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Home My WebLink About20121813.tiff RESOLUTION RE: APPROVE NINE (9) 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 nine (9) 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 nine (9) 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 16th day of July, A.D., 2012, nunc pro tunc June 1, 2012. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: _ Sean P. Co , y, Chair Weld County Clerk to the Board /^ E ll,,a Wil iam F. Garcia, Pro Tem BY: L L Deputy CI k to t Bo A) 4//.1861 ` `� ar ra Kirkmeyer APP OVED AS R FesG,; ` -� • �(1 �:�rl'+�� David E. Long ttorney (.3L,, (Q,[ S.b-v1 Doug �Rad Lr^ I mac`Ixer e Date of signature: �' '� � -1 3 eiyaw /444t) // -f O/ 2012-1813 HR0083 MEMORANDUM EXHIBIT X861 � �' DATE: July 12, 2012 Ua� V9 VI \ _ Y TO: Sean P. Conway, Chair, Board of County Corniss ners tiu FROM: Judy A. Griego, Director, Human S ices e a m p 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 first 9 agreements received leaving 43 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) I Ackerman and Associates, PC Sex Abuse Treatment $110.00/Hr 06/01/12-05/31/13 Core 2 Collaborative Services for Mental Health Services $85.00/Hr(Therapy-Individual or Family) Change, PC $85.00/Hr(Evaluations - not to exceed Core $1,350.00) 06/01/12-05/31/13 $65.00/90 Minute (Therapy-Group) $85.00/Month (Case Management) 3 Collaborative Services for Sex Abuse Treatment $85.00/Hr(Therapy-Individual or Family) Change, PC (Offense Specific) $85.00/Hr(Evaluations - not to exceed $1,350.00) 06/01/12-05/31/13 Core $65.00/90 Minute (Therapy-Group) $85.00/Month (Case Management) 4 Crossroads Counseling, LLC Sex Abuse Treatment $80.00/Hr 06/01/12-05/31/13 Core 5 Devereux Cleo Wallace Day Treatment $95.00/Day 06/01/12-05/31/13 Core 6 Family Matters of Colorado, Life Skills Note: Higher rate for each service is outside LLC 25-mile radius of Greeley or Ft. Lupton. Core $45.00/Hr(Safe Exchange) 06/01/12-05/31/13 $75.00/Hr(Safe Exchange) $75.00/Hr(Monitored/Supervised Visitation) 2012-1813 $105.00/Hr(Monitored/Supervised Visitation) $1 10.00/Hr(Therapeutic Visitation) $140.00/Hr(Therapeutic Visitation) $110.00/Hr(Parenting Skills) $140.00/Hr(Parenting Skills) 7 Family Matters of Colorado, Mental Health Services Note: Higher rate for each service is outside LLC 25-mile radius of Greeley or Ft. Lupton. Core $110.00/Hr(Individual or Family Therapy) 06/01/12-05/31/13 $140.00/Hr(Individual or Family Therapy) 8 Greeley Counseling Center Mental Health Services $160.00/hr(Crisis Intervention Services) $183.75/hr(Partial Evaluation-Not to 06/01/12-05/31/13 Core Exceed Full Evaluation Cost) $120.00/hr(Individual or Family Therapy) $120.00/hr(Court Facilitation/Staffing/ Mediation) $168.00/hr(Interactional Evaluation) $140.00/hr(Case Consultation) $1,000.00 (Parental Fitness Evaluation) $1,470.00 (Psychological Evaluation -In- Office) $1,780.00 (Psychological Evaluation -Off- Site) 9 W. Troy Hause, Attorney-at- Mediation $200.00/Hr Law—Greeley Location Core 06/01/12-05/31/13 If you have any questions, give me a call at extension 6510. 'PY-12-13-CORE-0155 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND ACKERMAN AND ASSOCIATES,P.C. 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 Ackerman and Associates,P.C.,hereinafter referred to as the"Contractor". WITNESSETH ESSETH 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 Sexual Abuse Treatment(SAFE-T Program);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-0155 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-0155 • 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-0155 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-0155 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-0155 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-0155 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: Joyce Shohet Ackerman,Ed.D. Psychologist 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 Joyce Shohet Ackerman, Ed.D. P.O.Box A 1750 25fh Avenue,Suite 101 Greeley,CO 80632 Greeley,CO 80634 (970)352-1551 1970)353-3373 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-0155 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§§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-0155 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 subcontractors,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-0155 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-0155 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: �L...._._ BOARD OF COUNTY COMMISSIONERS ` 6 ti, WELD COUNTY,COLORADO Weld County Clerk to the Board e i;,.,,gia. 161 "� .t, can P.Conway,Chair 4 JUL 16 By: R Deputy Clerk t e Board 1111 OVE ST O M: Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES l By: By: Ju A.Grieg Director Contr for Ti le 11 d c•/, e /P/ PY-12-13-CORE-0155 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide time limited,outcome focused therapy through the SAFE-T Program for the treatment of the non-offending parent,the victim and siblings of the victim in sexual abuse cases referred by the Department. 2. CONTRACTOR utilizes a program composed of four parts. Each part can be used as an integrated program,may stand alone or be used in combination with other treatment regimens. The four parts are as follows: a. Part A—The development of the prescriptive safety education and treatment plan if a formal plan does not exist or has not been developed by the Department.Services will be provided in 15 or less hours,delivered over no more than three(3)months. b. Part B—Implementation of the safety education and/or treatment plan as developed by the Department or in Part A(above)with the non-offending parent to increase safety and void repetition of sexual abuse in the family unit. Services will be provided in 20 or less hours,over no more than four(4)months. c. Part C—Short term treatment for the sexually abused child and for the siblings to develop skills for future safety and reestablish trust. Services will be provided in 20 hours or less,over no more than four(4)months. d. Part D—Therapy to encourage maintenance of skills developed and additional support to families who have completed Part A,B and/or C. Services will be provided in 10 hours or less, and are provided at frequency of two times per month over four(4)to six(6)months. 3. CONTRACTOR employees a bilingual staff person who can provide services in Spanish and/or provide translation services. 4. CONTRACTOR has a maximum capacity of eight(8)open cases per month. 5. 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. 6. 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. 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 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 submit reports on a monthly basis for each active referral. 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-O155 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 $110.00/Hour 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-0155 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-0155 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-0155 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-0155 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. 17 PY-12-13-CORE-0155 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 PY-12-13-CORE-0135 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COLLABORATIVE SERVICES FOR CHANGE,PC 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 Collaborative Services for Change, PC, hereinafter referred to as the"Contractor". WITNESSETH WHEREAS, required approval,clearance,and coordination have been accomplished from and with appropriate agencies;and HEREA ,the rado Department of Human Service has provided Core Services to the Department for Mental Health Services; a 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 4?)/ -/Q/3 PY-12-13-CORE-0135 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-0135 • 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. 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; 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-0135 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-0135 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-0135 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-0135 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: Marci Brewer, LCSW Clinical Director/Co-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 Marci Brewer,Clinical Director/Co-Owner P.O. Box A 2480 W. 26th Avenue,Suite 130-B Greeley,CO 80632 Denver,CO 80211 (970)352-1551 (303)433-0188 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-0135 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§§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-0135 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-0135 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-0135 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day, month, and year first above written. ATTEST: a •! , BOARD OF COUNTY COMMISSIONERS rcsv r a,,' WELD COUNTY,COLORADO Weld County Clerk to the Board 1861:' 4 it:::::,,,.ik can P.Conway,Chair JUL 16 2012 0 By: De uty Clerk to a Board RO AST R . orney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES cc By: II. .I I ��. By: CY6 �,, d A.Griego Directo Contractor (.. -cwt cr -1 G\s nice., \ (1C-43-- Title 11 090/02—A?X5 • PY-12-13-CORE-0135 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide mental health services to clients referred by the Department, in the Denver area. Services include individual,couples and family therapy to address specific problematic issues that may include, but are not limited to,abuse recovery,anger management,trauma recovery, behavior disorders, mood disorders and social skills interventions. 2. All services will be provided by Marci Brewer, LCSW,and/or Jeff Kisicki, LCSW. 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 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. 12 PY-12-13-CORE-0135 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 $85.00/Hour(Therapy-Individual, Family) $85.00/Hour(Evaluations- Not too exceed$1,350.00) $65.00/90-Minutes(Therapy-Group) $85.00/Month (Case Management) 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. 13 PY-12-13-CORE-0135 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-0135 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-0135 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-0135 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-0135 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 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-0135 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 AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAMAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core& Service Contract Coordinator Date 19 * :: jai R2 - N O 0) O Q O_ 0 • C .L.. O) 76 N X .' ry ^..:... d i Q O U SW N 0N. `K s k" ai,y 4K E3 � v cc • dim t °� . � �4914 i'it�3 �, 4 !st�+�` O (n HUI20. OLM Y. %-t,?:'„'� r..'p^� ' ,.Eo-#R 1kM. 5 i-. �t." tGG to 15 N 0.2 `CC o 7 W d N ,N r O -0 r T _ a1 E > O CC ') O = O a) O < m b- I- U 0 y�miy Q in N U - CC N 2 O O F- O _ d l O CD O Z o O otnoo O U `m rn o a) vy I- O L (O? O Q N N N C E 0_-0 N it •-•'""- I- W tin ¢w` a - co w C, m d a — o J `aro N N 0 < co o d `° i0 Q -o in in w c N A N N _Ja en w L O J D "- N Z 2Zad CO = 00 To 0 m U C O g an d o N (n a) J _ N d Q -oED '_= and CD N0 #` a en m J Q J O K s-1 ` oa >- w d CC U dca 0_ s CL Z a O a) Z m mW .-.ws O O N J E m z TO J O U 0 d w e d N r-1 N a)--e O 0. N Q O Y � CKW a0 UmcnO a CU } a k ) \ { | \ { \ � \ \ 46 n : a. 15 \ \ w i. f — | 11 - ) \ To | VI 0. / r. ` a \ fa Z # - \ \ . | f ; 392 [ th § � tr' $ § ! Z f w 2 | ) ) O _ { \ ) ° `0 tc 2 § ( ) / - o co } o la zVI _ j b " -?Ji | \ { k — c Ti to o U \ O E cc ) ( N � ` z ' \ ( § ) ) 7 ; 3 \ \ \ \ \ 1 � \ _ PY-12-13-CORE-0158 Em •07 Go is CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND COLLABORATIVE SERVICES FOR CHANGE,PC This Agreement, made and entered into the 1 day of June,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 Collaborative Services for Change, PC, hereinafter referred to as the "Contractor". S WITNESSETH WHEREAS,required approval,clearance,and coordination have been accomplished from and with • �f appropriate agencies;and • WHER€AS - o epenmen, uman Service has provided Core Services to the Department for; -Sexual Abuse Treatment(Offense Specific); 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 dt/t?—/&3 PY-12-13-CORE-0158 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-0158 • 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; 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-0158 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-0158 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-0158 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-0158 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: Marci Brewer, LCSW Clinical Director/Co-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 Marti Brewer,Clinical Director/Co-Owner P.O. Box A 2480 W. 26th Avenue,Suite 130-B Greeley,CO 80632 Denver,CO 80211 (970)352-1551 (303)433-0188 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-0158 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§§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-0158 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-0158 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-0158 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 `P. WELD COUNTY,COLORADO Weld County Clerk to the Board taw ry t Sean P.Conway, Chair ~ z ' JUL 16 2012C) Deputy Clerk t he Board AP VE STOF • Cou Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: Y � J Griego, irector Contractor Co—o-..A,cr C.\`MZn.\ 7.`C4siy Title 11 02C/c9—/3'/3 PY-12-13-CORE-0158 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide offense specific services to clients referred by the Department, in the Denver area. Services include intake assessments,offense specific evaluations,individual,family and group therapy, specialty services for special needs and developmentally disabled youth. 2. All services will be provided by Marci Brewer, LCSW,and/or Jeff Kisicki, LCSW. 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 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. 12 PY-12-13-CORE-0158 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 $85.00/Hour(Therapy-Individual, Family) $85.00/Hour(Evaluations-Not too exceed$1,350.00) $65.00/90-Minutes(Therapy-Group) $85.00/Month(Case Management) 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 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 E of this Agreement in accordance with criteria established by the Department. 13 PY-12-13-CORE-0158 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-0158 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-0158 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-0158 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-0158 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 71h 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-0158 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 i o .2 - Q � • a) Q .� I • - > c (-ald a`) a) co C E cn E CD E O m O. N 7 C () Q C 0 = O U • 0 U M M l('I CO .. . 1. .i. -1 1 1 i 1 . 1. .F•. 1 II . -•••• C) m o Y > aU mm aM (�o to r to g to o m j O 0 ^ th LI. C p o • CC o cnHU5. TEL :::33 ' M 2V as coco Lc)0 4-. N (a co O C I' aI O3 Y UTo 2 _ C > O It Y (I) O Q = O (-12 Q I— Qct i a) ^ _ U '- N = 4) i O Q 0 o 0 ocnoo Mm E 0 m o O a a� c) ti F } a> > (a 0 L U O O N yam+ ZC L 8_7:3 y w O N W 2co Qwa ,_ ooa a w - ro rn U m N - Q .� _i > a Q J O ca N 5 a� Y Qcn 0 2' CZ �° I- 0 F- Z a J O Lo = N - u O a) _0 2 ,n W L O 7 a) Z co = Za v • w _ CO = co _ 0 OD . ai aa) ti m � U CC Cfl > O G m a) a) G J N U w C Q - y E-0 D N m a) • oo `2U J Ha � 2 Q X 0 o N J W a) > VrtZ � U a? Z 0 0 a' W C • F- 0 = �- W ro o rYn J CO Z m u o U a)) d to C ` CL -) } Ti) g< O a �- 0 Q O a 3ct0 6-_ O ow 00 12 E c 2 O V0 \ \ ac 0 — 0 O 715 - 7. \ \ 0 E in o. o re 6 2 - -To - E - 2 \ t 24 | § I - - ( i 420 al k § { , O E in ; > \ / \ \ \ \ \ \ \ ■ B : ! $ - 10 0 - O It \ § D Ill \ _tri \ ra | _ ! — � { ( a eNi \ ii i _ \ § kLn / k 4 § ) \ k + 02 ` 5' ` ` _ } ! / ] rl ; ; \ ! \ \ \ � j \ PY-12-13-CORE-0209 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN JUN 27 202 THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND CROSSROADS COUNSELING,LLC This Agreement,made and entered into the v�day of ,2012,by and between the Board of Weld County Commissioners,sitting as the Board of Human Ser ces,on behalf of the Weld County Department of Human Services,hereinafter referred to as the"Department" d Crossroads Counseling, 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 Sexual Abuse Treatment(Offense Specific Treatment);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 q70/o?—/P/`; PY-12-13-CORE-0209 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-O2O9 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.sea.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(AI DS)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-0209 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)(6). 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-O209 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-O209 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-0209 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: Bob Dix President 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 Bob Dix,President P.O.Box A 1211 Lake Avenue.Suite 203 Greeley,CO 80632 Berthoud,CO 80513 (970)352-1551 J970)685-7469 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-0209 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§§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-0209 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-0209 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-0209 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 .‘ lS I t() WELD COUNTY,COLORADO .rte Weld County Clerk to the Board * 9m= 185 can P.Conway,Chair `'' JUL 16 2012 By: 4 • Deputy Clerk to he Board PROV AS TO FO Co A o y WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES /4144.L174-_. f ', By: By: J y .Griego, hector Contractor \ �r vim-• Title 11 C)7O/n7-/c/ PY-12-13-CORE-0209 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Offense-Specific Treatment services to youth,ages 11-18,and their families as referred by the Department. 2. CONTRACTOR offers two programs; Family Solution Directed Therapy and Individual Solution Directed Therapy. 3. Family Solution Directed Therapy includes: Five to seven months of service. Wrap-around format that involves the youth's immediate and surrounding community. In-home family therapy. Minimal individual therapy. Strength-based solutions. Safety plans. 4. Individual Solution Directed Therapy includes: Six to eight months of service. Wrap-around format that involves the youth's immediate and surrounding community In-home therapy. Individual therapy. Emancipation emphasis. Strength-based solutions. Safety plans. 5. Services will be provided by Bob Dix or James Skeen. All services follow Sex Offender Board Management guidelines,if applicable. Bob Dix is a Full Operating Level SOMB Provider for juveniles. 6. CONTRACTOR will work closely with caseworker,probation officer,Guardian ad Litem and school counselors,and will participate in court hearings and staffings as requested. 7. CONTRACTOR is sensitive to family ethnicity,culture,values and beliefs. 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 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 submit reports on a monthly basis for each active referral. Reports will be submitted per the online format required by the Department, unless otherwise directed by the Department. 12 PY-12-13-CORE-0209 12. 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-0209 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 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`"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-02O9 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-0209 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 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-0209 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-0209 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. 18 PY-12-13-CORE-0209 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 CERTIFYTHE 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 FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 19 3 § O 0 a) N. 3 _ 2 — a d k a a) $ n c E \ / k z §� E .- 2R < t M0 () - 0 >-, / o CV / 0 _2 . . . . . . . . . . . . . . o O,Q) t � � t ® ea_ oIx & ® Rak � § QCo �03 0 g2 M �� k _0.0 C a) <o 2 f� 0 0 a 3 / / 41 (1O ±/ I�2 R R f � j , 7 cc OIo = 4 S 2 INI TLc 2 \ O \ \ \ \ / < w \ . >1 / a / � 0 z # . 0ea g 5 20@00 Co o % / 22 ° eN o H 28 3 \ \ 7 z o f O_ \ cti / m < I ± ± $ 7 i $ % � § 0 _\ > ±k / _ \ �kf 6- < 0 4202 O < ® -o o \ � a — ^ \ X J j { % \ in 2 CL a) _ E _ \ 0 j $ z { \ 0 7 u. ,- O \ < vi_ � \ 2 % / w / } o <0 - —� • —— -- \ \ \ y w & Urz �� a / 0 >, e ° c z 9 JO0 « � E w 3 Dam \ Ea (0 —m = z } uo o % E 2c Es N ° § /7 \# k ) < 0 & 4 ± y ± 0 ° W@0 i _ $' § k 7..L ) _ f § \ k % f , { ) to C ° I . j 7 2' }o • a § f — ° } $ s ii 2 s { \ E k � . E 2 f a � & � § I \ G \ $ \ °u. f ` . a CC 0" § - E I 2 � \ / 2 - 2 $ § % i k / DI ) IIJ B ) } § e a.z z � . ra k � k g � 1 ± - e 2 § ) E / -.5. ® % ■ § - -- \ / \ 1 } • ` W 0 c @ C ca. § 8 § ) 4 ( \ \ 2 . .- o j \ \ 0 ® a - , u k6 ) B CO ) | ) ( © 2 _ / k } a Z ` } a \} t ° \ 10� \ f 12 -Otp- § $ 2 § ^ a % 0 V f ` 2 � 2 To - E 5 x \ i (GI S IS . k / O. 'DSV 0 k / { % 8 \ a 0 k O § ' = f 2 ;) & _ § 2 / ) ( 0 § k ° a t = u k z 2 ` (41 � \ ; � 7, \ k \ m ( z 2 Z • I.1-12-13-CORE-0218 L Lay CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND DEVEREUX CLEO WALLACE This Agreement, made and entered into the 1 day of June,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 Devereux Cleo Wallace, 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;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 JUN 29 2012 PY-12-13-CORE-0218 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-0218 • 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-0218 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-0218 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-O218 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-0218 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: Perry May Assistant 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 Perry May,Assistant Executive Director P.O. Box A 8405 Church Ranch Boulevard Greeley,CO 80632 Westminster,CO 80021 1970)352-1551 (303)438-2202 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-0218 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§§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-0218 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-0218 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-0218 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: Ra-li ';'- ,,BOARD OF COUNTY COMMISSIONERS • ! ,2WELD COUNTY,COLORADOWeld County Clerk to the Board ,1%61 / ♦, `` < , A �;Sn P.Conway,Chair By: �i _ �� !' ..r JUL 162012 y: Deputy Clerk t the Board APP AS TO FOR • Co i ttorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: dy A.Gri go, Dirt or Contractor • 56,41-LEI SMITHtistwrn/£ Title 11 22)/0 -Ad/c3 PY-12-13-CORE-0218 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Day Treatment to children and adolescents referred by the Department,whose behaviors prevent them from attending public school. 2. Services within the Day Treatment Program include: a. Weekly individual,group,and family therapy or as determined by the Multi-Disciplinary Team. Therapy services may occur in-home or at the facility,as appropriate. b. Six(6)hours of academic instruction daily in a structured therapeutic environment. c. Educational Evaluation, if needed,including assessment of special education services. d. Psychiatric Evaluation and treatment including medication monitoring, if needed. e. Substance abuse evaluation and treatment if needed. f. Sexual offender treatment for adjudicated sexual offenders and youth who have been identified to have sexual perpetration and/or victim issues. g. Structured recreation therapy on and off site. h. Independent living instruction for youth ages sixteen(16)and older. i. Transition services for return to public school when youth when deemed appropriate. 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 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. 12 PY-12-13-CORE-0218 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/Day(Day Treatment) 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-0218 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-0218 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-0218 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-0218 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`"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 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-0218 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 y Q 0) �r s to E r o w a c °- y = p a $ L N 1n N j< >. - Y.k U o M v� m ≥, a ,%. 4 o 0t c mam7LL' m r �., I-• O)° p fn X x, CO F O > ... d (.� M ra,. ate.28 -as M ,,,it o ` j .. LO N o fx co ax O D N N T. ... U_ N ' p yo j cu p ¢ x `o92o ti H CO O -5-, N N ZOO $ D `Oinoo CO U m rn o m H o L _U p Qct N .Fp H C Z O.'0 a1 w M 10 I-- al Mfn O. m rt w m o rn U m d m o •I.3,� __I o rcN CI E Q H z ¢ -o LU J O w L a U y U) W O Z m 2 Z a 5- o CI) = co To o co U Q yroll to co O u U) N J N N d a E � N m m ..- 0 E/2 0 Fa �r. COr as = ¢ N K O co E }• it! a > w U J co CL H >. Z o a) Z O w O IoW ¢ � c cc co W z .1 U N a m m z m J ' N Bog o> g "Ew2 ai > gym¢ on za) ¢ O a et � a0 O � UQ r 1 I S ao k § . = \ — 0 e o { E au / 7 . o ; \ ) 05 = k ° ® . � ` . } \ . k } } ) % $ / j & E { L) # ± . •2 o.0.42 \ \4J / / _c, • 2 f . . / %• s 2 O. { f . in 2 o § - - u § - § 7 • Z % } 0 ) 2 / . . co a o { E i % e o . ; I \ § \ cu / /MD 2 b • k | @ . & tw° § j k t• E / � I- ) ! e 0 2 u § c ) 2 K . . / 4 a • a 13 � § �vl ) f - . } § § \ k \ • �• } 2 O � ., - a §• Q. ) % 3 § LA z \ • \ E E f / lEo c 2 2 ■ % c . . Eo \ ° t % . = E I ( w - a 2 § e / k o - ©• a . - j 2 / a , c � ! § E > % $ 2 E _ • § ) k q \ / 2 ( . k O 2 LLJ � \ E _ _ v \j , § ) o § \ cu/ a a . z ) \ § E I _ )k § 0 2 & ) -k7J 7) 0 M \ ) a . 2 7 i § & § a - 0_ ) \ $ E I I] ) z u : PY-12-13-CORE-0198 (40 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND FAMILY MATTERS OF COLORADO,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 Family Matters of Colorado, 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(Visitation,Parenting Skills);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 cPD/ /1/ PY-12-13-CORE-0198 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`n 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-0198 • 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-0198 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-0198 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-0198 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-0198 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: Belinda McKenna Owner/Therapist 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 Belinda McKenna,Owner/Therapist P.O. Box A 712 2nd Street Greeley,CO 80632 Fort Lupton,CO 80621 (970)3524551 1970)576-2906 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-0198 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§§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-0198 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-0198 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-0198 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 ��7): WELD COUNTY,COLORADO Weld County Clerk to the Board t , s 1 an P.Conway,Chair 1O1 i ..�,. JUL 16 2012 r\ Deputy Clerk the Board G :V `_A, RO AS T C u Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES &ULIL �j� /�Q,By: By: i i°4''VIW�"", I�� N�o J d A.Grie , Direct i Contractor atu h em t nitre pi's-f Title 11 Ja)/3 PY-12-13-CORE-0198 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide in-office and in-home Life Skills services to individuals and families referred by the Department. In office visitation services will be provided at 712 2nd Street,in Fort Lupton,Colorado, or 1120 38th Avenue,Greeley,Colorado. 2. CONTRACTOR utilizes therapy models that include,but are not limited to,Structural,Integrated,Solution- Focused,and Cognitive Behavioral,as well as the Satir Communication Model. 3. Services include the following: a. Safe Exchanges—Supervised exchange of children for the purposes of parenting time where each parent or guardian shall have pick up and drop off times that will prevent face-to-face contact between the parties. b. Monitored/Supervised Visitation—Supervision of family visits,both verbally and physically,for positive and appropriate interactions. The supervising staff member shall be within sight and sound of all participants at all times and will intervene on a limited basis as necessary to ensure the safety and supervision of the child(ren). Supervision of family visits that include a competency-based nurturing program to meet the assessed needs of families.The supervising staff member will provide coaching and skills training to parents. Parents are then given the opportunity to practice new skills during visitation time. Emphasis will be placed on families completing the areas of greatest need first and progressing through the program accordingly. c. Therapeutic Visitation-An enhanced supervised visitation program that incorporates concepts from a variety of therapeutic disciplines such as individual,couples and family therapy,parent- child interactional therapy and parenting skills education. This blended approach is utilized to develop individualized interventions for the family. d. Parent Coach (In-home)—In-home support/coaching to teach parenting and household management skills in order for parents to become better caregivers for their children. Skills taught can include,but are not limited to,physical care of children,child development,discipline, nurturing,nutrition,relationships, budgeting,educational,medical,and safety. 4. All services will be provided by Belinda McKenna, MA, NCC, LPC. S. CONTRACTOR can provide transportation when needed. 6. CONTRACTOR will ensure that all contact between the parent and the child is structured to provide for the safety and well-being of the children,and allows the parents the opportunity to learn and practice positive parenting,while maintaining the continuity of family relationships. 7. CONTRACTOR will continually assess parents regarding their capacity to appropriately care for their children. 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. 12 PY-12-13-CORE-0198 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 submit reports on a monthly basis for each active referral. Reports will be submitted per the online format required by the Department,unless otherwise directed by the Department. 12. 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-0198 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 $45.00/Hour(Safe Exchange) $75.00/Hour(Safe Exchange-Outside 25-mile radius of Greeley or Fort Lupton) $75.00/Hour(Monitored/Supervised Visitation) $105.00/Hour(Monitored/Supervised Visitation-Outside 25-mile radius of Greeley or Fort Lupton) $110.00/Hour(Therapeutic Visitation) $140.00/Hour(Therapeutic Visitation -Outside 25-mile radius of Greeley or Fort Lupton) $110.00/Hour(Parenting Skills) $140.00/Hour(Parenting Skills-Outside 25-mile radius of Greeley or Fort Lupton) 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-0198 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-0198 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-0198 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-0198 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-0198 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 7t"of the month following the month of service in order to be processed for payment that month. Billing received after the 7t"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`"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-0198 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 AAAMAMAAAAMAAAAAAAAAAAMAMAMAMAAAMAMMAMAAMMA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: Core&Service Contract Coordinator Date 20 ....:: . ... : ' -,[ � S t E W E 7 0 ��ELf co OC Z �{ t rIt o LC y W Q _ .° .,�:', wTk. a t ..: a. +�'v oEo 0 a) to 04el N x Till t{: y m err,k0uo * S t f 3 , y vsrc� � xac9 ° r " N CL at `o 2 N _ U W W c '— O p < i Qa r y O N N .Z p p ` ' I— OQ O (n 00 t:. U m 0 - a) O N p r 0 N O L U O ay 0 a C N "O' M"Z O d len' � cn < WaI W Co d d o11144,14, U J o. N a`) c t_ a 2 cD 111 N too ¢ ≤no Z to J O N W .Cto m U yn 'n W r o E Z 2Za � U 2 Co m O U N in N Z W as e a) c J a U N co !ri -o E D m cN o w I- a- '"" o al 0 of >. w a a o Tcc ap o 2 a) Z W U O W Q O co c M O ... J E CO Z W J o '. - Uca me a � 't' . rq v C � mo t g ' 5i � aO O � uQio y`r a T 0J I 00 ( OJ _ s o § ■ k . $ \ ) \ $ 7 2 I § § \ \ j I s } $ 7.1 _ ° " 22. j \ 0 \ \_ J 13 \ f / { G , 01 13 / � .C , \ / 7 «3 u E � Mr — E \ a cr k te / ± . I in 2 i \ a / _ / , I } >U CC 0 k / $ w Z { ) 3 k 2 cr - ■ o { a = / �as ) ; as I 'V z § f { ) 0 0. 2 � 2E O / � \ e .0 � � � j co 71 § k iri b ) 7 . _ a § § \ _ « , B w 2q / \ \ . I_ W � ) co k k \ 0 . \ \ \ \ S § a § - � ' ) g R Q fa % r w § O. a. � 7 % U 2 E re } f \ . 2 -EI % | k \ / { } [ / { I � . .2 0J y - . C f0 � 0 u0 la k , » 0 ) \ . § 7 � § — \ $ ' k 2 Q . ea — ) k k / \ / 2 k 7j as _ . 4 . .§ CD K E E \/ CC 0 a ) % a f q K / / = k = \j 0 I ( % s § z 2 2 { \ el Z c ( � ( / 2 CL z § _ & 2 sn 2= [ } � f Y 1 Lei 19 %i PY-12-13-CORE-0197 CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND FAMILY MATTERS OF COLORADO,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 Family Matters of Colorado,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 q)0/O? /f/ PY-12-13-CORE-0197 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 a seq.and its implementing regulation,45 C.F.R. Part 80 a seq.; and 2 PY-12-13-CORE-0197 • 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-0197 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-0197 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-0197 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-0197 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: Belinda McKenna Owner/Therapist 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 Belinda McKenna,Owner/Therapist P.O. Box A 712 god Street Greeley,CO 80632 Fort Lupton,CO 80621 1970)352-1551 (970)576-2906 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-0197 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§§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-0197 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-0197 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-0197 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 Weld County Clerk to the Board • (k r P Sean P.Conway,Chair JUL 1 6 20 Deputy Clerk t. he Boar. APP % AS TO Fame' Cou1 orney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: &bah ) t44 44'T Neer A d A.Grieg , Director Contractor Ohm er/7hew sit Title 11 PY-12-13-CORE-0197 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide in-office and in-home Mental Health Services to individuals and families referred by the Department. In office visitation services will be provided at 712 2n°Street,in Fort Lupton, Colorado,or 1120 38th Avenue,Greeley,Colorado. 2. CONTRACTOR utilizes therapy models that include Solution Focused,Narrative,Structural,Cognitive Behavioral,as well as the Satir Communication Model. 3. Services include the following: 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. Couples Counseling—Services are available to couples to address existing issues in order to facilitate long-lasting systemic change within the family. Services build upon the strengths and resiliency of the couple in order to correct deficit areas that undermine the family's foundation. c. Family Counseling—Services are available to families to address communication,togetherness, flexibility,family structure,family lifecycle,and multi-generational issues. Family interactions and resiliencies also are assessed and treated. 4. All services will be provided by Master's,or higher, level therapists. 5. CONTRACTOR can provide transportation when needed. 6. CONTRACTOR will ensure that all contact between the parent and the child is structured to provide for the safety and well-being of the children,and allows the parents the opportunity to learn and practice positive parenting,while maintaining the continuity of family relationships. 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 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. 10. CONTRACTOR will submit reports on a monthly basis for each active referral. 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-0197 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 $110.00/Hour(Therapy-Individual or Family) $140.00/Hour(Therapy-Individual or family-Outside a 25-mile radius of Fort Lupton or Greeley) 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 7ih 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-0197 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-0197 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-0197 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-0197 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. 17 PY-12-13-CORE-0197 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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I .C § § § ( % _ 2 § § 2 } \ - § $ 0 _ ) R x 2 di 2 0 % % 2 E - } ° 2 CU k ) k 4 \ a ) a « ) ; \ q O ele a _ § 2 w cu k / § _ \ en I _C. - ■ E % / f 9 2 / Te 42 g . k 0 # } 2 - _ -1- Cr ii ' Z � " G \ E § E \ ) I , b } cc � 1 ` : � k S E a \ c § % / \ / \ \ z 2 2 , a t N (C = t = q . § . . a 2 § § \ « § ; ; f $ G. z § � I 2 2 j z - i... . 1 • N'/ 0/ PY-12-13-CORE-0139 L Z' CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND GREELEY COUNSELING CENTER 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 Greeley Counseling Center,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 9O/a -/f/3 PY-12-13-CORE-0139 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-0139 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, 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-0139 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)(6). 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 4 PY-12-13-CORE-0139 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 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-0139 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-0139 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: Jack J.Gardner Psychologist 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 Jack J.Gardner.Psy.D. P.O.Box A 1228 8th Street Greeley.CO 80632 Greeley,CO 80631 1970)352-1551 1970)356-8482 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-0139 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-0139 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-0139 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-0139 IN WITNESS WHEREOF,the parties hereto have duly executed the Agreement as of the day,month,and year first above written. ATTEST: f: BOARD OF COUNTY COMMISSIONERS %‘"v,,- "(\\ WELD COUNTY,COLORADO • .Weld County Clerk to the Board �� -�``��' 1861 fSean P.Conway,Chair JUL 1 6 20 Deputy Clerk t the Board AP V AS C ty Attorney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: I1 . I . . . �V By: r F � o-✓`C, .C�,�r� Judy A. riego,D rector %onttrraactOr ! �' /5�c6a-�0Sr S Title 11 Q9oia-J?%3 PV-12-13-CORE-0139 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide evaluation,therapy and crisis intervention therapy services to individuals and families referred by the Department. Services include the following: a. Psychological Evaluations(Adult or Adolescent)—Evaluations utilize a multimodal approach specific to the client's needs using a variety of standardized personality tests(i.e.,MMPI,MCMI), intelligence tests(i.e.,WAIS-Ill,GAMA),substance abuse screens(i.e.,urine or saliva samples), non-standardized tools(i.e.,Life History Questionnaire,Children's History Questionnaire),clinical interviews,mental status examination,and review of collateral references. b. Parental Fitness Evaluations—Evaluations utilize a structured interview and rating scale to be completed by the examiner and the caseworker supervisor. The caseworker observes the interview and completes a rating scale. The interview utilizes a"job testing"assessment approach to help determine a parent's knowledge,skills,motivation,and capacity to effectively parent. c. Interactional Evaluations—Evaluation utilizes observation of parents and children to determine parenting capacities,strengths,needs,and attachment. d. Individual/Family Therapy—Therapy services are provided to address specific identified areas of trauma and/or conflict with individuals,families,couples and/or children. A combination of insight oriented therapy techniques with behavioral objectives is applied on a situation-specific basis. e. Crisis Intervention Services—Therapy services for adults,and/or children to address specific urgent situations. Crisis intervention techniques with behavioral objectives are applied on a situation-specific basis. f. Consultation—Consultation is available on a case-specific basis and is available to clarify treatment needs,diagnosis and prognosis,and better understand client needs. If requested,a brief report will be produced. 2. Services will only be provided by Jack J.Gardner,Psy.D. 3. 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. 4. 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. 5. CONTRACTOR will make at least three(3)attempts to contact the client and set up services,unless otherwise agreed to by the Department. 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. 12 PY-12-13-CORE-0139 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-0139 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 $1,470.00/Episode(Psychological Evaluation,Adult or Adolescent-In-office) $1,780.00/Episode(Psychological Evaluation,Adult or Adolescent-Out-of-office) $1,000.00/Episode(Parental Fitness Evaluation) $183.75/Hour(Partial Evaluation Hourly Charge-Not to exceed cost of complete evaluation) $168.00/Hour(Interactional Evaluation) $160.00/Hour(Crisis Intervention Services) $140.00/Hour(Case Consultation) $120.00/Hour(Therapy-Individual,Family) $120.00/Hour(Court Facilitation,Mediation or 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 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-0139 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-0139 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-0139 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-0139 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-0139 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 PY-12-13-CORE-0139 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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J a cc 0 O a� Z 92 "5 m Z U coo < °' E W c co 71.eh O N J E m Z N J O U ya m c - a -) r. a) 0 Q 2 a °) `a) <¢ o } CC a0 5cctn0 a , $ \ j . 2 m : 0 o = o 2 ] 9 &\ =t 0. •L ea # a - c 0U k § # r. . f \ a ; ) § a / ] & G 00 � § k \ / � � a Cu, § ( > k % c kt - � # « z a ■ 2 0 7 \ \ = a Y. t i ) f } } la 1 a o % E _ / { a ; 2 � I { � E O. i ■ k & e ca ae # 2 a 3 } § \ } / § k IL \ } } k } E q el k a a InC6 3E 0_ w a § § § \ § / / & o ob a - 2 - Q � 5 o § O. /3.E % i 2 § " ` S % E / / t 2 � E 6 % § ) } ■ I ] kt 00 4 A ) v ) . « ; C # 2 7 \ \ O ° a § ) } 7 $ _ . a , S 2 % § St 2 } a 2 10 . k s ` ) k \ 4 5 4 o ii "' 2 O. a mi a ,.Q.O { § •• ■8 & 12! § U a 5) Zk m 8 g • . « E 4 o 15 8 c , - _ = S o © x a k / 2 § a\ ; - a E E § § i2 r 2 a. z = , » I _ 2 2 z & • PY-12-13-CORE-0131 /6'/42/' z CHILD PROTECTION AGREEMENT FOR SERVICES BETWEEN THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES AND W.TROY HAUSE,ATTORNEY AT LAW 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 W.Troy Hause,Attorney at Law, 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 Mediation 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-O131 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-0131 • 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. 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; 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-0131 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)(6). 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-0131 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-0131 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-0131 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: W.Troy Hause Attorney at Law 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 W.Troy Hause,Attorney at Law P.O. Box A 71011`h Avenue,Suite 205 Greeley,CO 80632 Greeley,CO 80631 1970)352-1551 1970)351-6711 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-0131 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§§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, 8 PY-12-13-CORE-0131 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. 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-0131 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-0131 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 f { CT Weld County Clerk to the Board jr ?)��,�5 Sean P.Conway, Chair wP A t ey: y JUL 16 20 Deputy Clerk t the Board APPR TO F orney WELD COUNTY DEPARTMENT CONTRACTOR: OF HUMAN SERVICES By: By: J d A.Griego Director Contractor iTba ions 4--,— LOLL Title 11 3)Cia —AP/3 PY-12-13-CORE-0131 EXHIBIT A SCOPE OF SERVICES 1. CONTRACTOR will provide Mediation services to Weld County families in Dependency and Neglect cases as referred by the Department. 2. CONTRACTOR will attempt to facilitate resolution of issues between the parties,which will lessen the amount of Court time and contested matters,assist in providing permanency for children in a shorter time frame,and assist the parties in coming to their own resolutions which are more likely to be followed. 3. CONTRACTOR can facilitate up to six(6)mediations per month and can offer flexible meeting times to accommodate mediations including early morning,noon,evenings and weekends. 4. Mediation sessions are generally scheduled for one(1)to two(2)hours in length; however CONTRACTOR can accommodate longer sessions up to one(1)day in length under special circumstances. 5. CONTRACTOR employs a full-time legal assistant who schedules and prepares for mediation sessions on behalf of the CONTRACTOR. 6. All mediation services will be provided by W.Troy Hause,Attorney at Law. 7. CONTRACTOR will submit a statement that states whether or not agreement or partial agreement was reached for each referral. This statement will be submitted with each monthly billing. 12 PY-12-13-CORE-0131 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 $200.00/Hour(Mediation 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 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-0131 EXHIBIT C CHILD and FAMILY SERVICES REVIEWS(CFSR) The Child and Family Services Reviews(CFSR)examines child welfare service outcomes in three areas;Safety, Permanency and Well Being of families. For each outcome,data and performance indicators measure each state's performance according to national standards and monitors progress over time. Following the review,a Performance Improvement Program (PIP)will be implemented for the state to enhance services to families. Additionally,the review will assess statewide, systemic factors to determine if the systems necessary to achieve positive outcomes for families are in place. All agencies that contract to provide service to families and children in Weld County must continually strive for positive outcomes in the areas of safety, permanency and well-being for our youth. In order to insure continued progress in this area,the Department is requiring CONTRACTORS to comply with a standard assessment and reporting system which will address these three areas.* The Department is requesting that CONTRACTOR reports include observations and recommendations regarding clients in a way that specifically addresses the areas of safety,permanency and well-being. Below are the specific outcomes that will be assessed by the CFSR in the areas of safety, permanency and well-being,followed by specific considerations and tasks which must be addressed by the Department contracted CONTRACTORs. Safety Outcomes CFSR Outcome Measures Safety 1 Children are,first and foremost,protected from abuse and neglect. Safety 2 Children are safely maintained in their homes whenever possible and appropriate. Considerations for the Department's CONTRACTORs • CONTRACTORs should always consider the following definitions regarding child safety when assessing families. o Children are considered safe when there are no present dangers or impending danger threats,or the caregivers' protective capacities control existing threats. o Children are considered unsafe when they are vulnerable to present or impending danger threats, and caregivers are unable or unwilling to provide protection. o Risk is the likelihood(chance, potential, prospect)for parenting behavior that is harmful and destructive to a child's cognitive,social,emotional and/or physical development,and those with parenting responsibility are unwilling or unable to behave differently. • Monthly reports should continually document an assessment of risk and safety concerns and the interventions that are being offered by the CONTRACTOR to ameliorate those concerns. • Monthly reports should make recommendations regarding services and/or safety measures that the CONTRACTOR believes should be implemented to insure safety of the child(ren). • CONTRACTORs must specifically document efforts to engage families in services and to control for safety. 14 PV-12-13-CORE-0131 Permanency Outcomes CFSR Outcome Measures Permanency 1 Children have permanency and stability in their living situations. Permanency 2 The continuity of family relationships and connections is preserved for children. Considerations for the Department's CONTRACTORs: • CONTRACTOR reports should always note the primary permanency goal for the child and document how interventions are working toward achieving that goal. • CONTRACTOR reports must indicate progress toward achieving the permanency goal and should make specific recommendations regarding how the continuation of the service may assist in achieving the goal. • CONTRACTORs should continually provide recommendations about whether any out-of-home placement continues to be appropriate and should make recommendations regarding when changes in this area should be made,in the CONTRACTORs'opinion. • CONTRACTORs should continually assess family relationships(parent/child,sibling/sibling,extended family/child,etc.)and should report any concerning relationship issues which may be a barrier to achieving permanency. CONTRACTORs should document ongoing efforts to resolve those issues and/or make recommendations regarding additional services that may be required to address relationship issues. • CONTRACTORs must document specific time frames when recommending ongoing services and/or recommending changes to services and/or placements. Child and Family Well-Being Outcomes CFSR Outcome Measures Well Being 1 Families have enhanced capacity to provide for their children's needs. Well Being 2 Children receive appropriate services to meet their educational needs. Well Being 3 Children receive adequate services to meet their physical and mental health needs. Considerations for the Department's CONTRACTORS: • CONTRACTORs must engage in ongoing assessments of the parents'capacity to appropriately care for their children and whether or not the service being provided continues to be appropriate. This must be clearly documented in monthly reports. • CONTRACTORs should specifically detail areas of continued concern within the family and make recommendations regarding whether that CONTRACTOR's service continues to be appropriate. Reports should also document what barriers may be impeding progress. • CONTRACTORs should document any and all observed concerns regarding any child with whom the CONTRACTOR is working. This should include concerns regarding physical,emotional,educational and behavioral well-being of the child. When appropriate,CONTRACTORs should make recommendations regarding evaluations and/or additional services that may address these concerns. *Standardized reports will be provided and should be utilized by all agencies providing ongoing services to the Department's families unless otherwise noted. 15 PY-12-13-CORE-0131 EXHIBIT D PROCESS REFERENCE GUIDE FOR CONTRACTORS Contracted Services Referral/Tracking/Billing Procedures The following procedures apply to all CONTRACTORs regardless of the service being provided,unless otherwise directed by the Department. Failure to comply with these procedures may result in delay of payment or denial of billed charges. Referral: 1) Authorized referrals are forwarded to CONTRACTORs via e-mail from the Core and Contracted Services Coordinator or Service Utilization Assistant. 2) Once received, carefully review the referral for service information, client contact information and specific information regarding the start and end date of the referral. a. Services provided prior to the start date or after the end date of an authorized referral will be not be reimbursed. Services SHOULD NOT begin prior to having an authorized referral. b. A verbal or written authorization from a caseworker or supervisor does not constitute an authorized referral. If contacted by a caseworker or supervisor to start a service please contact the Core and Contracted Services Coordinator for a referral. 3) Referrals for ongoing services (visitation,therapy, home-based, etc.) are reviewed by the Department's Utilization Review Team (URT) prior to the referral end date. CONTRACTORs are asked to provide input regarding client status/progress. You will be notified in advance via e-mail if you have case up for review. CONTRACTORs can attend in person or via phone if more convenient. 4) Any and all modifications to an authorized referral can only be approved by the Core and Contracted Services Coordinator,the Service Utilization Manager or the Utilization Review Team. A verbal or written authorization from a caseworker or supervisor does not constitute authorization to modify a referral. If contacted by a caseworker or supervisor to modify a referral please contact one of the abovementioned parties for proper authorization. Tracking: 1) Each client receiving face-to-face services must sign a Client Verification Form at the time of service regardless of the service being provided unless otherwise directed by the Department. 2) If multiple clients are receiving services together(ex. Family therapy), each member should sign the same form at the time of service. 16 PY-12-13-CORE-0131 3) If the client receives services over multiple dates,then the client must sign at the time of service for each date (appointment). 4) If a child is receiving services and is unable to sign,then an appropriate person should sign for the child and indicate their relationship to the child (ex.Jane Smith,foster mom,for Jimmy Jones). 5) The Client Verification Form should track services for one calendar month only,should not cross months, and must be submitted with that month's billing. Billing: 1) All billing must be submitted by the 7th of the month following the month of service in order to be processed for payment that month. Billing received after the 7th of the month may result in forfeiture of payment as noted in the Agreement. 2) All payments are contingent upon receiving a complete and accurate billing. A complete billing should include a 1) monthly progress report submitted online(if applicable to the service provided), 2)the billing documents (Authorization for Contractual Services with original signature and Request for Reimbursement), and 3) Client Verification Form(s) with original signatures. A CONTRACTOR also may include their own invoice or other documents they feel are applicable. a. Monthly progress reports will be distributed to the appropriate caseworker once the billing is processed. b. Billing documents must be submitted with ORIGINAL SIGNATURES. Faxed copies of the Authorization for Contractual Services or Client Verification Form WILL NOT be accepted. 3) All billings should be submitted to: Tobi Vegter Core and Contracted Services Coordinator WCDHS/Service Utilization Unit Mailing Address: P.O. Box A,Greeley,CO 80632 Physical Address: 315 A North 11th Avenue,Greeley,CO 80631 4) Final remittance will be provided by the Weld County Department of Human Services Fiscal Office. 17 PY-12-13-CORE-0131 WELD COUNTY DEPARTMENT OF HUMAN SERVICES AUTHORIZATION FOR CONTRACTUAL SERVICES TO BE COMPLETED BY CONTRACTOR: Date: CONTRACTOR: Billing Contact: Phone Number: Address: Description of Services (Program Area): *Service Month/Year: Charges: $ *Month/Year services were provided. I CERTIFY THE SERVICE AUTHORIZED WAS PROVIDED ON THE DATE(S) INDICATED AND THE CHARGES ARE MADE PURSUANT TO A BONA FIDE CONTRACT BETWEEN ME AND THE WELD COUNTY DEPARTMENT OF HUMAN SERVICES. Printed Name of Signer CONTRACTOR Signature Date AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA FOR COUNTY USE ONLY: AMOUNT AUTHORIZED FOR PAYMENT: $ Approval: / Core&Service Contract Coordinator Date 18 v - a . #33x,.. til t i ; :� `,a r1,4444,4044.C,„-4,r h r3 4µ s:" a i dai3� .t'+k ` arJAr !� . € .r i irirdy may. 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