. b. Maintain flexibility with family situations in order to help families and youth access service. c. Provide therapeutic and behavioral skills and assistance in the environment in which the youth resides and spends their time. d. Provide support to the family in addressing their struggles with the youth's behavioral problems. e. Assist with transition from residential level of care to the community(if applicable). f. Complete therapeutic work that would have been interrupted with a transition out of residential or day treatment services(if utilizing the in-home intervention with ongoing therapy). g. Work collaboratively with youth,families,client managers,mental health centers and other Multi Disciplinary Team(MDT)members to establish individualized goals and treatment/reintegration plans. h. Set individualized goals for referred youth that can be tailored around emotional regulation, relationship skills,substance abuse treatment,and other behavioral areas/concerns. i. Increase family and youth's ability to access other community resources(e.g., mental health centers, support groups). 5. All services will be provided in the referred youth's home and/or community unless otherwise directed by the Department. 6. CONTRACTOR will develop a case management plan within 30 days of receiving a referral and provide that to the referred family,with a copy to the caseworker. The plan will include,at a minimum;goals,goal timelines and a measurement of success. 7. CONTRACTOR will update the caseworker at least twice(2)per month with updated progress information and concerns. 8. CONTRACTOR will provide interpretive services,transportation and on-call support on a case-by-case basis as needed. 9. Services will be provided by therapists with a Master's degree and two years experience in the field or a Bachelor's degree and three years experience in the field. 10. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 11. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 13 • PY-12-13-CORE-0206 13. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 14. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 14 PY-12-13-CORE-0206 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 $307.00/Week(10 Hours/Week without Therapy) $543.00/Week(10 Hours/Week with Therapy) $495.00/Week(20 Hours/Week without Therapy) $763.00/Week(20 Hours/Week with Therapy) $1,010.00/Week(30 Hours/Week with Therapy) 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 E. 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 E of this Agreement in accordance with criteria established by the Department. 15 PY-12-13-CORE-0206 b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 16 PY-12-13-CORE-0206 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 Departments 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. 17 PY-12-13-CORE-0206 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. 18 PY-12-13-CORE-0206 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. 19 PY-12-13-CORE-0206 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. 20 PY-12-13-CORE-0206 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 AAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 21 It • 8 % « g 3 •E 2 a g 0) Q ■ ■ — m E 22 < 2LL kC J tee _ _ IO, � k � �� Pk2 m . a m0jO COP CNI G .22J \ w000>co CO .12 ■ k � � - E So— 1 t q O 2 � v \ 2� \ �� 2 8 R g 45 d 7 " rt Q I O : 4S 2CNI � § \ 57 ri / $ b � a_ I— (_) e g C / 0d R o % 76 4= 2 O E O m 2 cNi q 00 \ ~ Z ka) E28k 0 0 $ > I « w - e $ 2 w $ q -- - co - 2_ > 22 K m 0 k$ 034- 0 < ecP Q 0 < 0 U) -J - ® w = e 7 $ O $ � m w = E - L U) $ 7 IZ = F § 0 § 2 42 0 ^ co ? E 2 ) a) k = f � a o 2 2 � f ) $ - 3oR $ I R � \ Lt < . Ja \ .E 0 > \ Z\ 0 q ° o � V c o I. w « O E " 3 ocn Eco 27wt % �.2 a) $ .. & CL / I � / O oI % o 4-0 . / C 2 s o \ \ E E E J -0 g .2 j 6 f f o ) ID 0 I is } § R s A I ; •2 - $ o i i - ■ is § f § } to § k � ) � .c _I " Z i E ■ � Q \ { >. E E 2 of S ( k z # f � CO ° = To / .2 alr k - 0 / al k i _ o % _ § $ ■ 2 § U lia 15 ( 0_ tio 1 a 11 § k - & \ ' r - ; % E © >:: � § 8. 2 d / k C. e C q $ • O t t ■ to 0 � � �_ 2B f4 C § . \ i . / } \ k � •� . \ Z0 k 2 E ( } f2 5 - 2 % � § � .a• OJ 2 ® E 4J r 4J « J t , C r oj K . E 13 C « ) § m ; ■ { a § _to c { % 8 2 a I 7 . To z g R t ■ k / a / § - 9 §CC f E E by a § § B & ! b 1 O. E -" ° ; § i \ § U - z \ d k g 8 2 ~ 1 \ 2 B } g g t E s § « � k a » 2 2$ 2I PY-12-13-CORE-0112 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND REFLECTIONS FOR YOUTH,INC. This Agreement,made and entered into the day of ,2012,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 Reflections for Youth,Inc.,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 Core Services to the Department for Day Treatment 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 June 1,2012 upon proper execution of this Agreement and shall expire May 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 E"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 Core Services funding during the duration of this Agreement. 1 49O/02-/b'4� PY-12-13-CORE-0112 a. CONTRACTOR shall submit an itemized monthly bill to the Department for all costs incurred and services provided pursuant to Exhibit A and Exhibit E of this Agreement in accordance with criteria established by the Department. CONTRACTOR shall submit all itemized monthly billings to the Department by the 7`h 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. 5. 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 2 PY-12-13-CORE-0112 • 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0112 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 D 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 4 PY-12-13-CORE-0112 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. 5 PV-12-13-CORE-0112 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. 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 6 • PY-12-13-CORE-0112 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 Administrator Name Title For Contractor: Jeffery Johnson Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Griego,Director Jeffery Johnson,Executive Director P.O. Box A P.O. Box 1860 Greeley,CO 80632 Berthoud,CO 80513 (9701352-1551 (970)344-1380,x202 18. Litigation 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. 7 • PY-12-13-CORE-0112 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 8 PY-12-13-CORE-0112 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. 9 PY-12-13-CORE-0112 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. 10 PY-12-13-CORE-0112 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: : �; "`-�,,, BOARD OF COUNTY COMMISSIONERS M1WELD COUNTY,COLORADO Weld County Clerk to the Board • Je Sean P.Conway,Chair By: JUL 2 3 2012 Deputy Clerk t ie Board AP V AS T C ty Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES \_ UIth 6\)(4-Y„q I(L, By: �1 A. ♦ �♦ �'� By: U�''� " J d A.Grieg. Director Contr 44-1)i,[ .W Titl 11 aria -/J'cy PY-12-13-CORE-0112 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide comprehensive,highly structured Day Treatment services to female and male youth,ages 11-18,as referred by the Department. Youth,age 18-21,which are considered special education and eligible for educational services,any youth with an extensive history of aggression to self and/or others, adjudicated sexual offenders,youth will a full-scale IQ below 70 and youth requiring routine medical assistance(diabetes,seizure disorders,etc.)will be assessed on a case-by-case basis for admittance into the program. 2. CONTRACTOR will provide services in Loveland,CO,at 1000 South Lincoln Avenue,#190,or in Brighton,CO,at 60 South 27th Avenue. CONTRACTOR is licensed by the Colorado Department of Human Services State Child Care Licensing(Loveland: 1545846,Brighton: 1609468). 3. Services include: a. Regular Day Treatment: Comprehensive,highly structured educational program that incorporates therapeutic components. b. Enhanced Day Treatment: Comprehensive,highly structured educational program that incorporates therapeutic components and optional enhancements(up to three[3]enhancements at one time.) Optional enhancements include Drug and Alcohol Therapy and Support,In-Home Family Therapy,or five(5)hours per week of community-based involvement(behavioral coaching)for the youth. Enhancements can be combined to meet the needs of the client and any one enhancement may be doubled. Services further include,but are not limited to,assessment and evaluation,development and implementation of a treatment plan,therapy,daily information to parent and/or caretaker regarding homework and treatment goal progress,stain ngs as needed(at least monthly),a discharge plan and aftercare. Parents and/or caretakers are expected to participate in the above progression of services and will be provided detailed information at the time of discharge. 4. CONTRACTOR will provide individual,group and family therapy to all referred youth unless otherwise directed by the Department. 5. CONTRACTOR will provide interpretive services and transportation on a case-by-case basis as needed at no additional cost to the Department. 6. Testing and psychiatric medication evaluations and appointments will be conducted as needed to aid in case planning and ensure the appropriate treatment is utilized for the referred youth's maximum growth and benefit. 7. Services will be provided by Masters' level therapists who have specific training in one or more of the following areas: Eye Movement Desensitization and Reprocessing(EMDR),Dialectic Behavioral therapy, Cognitive Behavioral Therapy and/or Reactive Attachment Disorder. 8. Referred youth will receive services for approximately four(4)to six(6)months. Length of services is dependent upon the referred youth's daily/weekly progress,individual/family needs and availability of funding. 9. CONTRACTOR is a Medicaid approved provider through ValueOptions,Inc.,and can bill Medicaid for Regular Day Treatment only. Eligible clients referred for Regular Day Treatment will be identified at the time of referral. 12 PY-12-13-CORE-0112 10. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 11. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 12. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 13. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 14. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 • PY-12-13-CORE-0112 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 $111.25/Day(Regular Day Treatment-No Enhancements) $135.25/Day(Day Treatment-One(1) Enhancement or Enhancement Doubled) $155.25/Day(Day Treatment-Two(2)Enhancements) $171.25/Day(Day Treatment-Three(3)Enhancements) 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 E. 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 E of this Agreement in accordance with criteria established by the Department. 14 • PY-12-13-CORE-0112 b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0112 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. 16 PY-12-13-CORE-0112 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 Departments 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 Departments 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. 17 PY-12-13-CORE-0112 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. 18 • PY-12-13-CORE-0112 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 7`h 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. 19 PY-12-13-CORE-0112 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 AAAAAAAAAMMAAAAAAAAAAAAAA AAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 20 a, .2 S 2 « & 3 2 2 a Sil e $ 2 f — Cr) $ E en < t � §C 0 c e _ _ z 0 7\ � E/ 8 / � a . . V..— co 7 G g 0 R o_ o @ x : $ § � &20� k k � 22EdS6 U %2 0 � / v � 2a: O �PI: 2 0 2 R i r k 7 � Cro 1 o ® 0 2 CV 7x72 _ z o / = Q@I 113 0 ,--7,- -q 04 2 e 2 fee 2 z co meo O % c > moo to O & / \ e > - 0 2 2 = g 00 # z \ O. & @ \ e $ � $ <3 �k . ------- -- c0 -O Q _ U -J § �2 ( co RR2k < 9 < @0r , . . , O < I- _1 1 � ® u -c O 7 ± O a) � 2 X ® R § < 2 % izE cn I co. — g 2 co o I S m 7 .— a) $ _, w 0 \ 2g / \ a- q Tom / 2 ® � . / \ k » ui b > ii CC o �/ 0 § # a) Z U c o < ® E & C g 0 � � E � z7� t • 1O z� E\ (Sc = 0 < o cg LIT 1iO 0a@c ) - 1 a)o } k wg § k { ! , 2 ! o o \ f ICI / f ! z co 0 - 7 E 13 \ � \ | E } / in ] I IMs ! ( , o � 0 � \ _ § § \ , ti - [ go 7,1 - f | k i ) ! § / ) } � 4. ; B :in tra , CA _ _u a. $ ~ ! ! 1.0 in D aj � / / 03 3 CO\ \ I o & § ) k § ) " _ ! ! ) § t . | I Ct t I \ \ to is 0 is to ! _ j k B \ ! § -o ---- 0 § | R. 8 : en ) / { \ ) � I 1 ! < o § � | ! r` § 1 z cc | � b CU CU- } \\ 2 § § r11 ; 34 - :; 7gk . ! .2 / I k k� • • PY-12-13-CORE-0118 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS,LLC This Agreement, made and entered into the day of 2012, 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 Strong Foundations, LLC,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 Core Services to the Department for Foster Parent Consultation;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012,upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 PV-12-13-CORE-0118 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 7`°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. 5. 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.sec..and its implementing regulation,45 C.F.R. Part 80 et.seq.;and 2 PY-12-13-CORE-0118 • 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0118 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 into 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)sha II 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 4 PY-12-13-CORE-0118 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. 5 PY-12-13-CORE-0118 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. 6 PY-12-13-CORE-0118 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 Administrator Name Title For Contractor: Julie Box Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Grieco,Director Julie Box,Executive Director P.O. Box A 1702 68th Avenue Greeley,CO 80632 Greeley,CO 80634 1970)352-1551 f970)302-1471 18. Litigation 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 documents)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. 7 PY-12-13-CORE-0118 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 8 PY-12-13-CORE-0118 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. 9 PY-12-13-CORE-0118 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. 10 PY-12-13-CORE-0118 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: ."" 'i ` , BOARD OF COUNTY COMMISSIONERS ,,,\A WELD COUNTY,COLORADO .-vv ‘a Weld County Clerk to the Boar 19,61 S1,', 4 '-��—may �l > J. t j Sean P.Conway,Chair J\ >" By: ��✓//-/ � `—'°��✓�� JUL 2 3 2012 Deputy Clerk t;.'a Board 1- APP S TO FO • Co Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES itIV By: II I . %i By: 1.-C11.1J1d A.Grieg ,Director ontrraacct�o�a br Mrt Title 11 C7O/r? -ar_f9 PY-12-13-CORE-0118 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide consultation for children and youth residing in Weld County foster homes within a 50-mile radius of Greeley,CO.,as referred by the Department. The goal of the program is to enhance and improve the quality of care being provided to Weld County's children and youth. 2. CONTRACTOR will work collaboratively with children,foster parents,caseworkers,foster care coordinators and other service providers to identify and address issues,in a solution-focused manner, that could potentially disrupt placements. 3. CONTRACTOR will make recommendations to foster family following assessment of the child. CONTRACTOR will document recommendations and follow through of foster family with regard to recommendations. 4. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information on a monthly basis to the Department. 5. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 6. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 7. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 8. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 9. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 12 PY-12-13-CORE-0118 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 $100.00/Hour(Foster Parent Consultation,Face-to-Face) $40.00/Hour(Foster Parent Consultation,Phone Crisis) 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. 13 PY-12-13-CORE-0118 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. 14 • PV-12-13-CORE-0118 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. 15 PY-12-13-CORE-0118 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. 16 . PY-12-13-CORE-0118 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 7`h 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 11h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-12-13-CORE-0118 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 18 H > v UO `11- 4 M y E 0 ,_ E (I) .-. t E ut3 $ c Z X O E O d c N Q a) = O O Ov 4) toNrti U %- o .- co u, co A r 1-- 00 >,•s M ca in co m a; S a) ao � ti 0 o 2 — o U ooN (O y � .. ~ y ro U t ° M coo > >' 003 C 0 Ems : a_ tom 0) 00 o c = o 0 • c 0 0 0 = O Lrti o c o cn i— 0 I Oa �e 2 U ca r) co L _ to ca y O L C N a o.= o t i (fl U cv CV ` •C .- O Q Q = O C9, d iI— . I U = Q � U_ .-N Ce � OO H 8 Z " 0 Ocn QO (0 Q) Q) 0O i Q a) j f0 O Q L U_ O D L N i a) IA o co u) 2u) QW a 1- 000 I v W m a> 0 ^ o U p J O N To N J a @ (K3 `•O--. C.1 <WO 2 c° 0 Q -o in J O to w t L to N to U 0 � to 2 L X N L a) W L 0 7 0 `- Z t0 = — ) = co I t U g f° 0 coo N c i a) a) cL0 to O 2 to L (Q .C U- ca a) .- Q) J U1 V y cn a) Q = w k- a) a> I— m E ` V .~ .� .L. i] X L Wo o .a � w a } 0r VWz � � ~ ! 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L.., § { { 0_ , \ § - B ) k c \ u . 0D / \ \ / } \ 2 = \ 5 ` 10 } \ c � ) % z al E2 » : ° 2 0 2 - $ \ , § q 7.5_ » 2 ° ,a } - ' - / ) n � a - t ) en - k7 & § } $ \ z13 I \E 7 71 \ a . . ) ik \ \ \ Z . .§ . . - .\ '5 ` I . c � � \ _ o. /k § � O $ � ( \ f !f ) z f \ o § 0 - 2 t b c. $ § - O] \ o c k ( § /) �j } a z § a 0. _ - 1 PY-12-13-CPS-0096 ©2197N- CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS,LLC This Agreement,made and entered into the_day of .2012, 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 Strong Foundations,LLC,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 Foster Parent Training;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1.2012,upon proper execution of this Agreement and shall expire May 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/Billinp/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. 1 I PV-12-13-CPS-0096 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 7`h 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. 5. 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 2 PY-12-13-CPS-0096 • 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; iii. 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 3 PY-12-13-CPS-0096 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 4 • PY-12-13-CPS-0096 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. 5 PY-12-13-CPS-0096 11. Trainin 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. 6 PY-12-13-CPS-0096 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 Administrator Name Title For Contractor: Julie Box Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Griego,Director Julie Box, Executive Director P.O. Box A 1702 68th Avenue Greeley,CO 80632 Greeley,CO 80634 f970)352-1551 f970)302-1471 18. Litigation 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. 7 PY-12-13-CPS-0096 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 8 PY-12-13-CPS-0096 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. 9 PV-12-13-CPS-0096 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. 10 PY-12-13-CPS-0096 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: �1. BOARD OF COUNTY COMMISSIONERS (�.;.\ F,' •�/' WELD COUNTY,COLORADO )r.. Weld County Clerk to the Board Sean P.Conway,Chair JUL 2 3 2012 By: Deputy Clerk to e Board AP V AS TO Co ty Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES _ By: By: LW tA Ju y A.Gri go, Direc r ''Contrac r Title 11 PY-12-13-CPS-0096 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Core Certification Training for foster care applicants. The goal of the program is to enhance and improve the quality of care being provided to the Department's children and youth. 2. All trainings will satisfy the requirements set forth in the State of Colorado Volume VII and as set forth by the Department. 3. Full Core Foster Parent Training consists of a 27-hour training that includes, but is not limited to,a complete review of the Weld County Foster Parent Handbook,as well as attachment and bonding issues, grief,loss and separation issues,adoption issues,child growth and development,boundary setting and discipline, providing for children of differing races,cultures and ethnicities,confidentiality,understanding adoption laws and procedures,including termination of parental rights, relinquishment and expedited permanency plans,contact and communication with the child's biological family members,safety and permanency for foster children,the well-being of families and the use of community resources. CONTRACTOR also specifically addresses infant care, Fetal Alcohol/Substance Abuse Syndrome,the oft times misleading or incomplete historical information foster parents receive regarding the child and their biological family members,special medical or emotional needs, parenting the neglected,emotionally, physically and/or sexually abused child,parenting the physically, mentally or emotionally challenged child and accessing available benefits and resources. 4. CONTRACTOR will accomdate 12-hour,15-hour and hourly levels of training within the full 27 hour training. CONTRACTOR will cover the 10 State mandated topics during the first 12 hours of training.The remaining 15 hours will provide more indepth training on those topics. 5. CONTRACTOR will obtain prior approval from the Department for any other training other than Core Foster Parent Training(as scheduled by the Department). 6. CONTRACTOR will provide a completion certificate to each applicant who completes training. 7. CONTRACTOR will provide Core Foster Parent Training per the agreed upon schedule below,at 1702 68th Avenue,in Greeley,CO,unless otherwise determined by the Department: July 27-28 and August 10-11 October 12-13,26-27 - November 16-17,30 and December 1 January 25-26 and February 8-9 March 29-30 and April 12-13 May 17-18,31 and June 1 12 PV-12-13-CPS-0096 8. CONTRACTOR will work collaboratively with foster parents,caseworkers,foster care coordinators and other service providers to identify and address issues,in a solution-focused manner. 9. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children in their home and report this information to the Department. 10. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 13 PY-12-13-CPS-0096 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 $150.00/Person(Foster Parent Training-12 Hours) $200.00/Person(Foster Parent Training-15 Hours) $250.00/Person(Foster Parent Training-27 Hours) $100.00/Hour/Couple or Individual(Foster Parenting Training-2 Hours) $810.00/Episode(Foster Parent Training. Elate rate for interpreter.) 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 7`h 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. 14 PY-12-13-CPS-0096 b. For Monitored Sobriety services, proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CPS-0096 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. 16 PY-12-13-CPS-0096 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. 17 PY-12-13-CPS-0096 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. 18 PY-12-13-CPS-0096 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 7`"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 ll`"Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CPS-0096 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 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 20 r $ . . \ ; \ w \ - \ / / q 2« (0 1 x C \' . ® ® m z al § o . , � � a < ems « Q O - LON ,I = oy . O f .» R 2 2 2 m 2 . . . . . , . . . , . . B /3 \ gk2 & % $ � _ . 2 < ©, R 0).-, o m x , . . . . «: - = o o -q �3 2 \a . « > @ cv 0 2 co co ` ° » a $ ` ydzo I327E6 §a� U. m<§ ik . o « a / // 5. 1E0 ---2� 22�2 . ^ » 2 i r k a nlo 2 0 a S N : q • � . 0 7 • D o < Io@I R . < S 54 - a 7 ~ a � / d $ = e % comoo E o % 2 a) = N R / a) > o \ < ~ z 0 \ O.-o $ \ :2 $ Mm 4 & - i_ a z m = c « CO -J k Cl- t O -J a O.<k042 - _ «0 z « w z = 2 i f Zr, - $ \ o = 4— z 7 I2 � r @ I o / g � 2 k \ k S � c t2 _I a f ) ma) « _ 0 c 7E � \ � a- u � U 2 E � \ '6 f > / . I- 2 �� 0 & ° a) z 2 E U c z4- ° ^u = 4-) C7 � § f z # � \ _ \ O ° \ k I - o / I � a. O ( I \ / ho ao ) \ 2 m 7 2 / /] { 9§ / f a E � § \ / ) k O $ > E § _ § ) ] f . E A ; ■ e / § fl v) 2 z § a 2 _ / o. b U. . 17 z \ ) § \ .c « o E = i e , zE ; - k 2 / ( k k a � I ) ) o ii 2 § $ \ 2 - z z E k m § 0 z - o ©0 ; . § j 3 Q. ~ • . E ) - ms % $ Si 0 k \ } e 2 to ) _ , o. \ § \ • § \ oa j O. % \ 27 { � DI 6 § k - f 0 E � 2 % � kf \ ° � � 2 • E k ? E » z e 2 i $ "iv ? . C 2 \ \ 7 i 2 o / c 2 : irt k , a I � � UO \ � F I. E f 0 V / i - $ 2 { \ ! a \ . f - / i - .. (� § § 5 N \k § } 0- § f = . .E . g - \ § \ \ z \ ) 0 0 a ° _ - z a- 0 { \ a) / \ - 9 - 2 \ 2 z \ \ } \ \ }/ jZ 2 PY-12-13-CORE-0199 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN 6? 1 THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS,LLC This Agreement,made and entered into the_day of 2012, 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 Strong Foundations,LLC,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 Core Services to the Department for Home Based Intensive 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 June 1,2012,upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 .29e/07 -4,1'71 PY-12-13-CORE-0199 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 7`h 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. 5. 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 2 PV-12-13-CORE-0199 • 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.5.) 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0199 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 4 PY-12-13-CORE-0199 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. 5 PY-12-13-CORE-0199 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. 6 PY-12-13-CORE-0199 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 Administrator Name Title For Contractor: Julie Box Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Griego,Director Julie Box.Executive Director P.O. Box A 1702 68th Avenue Greeley,CO 80632 Greeley,CO 80634 f970)352-1551 (970)302-1471 18. Litigation 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. 7 PY-12-13-CORE-0199 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 8 PY-12-13-CORE-0199 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. N. 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. 9 PY-12-13-CORE-0199 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. 10 PY-12-13-CORE-0199 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month,and year first above written. ATTEST: ..�� ! ' `";.;i% BOARD OF COUNTY COMMISSIONERS .WELD COUNTY,COLORADO Weld County Clerk to the Board C1' 441th 6 '`s` Sean P.Conway,Chair IP a Y. `s By. ,� JUL 2 32012 Deputy Clerk to t e Board RO • unty Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: --` q � 1 A.Grieg Director Contra r Pl�ltllVP IQYLI'�W Title 11 ogaa —/88 PY-12-13-CORE-0199 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Home Based Intensive Services(Placement Stabilization Services)for children and youth residing in Weld County foster homes within a 100-mile radius of Greeley,CO.,as referred by the Department. The goal of the program is to stabilize placements therefore ensuring safety and permanency for Weld County's children and youth. 2. Services will include the following: a. Baseline assessment through identification of specific issues and goals related to the needs of the child/youth and foster family. b. Individual intervention with foster children and youth that can include appropriate therapeutic and community activities in the community such as addressing socialization needs. c. Therapeutic interventions to address common childhood diagnoses such as Attention Deficit Hyperactivity Disorder(ADHD),mood disorders,attachment issues,trauma,Post Traumatic Stress Disorder(PTSD)and behavior issues. d. Directive Play Therapy,Grief/Anger Therapy,and Cognitive Behavioral Therapy as appropriate. e. A minimum of one(1) hour per week of services. More than one(1) hour can be provided as needed. f. Reassessment after three(3) months to determine progress. 3. CONTRACTOR will work collaboratively with children/youth,foster parents,caseworkers,foster care coordinators and other service providers to identify and address issues,in a solution-focused manner to address issues that could potentially disrupt placements. 4. CONTRACTOR will make recommendations following assessment of the child/youth and foster family. CONTRACTOR will document recommendations and follow through of foster family with regard to recommendations. 5. CONTRACTOR will assess foster families abilities and capacity on an ongoing basis to appropriately care for the foster children/youth in their home and report this information on a monthly basis to the Department. 6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services. If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. S. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12 PY-12-13-CORE-0199 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0199 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 $50.00/Hour(Home Based Intensive Services,Face-to-Face) 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. 14 PY-12-13-CORE-0199 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. 15 PY-12-13-CORE-0199 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. 16 PY-12-13-CORE-0199 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. 17 PY-12-13-CORE-0199 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 11`h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-CORE-0199 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 19 ■ > ° S 0 < m c 6 g W § I E ' 2 -. § E .. • x E \ ca < '1"-- \ c O 0 -O,m 0 � onoo m 2 - _ o _ a � Q § ek � 00 & 6 § . 0 � a . . R 6- o $ x = ■ mztmEd § / \mom w ^ ckk 6 . . . . . . §>: / I- / � faoee_, ^ moR $ S m o 2 - W aloe � a S 2 \ 27 .o � � ° E / f _o $ a < cn § . 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If 0 / \ k } § }] Iz } : � �2 T PY-12-13-HS-0043 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND STRONG FOUNDATIONS,LLC This Agreement,made and entered into the_day of .2012, 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 Strong Foundations,LLC,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 Home Studies and Relinquishment Counseling;and NOW THEREFORE,in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 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. 1 070/0—ifce9 PY-12-13-HS-0043 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. 5. 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 2 PY-12-13-HS-0043 • 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.5.) 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. H. 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 3 PY-12-13-HS-0043 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 4 PY-12-13-HS-0043 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. 5 PY-12-13-HS-0043 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. 6 PY-12-13-HS-0043 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 Administrator Name Title For Contractor: Julie Box Executive Director Name Title 17. Notice 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: For Contractor: Judy A.Grieco.Director Julie Box. Executive Director P.O. Box A 1702 68th Avenue Greeley,CO 80632 Greeley,CO 80634 (970)3524551 (970)302-1471 18. Litigation 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. 7 PY-12-13-HS-0043 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 8 PY-12-13-HS-0043 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. 9 PY-12-13-HS-0043 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. 10 PY-12-13-HS-0043 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: # aR„�ti„J)j BOARD OF COUNTY COMMISSIONERS I ' WELD COUNTY,COLORADO Weld County Clerk to the Board I%61 '4 I' ) Sean P.Conway,Chair By: JUL 2 3 2012 Deputy Clerk t e Board AP VEAP VE STOFOO Co ty Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: J A.Griego Director Contrac r I'—'JW14t' - Title 11 acE-/JPy PY-12-13-HS-0043 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide home study and relinquishment counseling services for families within a 100- mile radius of Greeley,CO.,as referred by the Department. 2. CONTRACTOR utilizes the Structured Analysis Family Evaluation(SAFE)tool developed by the Consortium of Children. CONTRACTOR is SAFE certified and on the State's approved home study vendor list. CONTRACTOR also is certified as a SAFE supervisor. 3. CONTRACTOR will attend SAFE Refresher training during the term of this contract. 4. CONTRACTOR will ensure that all studies are completed utilizing the most up-to-date forms and templates as found on www.consortforkids.org or www.SAFEhomestudy.org. 5. All services will be provided by Julie Box, LCSW. 6. CONTRACTOR will complete a Department of Motor Vehicle background check at no additional charge. All CBI, FBI and LexisNexis background check information will be completed by the Department,unless otherwise directed by the Department. 7. CONTRACTOR will submit a completed home study to the Department with their billing within 60 days of receipt of the home study referral. A complete home study will include the study in SAFE format, background check information,SAFE questionnaires completed by the applicants,references and all other original documents submitted by the home study applicant. 8. Relinquishment counseling services will be provided to all adult individuals referred by the Department, as well as associated children 12 years of age and older,utilizing the required State format. CONTRACTOR will submit a written report and the appropriate affidavits and interrogatories. 9. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any specific Weld County home. Areas of concern may include,but are not limited to,any physical,emotional, educational or behavioral issues. Child abuse must be reported immediately per law. 12 PY-12-13-HS-0043 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 $950.00/Episode(Full Home Study) $425.00/Episode(Home Study Update) $250.00/Person(Additional Adult) $225.00/Episode(Study cancelled after 3.5 hours direct service.) $300.00/Episode(Flat rate for interpretive services/family home study.) $150.00/Episode(Flat rate for interpretive services/individual home study.) $110.00/Hour(Relinquishment Counseling) 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. 13 PY-12-13-HS-0043 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. 14 PY-12-13-HS-OO43 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. 15 PY-12-13-HS-0043 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. 16 PY-12-13-HS-0043 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. 17 PY-12-13-HS-0043 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 7`h 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 11`h Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 18 PY-12-13-HS-0043 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. 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C 2 Z n a E o v v 41 O E i_ c z io A o c col u o d v _ U v 0 U s e-) o u u o z 2 c c N " ep Q � a E .-1 u ;r1 m .1' 0 n = E . t E 0 o g o v a z° a 2° r. r z PY-12-13-CORE-0129 a i 0O.1V LJ l v) CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TRANSITIONS PSYCHOLOGY GROUP,LLC This Agreement, made and entered into the_day of .2012, 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 Transitions Psychology Group, LLC, 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 Core Services to the Department for Life Skills(Therapeutic Visitation,Parent Coaching);and NOW THEREFORE, in consideration of the premises,the parties hereto covenant and agree as follows: 1. Term This Agreement shall become effective on June 1,2012 upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 o? 2 /o? —/fl PY-12-13-CORE-0129 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. 5. 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 2 PY-12-13-CORE-0129 • 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0129 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 4 PY-12-13-CORE-0129 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. 5 PY-12-13-CORE-0129 11. Trainine 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. 6 PY-12-13-CORE-0129 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 Administrator Name Title For Contractor: Norma A.Alkire Co-Director Name Title Gregory S.Creed Co-Director Name Title 17. Notice 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: For Contractor: Judy A.Griego,Director Norma A.Alkire P.O. Box A Gregory S.Creed Greeley,CO 80632 7251 West 20th Street,Unit M-2 5970)352-1551 Greeley,CO 80634 5970)336-1123 7 PY-12-13-CORE-0129 18. Litigation 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. 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. 8 PY-12-13-CORE-0129 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 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. 9 PY-12-13-CORE-0129 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. 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. 10 PY-12-13-CORE-0129 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: Ir h/N BOARD OF COUNTY COMMISSIONERS ~`* , •� WELD COUNTY,COLORADO Yi PWeld County Clerk to the Board 1961c4: Sean P.Conway,Chair By: =,Y>` JUL 2 32012 Deputy Clerk the Board APR ED TO 171: Cou Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES gy: By: r' C„I) L.-3 I Judy Griego, it ctor �(; ontractor 6 [I 11 on— Al•rcc/ Title Contractor Title 11 c2/c —/PJ • PY-12-13-CORE-0129 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Life Skills services to clients referred by the Department, primarily in the Greeley area. Services include: a. Therapeutic Visitation—An enhanced supervised visitation program that incorporates concepts from a variety of therapeutic disciplines such as individual,couples and family therapy, play therapy, music therapy,parent-child interactional therapy and parenting skills education. This blended approach is utilized to develop individualized interventions for the family. All contact between the parent and the child is structured to provide for the safety and well-being of the children while maintaining the continuity of family relationships. Parents are given the opportunity to learn and practice positive parenting. Parents are continually assessed regarding their capacity to appropriately care for their children. Services are available both in-office and in-home to address the continuum of care issues as the client progresses to a less restrictive setting. b. Intensive Life Skills(Parent Coaching)—Services are designed to address family needs to prevent placement of children or facilitate the reunification process when children return home,and enhance the parent's capacity to provide for their children's needs. Services occur in the client's home. 2. CONTRACTOR can serve clients in South County,and retains a satellite office in Westminster,CO. 3. For referrals requiring transportation outside a 25-mile radius of the CONTRACTOR'S office,the Department will approve additional hours for transportation. CONTRACTOR will only bill for travel from the pick-up location to the visit and back. Travel time to or from the office,or other location,to the pick up or drop off location is not an allowable charge. 4. All services will be provided by Master's,or higher, level therapists. CONTRACTOR has one(1)bilingual (Spanish/English) staff member. 5. CONTRACTOR will utilize a team approach to link mental health services with existing services,such as Lifeskills or other community services to ensure a continuum of care. 6, CONTRACTOR will make at least three(3)attempts to contact the client and setup services, The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. S. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12 • PY-12-13-CORE-0129 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0129 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 $105.00/Hour(Therapeutic Visitation, Face-to-Face) $125.00/Hour(Therapeutic Visitation, In-Home or Intensive Life Skills/Coaching) 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. 14 PY-12-13-CORE-0129 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. 15 • PV-12-13-CORE-0129 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. 16 PY-12-13-CORE-0129 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. 17 PY-12-13-CORE-0129 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) Alt 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. 18 • PY-12-13-CORE-0129 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 AAAAAAAAAAAAAA A FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 19 • PY-12-13-CORE-0129 Weld County Contracted Services Submit To: Request for Reimbursement Tobi Vegter,Core&Service (SAMPLE ONLY. ACTUAL FORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.) Contract Coordinator Weld County Department of Human Services Program Area(Ex.Lifeskills, Mental Health, Month/Year of P.O.Box N315 A N.11th Ave., Option B,etc.) Service Greeley,80632 (970)352-1551,ext.6392 (970)346-7667(Fax) Actual Rate � • Household Approved Approved Hours per fl:/41:(s& Number Start End Date Date(s) or Units Hour ;,6 0,d!{ e Client Name(Per Trails Case ID (Per Date(Per (Per of /Service or � .:tp, • Referral) (Per referral) referral) referral) referral) Service Period Unit a i - + SAMPLE ENTRY: 06/01, 6' � '� �1 , 4.,�.a Doe,John 1654888 555555 6/1/2009 8/30/2009 06/02 12 25 4� ,1i � c +.fie„„Xq( r M g_ y�,�, ,gipp" m _ .,ate Iq 4e r e gin ' r+''S)tr's.�s v4r + ArTr� a`r'4:42 ti 20 • PY-12-13-CORE-0129 WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTED SERVICES CLIENT VERIFICATION FORM *eke to CONTRACTOR:&IAEA served during the service month must complete this verification form at the time of service.No request for payment of services will be honored for billed services unless accompanied by the appropriate signed Client Verification Form. Payment for servioes will riot exceed maximum hours or sessions authorized by the Department. Section I:(To be completed by the CONTRACTOR) Primary Client billed: Trails ID Total Hours Billed Household Number: Your Agencses Contact Person: Phone Number SECTION II(To be completed by client) Notice to Chose Your sigrunee mweh be obtained at the him•of service. Yew ngtuhac verifies that services were provided by the senior CONTRACTOR for direct face-to-face contact wily,for the horns and date indicated. Date Hours of Service Number of Hours of Client/Participant Signature(Please have all those attending sign.In the case of a child who is not able to (Es.1:00—2:3O) Service Provided sign,please have someone sign for the child;i.e.,Sally Smith by Gregg Jones,Foster Parent) Notice to CONTRACTOR:Attach d client verification forms to the monthly billing when submitting your billing.Ali requests for payment mud be received by the 7e day Weis month following the month ofseevite. 21 c,OV/i ice PY-12-13-CORE-0144 �� J�IO" 47 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN �0 THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND TRANSITIONS PSYCHOLOGY GROUP,LLC O 6 This Agreement, made and entered into the day of 2012, 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 Transitions Psychology Group, LLC, 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 Core Services to the Department for Mental Health 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 June 1.2012.upon proper execution of this Agreement and shall expire May 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 Core Services funding during the duration of this Agreement. 1 /SS/ PY-12-13-CORE-0144 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. 5. 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 2 PY-12-13-CORE-0144 • 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 Core Services 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; iii. 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 3 PY-12-13-CORE-0144 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 4 PY-12-13-CORE-0144 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. 5 PY-12-13-CORE-0144 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. 6 PY-12-13-CORE-0144 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 Administrator Name Title For Contractor: Norma A.Alkire Co-Director Name Title Gregory S.Creed Co-Director Name Title 17. Notice 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: For Contractor: Judy A.Griego,Director Norma A.Alkire P.O. Box A Gregory S.Creed Greeley,CO 80632 7251 West 20th Street, Unit M-2 (970)352-1551 Greeley,CO 80634 1970)336-1123 7 PY-12-13-CORE-0144 18. Litigation 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. 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. 8 PY-12-13-CORE-0144 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 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. 9 PY-12-13-CORE-0144 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. 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. 10 PY-12-13-CORE-0144 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: (.x BOARD OF COUNTY COMMISSIONERS WELD COUNTY,COLORADO • of ° !'( _ pWeld County Clerk to the Board 651 4;L ;- ♦� 3Wst ` ;- Sean P.Conway,Chair 5" L� r By: / ii ; . .• . ��-f � Jul 2 32012 Deputy Clerk to e Board _,.. ROV A my Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HU N S RVIC By: 11 By: Judy A.Griego, Di ctor ontractor AT' e , �1 Y Yhka) 64Pc_ Con ous.Akez-fro Title 11 02047— 4Pci9y PY-12-13-CORE-0144 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide mental health services to clients referred by the Department, primarily in the Greeley area. Services include: a. Individual Counseling—Services are available for adults and adolescents and are designed to address a wide variety of issues that impact the individual and family. The goal of the service is to remove any barriers to safety and well being in the home which may include, but are not limited to,behavior problems,depression,anxiety,stress,trauma,grief and loss,health,self-image,character and treatment compliance. b. Family Counseling—Services are available to families to address communication,togetherness, flexibility,family structure,family lifecycle,and multi-generational issues. Family interactions and resitiencies also are assessed and treated. c. Co-Therapy—Services are provided by two Master's,or higher, level family systems therapists to bridge services between programs and promote change in referred families in complex cases. Services are limited to one(1)to three(3)sessions per referred family and require pre-approval from the Department's Core and Service Contract Coordinator. d. Play Therapy—Services are available for children two(2)and older. e. Eye Movement Desensitization and Reprocessing(EMDR)Counseling 2. CONTRACTOR can serve clients in South County,and retains a satellite office in Westminster,CO. 3. For referrals requiring transportation outside a 25-mile radius of the CONTRACTOR'S office,the Department will approve additional hours for transportation. CONTRACTOR will only bill for travel from the pick-up location to the visit and back. Travel time to or from the office,or other location,to the pickup or drop off location is not an allowable charge. 4. All services will be provided by Master's,or higher, level therapists. CONTRACTOR has one(1)bilingual (Spanish/English)staff member. 5. CONTRACTOR will utilize a team approach to link mental health services with existing services,such as Lifeskills or other community services to ensure a continuum of care. 6. CONTRACTOR will make at least three(3)attempts to contact the client and set up services. The first attempt will occur within 24 hours of receiving the referral(excluding weekends and holidays). CONTRACTOR will document efforts to engage client in referred services.If after three(3)attempts the client does not respond the CONTRACTOR will notify the caseworker and the Core and Service Contract Coordinator immediately. 7. CONTRACTOR will identify in detail areas of continued concern and make recommendations to the Department regarding continuation of services and/or the need for additional services. 8. CONTRACTOR will document in detail any and all observed or verbalized concerns regarding any child whom the CONTRACTOR is working with under an active referral. Areas of concern may include,but are not limited to,any physical,emotional,educational or behavioral issues. Areas of concern should be reported immediately AND on the required monthly report. 12 PY-12-13-CORE-0144 9. CONTRACTOR will submit reports on a monthly basis for each active referral for ongoing services. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 10. CONTRACTOR will participate in team reviews of ongoing services as needed. These will primarily include staffings and Utilization Review Team(URT)and are not considered billable hours. 13 PY-12-13-CORE-0144 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 $95.00/Hour(Individual,Family or Play Therapy.EMDR.) $180.00/Hour(Co-Therapy) $110.00/Hour(In-home Therapy) $95.00/Hour(Court Facilitation/Staffing) 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 7`h 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. 14 PY-12-13-CORE-0144 b. For Monitored Sobriety services,proof of services rendered shall be a sign-in sheet with client signatures or the test result. 15 PY-12-13-CORE-0144 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. 16 PY-12-13-CORE-0144 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. 17 PY-12-13-CORE-0144 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. 18 PY-12-13-CORE-0144 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: I) 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 7"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 11c°Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 19 PY-12-13-CORE-0144 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 AA AAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 20 PY-12-13-CORE-0144 Weld County Contracted Services Submit To: Request for Reimbursement Tobi Nagler,Core&Service (SAMPLE ONLY. ACTUAL FORM IS IN EXCEL AND WILL BE SENT TO CONTRACTOR.) Contract Coordinator Weld County Department of Human Services Program Area(Ex. Lifeskills, Mental Health, Month/Year of P.O.Box N315 A N.11th Ave., Option B,etc.) Service Greeley,80832 (970)352-1551,ext.8392 (970)348.7867(Fax) Actual Rate -1R 7 C3.9„ boz '� Household Approved Approved Hours per " "42745711t":4:.-;t4/ a ' Number Start End Date Date(s) or Units Hour 1" • '� t`&4z '� ,�,_' Client Name(Per Trails Case ID (Per Date(Per (Per of /Service or ?'Jr '. ‘ k aF"� Referral) (Per referral) referral) referral) referral) Service Period Unit _ tit ) , e . SAMPLE ENTRY: 06/01, Doe,John 1854888 555555 6/12009 8/30/2009 06/02 12 25 £ ka� �2 v £ " 7 k a It s �er,v .1.4.c.9 r i s sue"` S:j i7 i t � ii ' 1.. 4 I .. ,4 v Y.yy q ),,,,,,„,t4 i 1/ ' ,t 1. t4,:$441r; gsl �£ k" ""144:"' m .,' ''''a'''''.' ^ '' 47:5714," -^,;77:1-i' ^a^as , .;,axe^' y' `` yyi a)lea ,j,. £r4:C,- 3,, 21 PY-12-13-CORE-0144 WELD COUNTY DEPARTMENT OF HUMAN SERVICES CONTRACTED SERVICES CLIENT VERIFICATION FORM Notice to CONTRACTOR:All clien served during the service month must complete this verification form at the time of service.No request for payment of services will be honored far billed services unless accgmpanigd by the appropriate signe client Verification Form. Payment for services will not exceed maximum hours or sessions authorised by the Department. Section b(To be completed by the CONTRACTOR) Primary Client billed: Trails ID _ Total Hours Billed Household Number: Your Agency's Contact Person: Phone Number SECTION II Do be completed by client) Notice to Cheek Yew signature mon be obtained e1 the time of service. Your signature verifies dial services were provided by the service CONTRACTOR for dimxi face-to-face contact only,for the hours and date indicated Date Hours of Service Number of Hours of Client/Participant Signature(Please have all those attending sign.In the case of a child who Is not able to (Ex.1:00—2:30) Service Provided sign,please have someone sign for the child;i.e.,Sally Smith by Gregg)ones,Foster Parent) Notice to CONTRACTOR:Attech ell client verification furors to the monthly biting when sebmlttbeg your Whig.All requests for payment must be received by the 7w day of the math followiig the month et/semis. 22 Hello