HomeMy WebLinkAbout20101376.tiff RESOLUTION
RE: APPROVE REVISIONS TO OPERATIONS MANUAL, SECTION 2.000, SOCIAL
SERVICES DIVISION POLICIES AND PROCEDURES
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 revisions to Section 2.000, Social Services
Division Policies and Procedures, for the Department of Human Services Operations Manual, and
WHEREAS,after review, the Board deems it advisable to approve said revisions, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, ex-officio Board of Social Services, that the revisions to Section 2.000, Social
Services Division Policies and Procedures, for the Department of Human Services Operations
Manual, be, and hereby are, approved.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 28th day of June, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
, ^ ELD COU' , COLORADO
ATTEST: i! t1�e ._ate s •�`:�� ' Yv
q,� o Gl- Radem=cher, Chair
We County Clerk to the Boa 1861 "
t� �,r SED
`� ?t� �•ara Kirkmeyer, Pro-Tem
BY: � �I�i. U N
Dep Clerk t., the Board I V
J Sean P. C ay
4
APPR AS TO
it a F. G cia
C my Attorney
David E. Long
Date of signature: 111A 10
C-11 as 2010-1376
aDAD HR0081
MEMORANDUM
6
fai 4 DATE: June 21, 2010
' TO: Douglas Rademacher, Chair, Board of County Comttasigners
IlIDAt, l CC ;.���1�
FROM: Judy A. Griego, Director, Human Servicwt��epa c
COLORADO j RE: Revisions to Section 2.000, Social Services Division
Policies and Procedures, Weld County Department of
Social Services Operations Manual
Enclosed for Board approval are revisions to Section 2.000, Social Services Division Policies
and Procedures, Weld County Department of Social Services Operations Manual. These
revisions were reviewed at the Board's June 21, 2010, Work Session.
The purpose of the updates to the Operations Manual is to include the Rate Setting
Methodology according to State Statute.
Per Section 26-5-104 (6) (d) C.R.S, "by July 1, 2008 and by July 1 of each even-numbered
year thereafter, the state department shall complete a review of the methodology by which
counties negotiate rates, services and outcomes with licensed providers...". These proposed
updates are fulfilling this mandate and will be submitted to the State upon approval of the
Weld County Board of County Commissioners.
The major update is to Exhibit A.
Section Citation Title of Section
2.320.1 -Exhibit A State Licensed Provider Reimbursement
2.320.2—Exhibit A County Certified Provider Reimbursement
If you have questions, please give me a call at extension 6510.
•
2010-1376
Social Services Division Policies and Procedures
2.320 Out-of-Home Placement Reimbursement
Effective 1/1/01 The Department establishes rates to be paid to providers for out-of-home
Revised 6/02 placements at the beginning of every state fiscal year. These rates are
similar to the State determined reimbursement for specific types of facilities.
2.320.1 State Licensed Provider Reimbursement
Added 6/02
Revised 6/06 A. The Department will reimburse a state licensed provider if such provider
Revised 8/06 meets the State reimbursement requirements of Colorado State Rules,
Revised 8/07 Section 7.405, Volume VII, Social Services Programs, and the State
Revised 6/10 requirements for State Licensed Providers of Colorado State Rules,
Exhibit A Section 7.417.2, Volume VII, Social Services Programs.
B. As required by C.R.S. 26-5-104, the Department will negotiate rates,
services, and outcomes with providers as outlined in the submitted Rate
Setting Methodology, Exhibit A, that has been approved by the State.
C. The Department will enter into yearly contracts with each State Licensed
Provider that the Department utilizes. The Contracts will be in force from
July 1, the start of the state fiscal year, to June 30, the end of the state
fiscal year.
D. The Child Welfare Rate Negotiator will initiate and mail out to providers,
both the State prescribed SS-23A, Agreement to Purchase, contract
Exhibit B, for Providers as outlined in Colorado State Rules, Section 7.304
and Section 7.304.661 of Volume VII, and the Weld County Addendum to
the Agreement to Purchase SS-23A, Exhibits C-G. The county specific
addendum will reflect the daily rate to be paid for each child placed with
the contracted provider for the state fiscal year, as outlined in paragraph B.
Rates reflected within the yearly contracts, will be determined by the State
and may include a cost-of-living increase the county has approved. Rates
may also be negotiated to reflect additional services that the department
has approved.
E. Once signed contracts have been received from providers, the State
prescribed SS-23A Agreement to Purchase contracts will be approved and
signed by the Director and All Weld County Addendums to the State
prescribed SS-23A will be approved and signed by the Director and the
Board of County Commissioners, Weld County, sitting as the Weld
County Board of Social Services.
F. Once Placement Contracts are approved and signed by the Director and/or
the Board of County Commissioners, each provider will be mailed fully
Social Services Division Policies and Procedures
executed copies of the Agreement to Purchase Services, SS-23A and Weld
County Addendum for their records.
Revised 8/07 G. All original contracts will be filed in the Service Utilization Unit. The
Service Utilization Unit will notify the Social Services Administrator, or
designee, if a provider is requesting reimbursement and does not have a
current signed contract. Payment cannot be authorized to the provider
until the required contract is provided to the Service Utilization Unit.
Revised 8/07 H. Bed hold payments for a child's temporary absence from a provider,
including hospitalization, are limited to a maximum of 3 days unless
otherwise negotiation as allowed in Volume VII.. All bed hold
authorizations need to be approved, in writing within 2 working days,
by the Administrator. Once a bed hold is authorized, the Negotiator will
contact the provider to negotiate a daily rate for the approved bed hold.
2.320.2 County Certified Provider Reimbursement
Added 8/07
Revised 6/10 A. The Department will reimburse a county certified foster care provider I
Exhibit A such provider meets the State reimbursement requirements of Colorado
State Rules, Section 7.405, Volume VII, Social Services Programs, and
the State requirements for County Certified Providers of Colorado State
Rules, Section 7.417.1, Volume VII, Social Services Programs.
B. As required by C.R.S. 26-5-104, the Department will negotiate rates,
services, and outcomes with providers as outlined in the submitted Rate
Setting Methodology, Exhibit A, that has been approved by the State.
C. Effective January 1, 2008, the Department will enter into yearly contracts
with each County Certified Provider that the Department utilizes. The
Contracts will be in force from July 1, the start of the state fiscal year, to
June 30, the end of the state fiscal year.
D. Effective January 1, 2008, the Child Welfare Rate Negotiator will initiate
and mail out to providers, both the State prescribed SS-23A, Agreement to
Purchase, contract Exhibit B, for Providers as outlined in Colorado State
Rules, Section 7.304 and Section 7.304.661 of Volume VII, and the Weld
County Addendum to the Agreement to Purchase SS-23A, Exhibits C-G.
The county specific addendum will reflect the daily rate to be paid for each
child placed with the contracted provider for the state fiscal year, as
outlined in paragraph B. Rates reflected within the yearly contracts, will be
determined by the State and may include a cost-of-living increase the
county has approved. Rates may also be negotiated to reflect additional
services that the department has approved.
Social Services Division Policies and Procedures
E. Once signed contracts have been received from providers, the State
prescribed SS-23A Agreement to Purchase contracts will be approved and
signed by the Director and All Weld County Addendums to the State
prescribed SS-23A will be approved and signed by the Director and the
Board of County Commissioners, Weld County, sitting as the Weld
County Board of Social Services.
F. Once Placement Contracts are approved and signed by the Director and/or
the Board of County Commissioners, each provider will be mailed fully
executed copies of the Agreement to Purchase Services, SS-23A and Weld
County Addendum for their records.
G. All original contracts will be filed in the Service Utilization Unit. The
Service Utilization Unit will notify the Social Services Administrator, or
designee, if a provider is requesting reimbursement and does not have a
current signed contract. Payment cannot be authorized to the provider
until the required contract is provided to the Service Utilization Unit.
H. Bed hold payments for a child's temporary absence from a facility,
including hospitalization, are limited to a maximum of 3 days unless
otherwise negotiated as allowed in Volume VII. All bed hold
authorizations need to be approved, in writing within 2 working days, by
the Administrator. Once a bed hold is authorized, the Negotiator will
contact the provider to negotiate a daily rate for the approved bed hold.
Social Services Division Policies and Procedures
Exhibit A
County: Weld County Department of Human Services
Contact Lesley Cobb - Child Welfare
Contract/Rate Negotiator
State Fiscal Year: 2010-2011
Rates, Services, and Outcomes Negotiation Methodology Form
Area: Adoption Subsidy
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5)contains promulgated rules referred to in statute at
Section 26-5-104(6) (a) and at Section 26-5-104(6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s) that will be used to identify and document the needs of the child.
Utilization of the Weld County Special Needs Worksheet and the request for
supporting professional documentation from providers
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
An adoption subsidy negotiation/meeting is scheduled with the adoptive
parents to discuss the completed Special Needs worksheet along with
review of professional documentation that was submitted from
providers. This meeting is held to determine the negotiated
services/monetary assistance the adoptive parents may need to help
with the special needs of the child once adopted.
b. Services that will be provided for the payment.
A monetary assistance may be provided to the adoptive family if the
need is determined as indicated above. Monetary assistance to the
adoptive family is not intended for normal child expenses of food,
clothing, and shelter but is intended to help out with the special needs
of the child as documented. The subsidized adoption payment may be
from $0.00 to the maximum monetary assistance established by the
County Basic Maintenance rate per age range. Once the adoption is
final the County cannot control how the monetary assistance is spent
as noted in Federal Policy.
Social Services Division Policies and Procedures
c. Outcomes to be achieved.
The adopted child is able to receive the services needed to help with
his/her documented special needs through Medicaid, public programs
free of charge and by a monetary assistance (if applicable) provided by
the County in order to promote a successful adoption of the child.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
Per State rule, Counties are required to mail the Subsidized Adoption
Review form (CWSA-4)to adoptive parents every three years. This
form is to be completed by the adoptive parents and reviewed by the
Department for continuation of the assistance.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates, services, and outcomes.
Legislated provider rate increases are not passed to the adoptive
parents that have negotiated subsidized adoptions.
c. Actions to be taken if services are not delivered or outcomes are not met.
Once an adoption subsidy is negotiated and agreed upon,the only
circumstances where a subsidy can be terminated are the follow:
1) The adoptive parent's written request.
2) The child turns 18 or 21 if developmentally disabled.
3) The adoptive parents are no longer legally responsible for the
support of the child.
4) The adoptive parents are no longer providing any support to
the child.
5) Upon the child's death or marriage.
4. Procedure for renegotiating rates,services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates, services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
Social Services Division Policies and Procedures
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board, the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: Relative Guardianship Assistance
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5) contains promulgated rules referred to in statute at
Section 26-5-104 (6) (a) and at Section 26-5-104 (6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Utilization of the Weld County Needs Assessment Worksheet and the request
for supporting professional documentation from providers
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
A Relative Guardianship Assistance negotiation/meeting is scheduled
with the relative to discuss the completed Assessment Worksheet
along with review of professional documentation that was submitted
from providers. This meeting is held to determine the negotiated
services/monetary assistance that the relative may need in order to
help with the needs of the child once guardianship has been
transferred.
b. Services that will be provided for the payment.
A monetary assistance may be provided to the relatives if the need is
determined as indicated above. Monetary assistance to the family is
not intended for normal child expenses of food, clothing, and shelter but
is intended to help out with the special needs of the child as
documented. The Relative Guardianship Assistance payment may be
from $0.00 to the maximum monetary assistance established by the
County Basic Maintenance rate per age range.
c. Outcomes to be achieved.
The child is able to receive the services needed to help with his/her
documented special needs through Medicaid, public programs free of
charge and by a monetary assistance (if applicable) provided by the
County in order to promote successful permanency for the child.
Social Services Division Policies and Procedures
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
Per State rule, Counties are required to mail the Relative Guardianship
Assistance Review form (CW-RGA-6) every three years. This form is to
be completed by the Guardian and reviewed by the Department for
continuation of the assistance.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates, services, and outcomes.
Legislated provider rate increases are not passed to the guardians that
have negotiated assistance agreements.
c. Actions to be taken if services are not delivered or outcomes are not met.
Once a Guardianship assistance agreement is negotiated and agreed
upon,the only circumstances where the agreement can be terminated
are the follow:
1) The relative guardian requests that payments end; or
2) The child reaches age eighteen (18); or
3) The Department determines the relative guardian is no longer
legally responsible for the support of the youth or child; or
4) The youth or child is no longer receiving any support from the
relative guardian; or
5) The County verifies the death or marriage of the youth or child.
4. Procedure for renegotiating rates, services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates, services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
Social Services Division Policies and Procedures
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board,the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: Child Placement Agency Foster Family Care
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5) contains promulgated rules referred to in statute at
Section 26-5-104(6) (a)and at Section 26-5-104 (6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Weld County utilizes a Placement Referral form containing the Needs Based
Care Assessment originally developed by the Northern Colorado Consortium of
Counties in 1996 and modified/approved by the Board of Weld County
Commissioners on July 1, 2008. (See Exhibit A)
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
The Placement Referral form containing the Needs Based Care
Assessment, as referenced above, shall be completed by the child's
caseworker with assistance from the Service Utilization Unit. Once the
Placement Referral form is completed, the County Rate Negotiator
shall contact the agency to conduct negotiations regarding the levels of
care assessed. The areas negotiated will be;foster care provider
services (Child Maintenance), agency case management services
(Administrative Maintenance), and additional services(Administrative
Service). Once levels of care/services/rates have been verbally agreed
upon with the provider,the County Rate Negotiator shall complete the
Needs Based Care Addendum, in conjunction with the SS-23B Child
Specific contract. These contracts will be mailed to the provider for
approval and signatures. Contracts are required to be signed and
returned to the department and shall be placed in the child's file once
fully executed.
b. Services that will be provided for the payment.
The Needs Based Care Assessment Rate Table shall be utilized in
conjunction with the assessment to determine the payment rate for
specific services. (See Exhibit B) The type of services consist of;
foster care provider services(Child Maintenance), agency case
management services(Administrative Maintenance), administrative
services, and respite. Additional services/rates may be negotiated with
a provider in order to maintain a child in the least restrictive setting.
Social Services Division Policies and Procedures
c. Outcomes to be achieved.
Safety
1) Children are first and foremost, protected from abuse and
neglect.
2) Children are safely maintained in the foster care home.
Permanency
1) Children have stability in the foster care placement and that
the permanency plan is being followed for each child in order
for them to reach their set goal.
2) The Continuity of family relationships and connections is
preserved for children and that the efforts were made to
promote, support, and/or maintain positive relationships
between the child in foster care and his/her mother and father
or other primary caregiver.
Well-being
1) Foster families have capacity to provide for the child's needs.
2) The child and foster family are involved in case planning.
3) The caseworker visits with both child and foster parents.
4) Children receive appropriate services to meet their educational
needs.
5) Children receive adequate services to meet their physical and
mental health needs.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
Initial negotiations shall take place within 30 days of the start of
placement.
All rates/services may be re-negotiated at anytime based upon the
changing needs of the child.
All CPA placement rates/services are re-evaluated by the Service
Utilization Unit, in callaboration with the caseworker and case specific
treatment providers, a minimum of every six months.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates, services, and outcomes.
The Weld County Department of Social Services shall take the
following steps regarding legislated provider rate increases:
1) Determine the estimated fiscal impact that the increase would
have.
2) Inform the Board of County Commissioners of the legislated
provider increase.
3) Make recommendations to the Board of County
Commissioners regarding provider rate increases.
Social Services Division Policies and Procedures
The Board of County Commissioners may approve or deny provider
rate increases through this informed decision process. Once a decision
is made by the Board,the Department will notify the provider in writing
of the changes that will be made regarding contracted rates.
c. Actions to be taken if services are not delivered or outcomes are not met.
The Director of Social Services or designee may exercise the following
remedial actions should s/he find the provider substantially failed to
satisfy the scope of work found in the Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper
activities or inaction by the provider. These remedial actions are as
follows:
1. Withhold payment to the provider until the necessary services
or corrections in performance are satisfactorily completed;
2. Deny payment or recover reimbursement for those services or
deliverables which have not been performed and which due to
circumstances caused by the provider cannot be performed or
if performed would be of no value to Social Services. Denial of
the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social Services;
3. Recover from the provider any incorrect payment to the
Contractor due to omission, error,fraud, and/or defalcation by
deducting from subsequent payments under this Agreement or
other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services
or otherwise as provided by law.
4. Procedure for renegotiating rates, services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates, services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board, the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: Child Placement Agency Group Home/Center Care
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5) contains promulgated rules referred to in statute at
Section 26-5-104(6) (a) and at Section 26-5-104(6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Weld County utilizes a Placement Referral form. (See Exhibit A) Caseworkers
are responsible for completing section I and II, and submitting this form to the
Service Utilization Unit for review and determination of the most appropriate level
of care. If needed,the Department's Mental Health Professional will review
information and conduct a face-to-face interview with the child to help in
determining the level of care.
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
The child's caseworker will meet with the Group Home/Group Center to
develop a treatment plan for the child in placement. These services are
expected to maintain a child who is unable to reside in a foster family
home or for a child who is stepping down from a RCCF/TRCCF setting.
b. Services that will be provided for the payment.
The developed treatment plan will drive the services to be provided for
each child in the home/center.The provider rate(Child Maintenance)
for group home/group centers are negotiated with the provider at the
beginning of each fiscal year. These rates are based on current market
value.
c. Outcomes to be achieved.
Safety
1) Children are first and foremost, protected from abuse and
neglect.
2) Children are safely maintained in the foster care home.
Permanency
1) Children have stability in the foster care placement and that
the permanency plan is being followed for each child in order
for them to reach their set goal.
Social Services Division Policies and Procedures
2) The Continuity of family relationships and connections is
preserved for children and that the efforts were made to
promote, support, and/or maintain positive relationships
between the child in foster care and his/her mother and father
or other primary caregiver.
Well-being
1) Foster families have capacity to provide for the child's needs.
2) The child and foster family are involved in case planning.
3) The caseworker visits with both child and foster parents.
4) Children receive appropriate services to meet their educational
needs.
5) Children receive adequate services to meet their physical and
mental health needs.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
All CPA placement rates/services are re-evaluated by the Service
Utilization Unit, in collaboration with; the caseworker and case specific
treatment providers, a minimum of every six months.
All rates/services may be negotiated at any time based upon the
changing needs of the child.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates,services, and outcomes.
The Weld County Department of Social Services shall take the
following steps regarding legislated provider rate increases:
1) Determine the estimated fiscal impact that the increase would
have.
2) Inform the Board of County Commissioners of the legislated
provider increase.
3) Make recommendations to the Board of County
Commissioners regarding provider rate increases.
The Board of County Commissioners may approve or deny provider
rate increases through this informed decision process. Once a decision
is made by the Board,the Department will notify the provider in writing
of the changes that will be made regarding contracted rates.
c. Actions to be taken if services are not delivered or outcomes are not met.
The Director of Social Services or designee may exercise the following
remedial actions should s/he find the provider substantially failed to
satisfy the scope of work found in the Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper
activities or inaction by the provider. These remedial actions are as
follows:
Social Services Division Policies and Procedures
1. Withhold payment to the provider until the necessary services
or corrections in performance are satisfactorily completed;
2. Deny payment or recover reimbursement for those services or
deliverables which have not been performed and which due to
circumstances caused by the provider cannot be performed or
if performed would be of no value to Social Services. Denial of
the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social Services;
3. Recover from the provider any incorrect payment to the
Contractor due to omission, error,fraud, and/or defalcation by
deducting from subsequent payments under this Agreement or
other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services
or otherwise as provided by law.
4. Procedure for renegotiating rates, services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates, services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board,the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: County Certified Foster Family Home Care
Rule Manual Volume 7, Section 7.406.1 (12 OCR 2509-5)contains promulgated rules referred to in statute at
Section 26-5-104(6) (a) and at Section 26-5-104(6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by, the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Weld County utilizes a Placement Referral form containing the Needs Based
Care Assessment originally developed by the Northern Colorado Consortium of
Counties in 1996 and modified/approved by the Board of Weld County
Commissioners on July 1, 2008. (See Exhibit A)
**Note: If a child is placed in a County foster/adoption home as a pre-adoptive
placement(child is legally free) or the home is certified as a Kinship foster care
home, the NBC assessment will not be completed and the default rate for these
placements will be the County Basic Maintenance rate as noted on the rate
table.
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
The Placement Referral form containing the Needs Based Care
Assessment, as referenced above, shall be completed at the 30 staffing
by the County Foster Care Coordinator,with assistance from the foster
care provider and the child's caseworker. Once the NBC assessment
is completed and the provider level of care is determined,the
completed assessment will be forwarded to the County Rate Negotiator.
The County Rate Negotiator shall complete the Needs Based Care
Addendum and mail to the provider for signatures. The addendum is
required to be signed and returned to the department and shall be
placed in the child's file once fully executed.
b. Services that will be provided for the payment.
The Needs Based Care Assessment Rate Table shall be utilized in
conjunction with the assessment to determine the payment rate for
specific services. (See Exhibit B) The types of service consist of
provider services(Child Maintenance) and respite. Additional
services/rates may be negotiated with a provider in order to maintain a
child in the least restrictive setting.
Social Services Division Policies and Procedures
c. Outcomes to be achieved.
Safety
1) Children are first and foremost, protected from abuse and
neglect.
2) Children are safely maintained in the foster care home.
Permanency
1) Children have stability in the foster care placement and that
the permanency plan is being followed for each child in order
for them to reach their set goal.
2) The Continuity of family relationships and connections is
preserved for children and that the efforts were made to
promote, support, and/or maintain positive relationships
between the child in foster care and his/her mother and father
or other primary caregiver.
Well-beinq
1) Foster families have capacity to provide for the child's needs.
2) The child and foster family are involved in case planning.
3) The caseworker visits with both child and foster parents.
4) Children receive appropriate services to meet their educational
needs.
5) Children receive adequate services to meet their physical and
mental health needs.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
All county certified foster home placement rates/services are re-
evaluated by the Service Utilization Unit, in collaboration with; the
caseworker, Foster Care Coordinator and case specific treatment
providers, a minimum of every 12 months.
All rates/services may be negotiated at any time based upon the
changing needs of the child.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates, services, and outcomes.
The Weld County Department of Social Services shall take the
following steps regarding legislated provider rate increases:
1) Determine the estimated fiscal impact that the increase would
have.
2) Inform the Board of County Commissioners of the legislated
provider increase.
3) Make recommendations to the Board of County
Commissioners regarding provider rate increases.
The Board of County Commissioners may approve or deny provider
rate increases through this informed decision process. Once a decision
is made by the Board, the Department will notify the provider in writing
of the changes that will be made regarding contracted rates.
Social Services Division Policies and Procedures
c. Actions to be taken if services are not delivered or outcomes are not met.
The Director of Social Services or designee may exercise the following
remedial actions should s/he find the provider substantially failed to
satisfy the scope of work found in the Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper
activities or inaction by the provider. These remedial actions are as
follows:
1. Withhold payment to the provider until the necessary services
or corrections in performance are satisfactorily completed;
2. Deny payment or recover reimbursement for those services or
deliverables which have not been performed and which due to
circumstances caused by the provider cannot be performed or
if performed would be of no value to Social Services. Denial of
the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social Services;
3. Recover from the provider any incorrect payment to the
Contractor due to omission, error,fraud, and/or defalcation by
deducting from subsequent payments under this Agreement or
other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services
or otherwise as provided by law.
4. Procedure for renegotiating rates,services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates, services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board, the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: County Specialized Group Home Care
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5) contains promulgated rules referred to in statute at
Section 26-5-104(6) (a) and at Section 26-5-104(6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Weld County utilizes a Placement Referral form. (See Exhibit A) Caseworkers
are responsible for completing section I and II, and submitting this form to the
Service Utilization Unit for review and determination of the most appropriate level
of care. If needed, the Departments Mental Health Professional will review
information and conduct a face-to-face interview with the child to help in
determining the level of care.
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
The County Group Home Coordinator meets with the specialized group
home parents to discuss the needs of the child and develop a treatment
plan within 10 days of placement. These services are expected to
maintain a child who is unable to reside in a foster family home or for a
child who is stepping down from a RCCF/TRCCF setting.
b. Services that will be provided for the payment.
The developed treatment plan will drive the services to be provided for
each child in the home. The provider rate(Child Maintenance)for
specialized group homes consists of the County Basic Maintenance
rate for ages 11-14, in addition to a direct care allowance of
$31.99/day, which equals a total daily rate of$50.04 or approximately
$1,522.00/month.
c. Outcomes to be achieved.
Safety
1) Children are first and foremost, protected from abuse and
neglect.
2) Children are safely maintained in the foster care home.
Permanency
1) Children have stability in the foster care placement and that
the permanency plan is being followed for each child in order
for them to reach their set goal.
Social Services Division Policies and Procedures
2) The Continuity of family relationships and connections is
preserved for children and that the efforts were made to
promote, support, and/or maintain positive relationships
between the child in foster care and his/her mother and father
or other primary caregiver.
Well-beinq
1) Foster families have capacity to provide for the child's needs.
2) The child and foster family are involved in case planning.
3) The caseworker visits with both child and foster parents.
4) Children receive appropriate services to meet their educational
needs.
5) Children receive adequate services to meet their physical and
mental health needs.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
All county certified group home placement rates/services are re-
evaluated by the Service Utilization Unit, in collaboration with; the
Caseworker, Group Home Coordinator and the case specific treatment
providers, a minimum of every 6 months.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates, services, and outcomes.
The Weld County Department of Social Services shall take the
following steps regarding legislated provider rate increases:
1) Determine the estimated fiscal impact that the increase would
have.
2) Inform the Board of County Commissioners of the legislated
provider increase.
3) Make recommendations to the Board of County
Commissioners regarding provider rate increases.
The Board of County Commissioners may approve or deny provider
rate increases through this informed decision process. Once a decision
is made by the Board, the Department will notify the provider in writing
of the changes that will be made regarding contracted rates.
c. Actions to be taken if services are not delivered or outcomes are not met.
The Director of Social Services or designee may exercise the following
remedial actions should s/he find the provider substantially failed to
satisfy the scope of work found in the Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper
activities or inaction by the provider. These remedial actions are as
follows:
Social Services Division Policies and Procedures
1. Withhold payment to the provider until the necessary services
or corrections in performance are satisfactorily completed;
2. Deny payment or recover reimbursement for those services or
deliverables which have not been performed and which due to
circumstances caused by the provider cannot be performed or
if performed would be of no value to Social Services. Denial of
the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social Services;
3. Recover from the provider any incorrect payment to the
Contractor due to omission, error,fraud, and/or defalcation by
deducting from subsequent payments under this Agreement or
other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services
or otherwise as provided by law.
4. Procedure for renegotiating rates, services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates,services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board,the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Social Services Division Policies and Procedures
Rates, Services, and Outcomes Negotiation Methodology Form
Area: RCCF/TRCCF Care
Rule Manual Volume 7, Section 7.406.1 (12 CCR 2509-5) contains promulgated rules referred to in statute at
Section 26-5-104(6) (a) and at Section 26-5-104 (6) (d), C.R.S.
Please address each process and policy and submit to the State Department by May 15, 2010.
LL. Subject to available appropriations, a county negotiates provider rates by either a request for proposal
process or other methodology that is submitted at least annually to, and approved by,the state and
includes the following.
1. The instrument(s)that will be used to identify and document the needs of the child.
Weld County utilizes a Placement Referral form. (See Exhibit A) Caseworkers
are responsible for completing section I and II, and submitting this form to the
Service Utilization Unit for review and determination of the most appropriate level
of care. If needed, the Department's Mental Health Professional will review
information and conduct a face-to-face interview with the child to help in
determining the level of care.
2. The process for documentation of provider participation and agreement regarding:
a. The needs of the child and the services that are going to be delivered.
The child's caseworker will meet with the RCCF/TRCCF to develop a
treatment plan for the child in placement.
b. Services that will be provided for the payment.
The developed treatment plan will drive the services to be provided for
each child in the RCCFlTRCCF.The child maintenance and
administrative maintenance rate for RCCFs will be the Trails base
anchor rate unless otherwise negotiated. Administrative services may
also be negotiated based on the child's needs.
**Note: Out-of-state RCCF placements and CHRP placements are
negotiated on a case by case basis and based on current market value.
c. Outcomes to be achieved.
Safety
1) Children are first and foremost, protected from abuse and
neglect.
2) Children are safely maintained in the foster care home.
Permanency
1) Children have stability in the foster care placement and that
the permanency plan is being followed for each child in order
for them to reach their set goal.
Social Services Division Policies and Procedures
2) The Continuity of family relationships and connections is
preserved for children and that the efforts were made to
promote, support, and/or maintain positive relationships
between the child in foster care and his/her mother and father
or other primary caregiver.
Well-beinq
1) Foster families have capacity to provide for the child's needs.
2) The child and foster family are involved in case planning.
3) The caseworker visits with both child and foster parents.
4) Children receive appropriate services to meet their educational
needs.
5) Children receive adequate services to meet their physical and
mental health needs.
3. The county's policy for:
a. Determining the timeframes for negotiation or re-negotiation of rates,
services, and outcomes.
All RCCFITRCCF placement rates/services are re-evaluated by the
Service Utilization Unit, in collaboration with; the Caseworker and case
specific treatment providers, a minimum of every 4 months.
b. Discussion of legislated provider rate increases in negotiation or re-
negotiation of rates,services, and outcomes.
The current rates Weld County uses for RCCF/TRCCFs, are based on
the Trails base anchor rate which are established by the State. Any
legislated provider increase/decrease for these services may be
reflected in the adjustment of the Trails base anchor rate per state rule.
c. Actions to be taken if services are not delivered or outcomes are not met.
The Director of Social Services or designee may exercise the following
remedial actions should s/he find the provider substantially failed to
satisfy the scope of work found in the Agreement. Substantial failure to
satisfy the scope of work shall be defined to mean incorrect or improper
activities or inaction by the provider. These remedial actions are as
follows:
1. Withhold payment to the provider until the necessary services
or corrections in performance are satisfactorily completed;
2. Deny payment or recover reimbursement for those services or
deliverables which have not been performed and which due to
circumstances caused by the provider cannot be performed or
if performed would be of no value to Social Services. Denial of
the amount of payment shall be reasonably related to the
amount of work or deliverables lost to Social Services;
Social Services Division Policies and Procedures
3. Recover from the provider any incorrect payment to the
Contractor due to omission, error, fraud, and/or defalcation by
deducting from subsequent payments under this Agreement or
other agreements between Social Services and the
Contractor, or by Social Services as a debt to Social Services
or otherwise as provided by law.
4. Procedure for renegotiating rates, services, and outcomes if a county reduces
rates due to a departmental or legislated county budget reduction. Address how
the county will renegotiate rates,services, and outcomes so as to mitigate possible
negative consequences for children in placement at the time of the reduction of
rates, and for children newly placed.
The Weld County Department of Human Services shall take the following steps
regarding a legislated provider rate reduction:
1) Determine the estimated fiscal impact that the reduction would have.
2) Inform the Board of County Commissioners of the legislated provider
decrease.
3) Make recommendations to the Board of County Commissioners
regarding provider rate reductions.
The Board of County Commissioners may approve or deny provider rate
reductions through this informed decision process. Once a decision is made by
the Board,the Department will notify the provider in writing of the changes that
will be made regarding contracted rates. This notification shall contain; a brief
description and reason for the rate reduction and information regarding the
Department's apeal process. County staff shall work with the provider to explore
the availablity of alternative resources so that the child's needs are meet and
placement can be safely maintained.
Please send an electronic copy of this form and any accompanying documentation to:
Larrv.Armstronaestate.co.us or to
Les.Cowger(cilstate.co.us after June 30, 2010.
Colorado Department of Human Services
Division of Child Welfare Services
1575 Sherman Street, 2nd floor
Denver, CO 80203
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
PLACEMENT REFERRAL FORM
E-MAIL COMPLETED FORM TO: SSUTILIZATION
Purpose of Referral:
❑ Request for new placement search.
❑ Request for assessment of child for appropriate placement.
*If Youth-in-Conflict Assessment is completed and submitted to SUU,do not complete Section II.
❑ Completion of Needs Based Care Assessment. (Level of care determination)
Section I
Date of Referral:
Child's Name: DOB: Gender: Male Caseworker Name:
Perm. Goal: Select
Legal Status: Select Date of next Court Hearing:
Trails Case ID#: State ID HH#: 62-
Current Placement Information:
Provider/Facility Name: (If DYC Commitment recommended,complete Section I and II only
and staff at URT.)
Level of Placement: Select
Requested Placement Information:
Provider/Facility Name(if known):
Level of Placement: Select
Reason Placement Needed:
Section II
MH Diagnosis(if any):
Medical Issues(if any):
School Issues:
IEP: ❑ Yes ❑ No Developmental Disability: O Yes ❑ No IQ(if DD):
BRIEF Case History:
Important Information for Placement Provider to Consider(Severe behaviors,run risk, JD involvement etc.): _
Family Involvement:
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
Section III
Possible Further Assessments Needed:
❑ Psychological Evaluation ❑ Substance Abuse Evaluation
❑ Neuropsychological Evaluation ❑ Psychiatric Eval/Consult/Coordination
❑ Developmental Evaluation ❑ IEP Coordination/Educational
❑ Polygraph ❑ Plethysmograph
O Family Interactional Evaluation 0 Other:
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
Section IV
WELD COUNTY DHS
NEEDS BASED CARE ASSESSMENT
ANSWERS TO THE FOLLOWING QUESTIONS WILL DETERMINE THE NEEDS BASED CARE
PAYMENT
• For each question below, please select the response which most closely applies to this child.
THE FOLLOWING SEVEN QUESTIONS ARE MUTUALLY EXCLUSIVE:
P 1. How often does the child require transportation by the foster care provider for the following:
Therapy; Medical Treatment; Family Visitation; Extraordinary Educational Needs; etc.,as outlined
in the treatment plan?
❑Basic Maint.) Less than one round trip a week 01)One round trip a week 011/4)2 round
trips a week
❑2)3-4 round trips a week. ❑2'/)5 round trips a week 03)6 round
trips a week
❑3'/z)7 round trips or more
Comments:
P 2. How often is the foster care provider required to participate in child's therapy or counseling
sessions?
0 Basic Maint.)No participation required ❑1)Once a month 011/4)Two
times month
02)Three times a month ❑2%)Once a week 03)Two times a
week
❑3'/:)Three times a week or more
Comments:
P 3. How much time is the provider required to intervene at home and/or at school with the child in
conjunction with a regular or special education plan?
❑ Basic Maint.)No educational requirements ❑I) Less than a ''/z hour per day 01%) 1/2 hour a
day
02) 1 hour a day ❑2 ''A) 1'h-2 hours per day 03)2%z-3 hours
per day
03%) More that 3 hours per day
Comments:
P 4. How often does the child require special and extensive involvement by the provider in scheduling and
monitoring of time and/or activities and/or crisis management?
0 Basic Maint.)No special involvement needed ❑1)Less than 5 hours per week 011/4) 5 to 7
hours per week 02) 8 to 10 hours per week 02%) 11 to 14 hours per week
0 3)Constant basis during awake hours 03%)Nighttime hours
Comments:
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
P 5. How much time is the provider required to assist the child because of impairments beyond age
appropriate needs with feeding, bathing,grooming, physical,and/or occupational therapy?
❑ Basic Maint.)0-2 hours per week ❑l) 3 to 4 hours per week ❑1'/n)5 to 7
hours per week
❑2)8 to 10 hours per week ❑2%:) 11 to 15 hours per week ❑3) 16 to 20 per
week
❑39:)21 or more hours per week
Comments:
A 1. How often is CPA/County case management required?(Does not include therapy)
❑Basic Maint.)Face-to-face contact one time per month with child and no crisis intervention.
(i.e. mutual care placements.)
❑l) Face-to-face contact one time per month with child and minimal crisis intervention.
❑1%:)Face-to-face contact one time per month with child and occasional crisis intervention.
❑2)Face-to-face contact two times per month with child and occasional crisis intervention.
❑2'/n)Face-to-face contact three times per month with child and occasional crisis intervention.
❑3)Face-to-face contact weekly with child and occasional crisis intervention.
❑3'/:)Face-to-face contact weekly with child and ongoing crisis intervention which may include intensive
coordination of multiple services.
**Please Note: The Case Management level may be assessed on a combined basis if a sibling
group,or more than one County foster child is with the same provider.
T 1. How often are therapy services needed to address child's individual needs per NBC assessment?
DO)Not needed or provided by another source(i.e. Medicaid) ❑1)Less than 4 hours per month
D2)4-8 hours per month ❑3)9-12 hours per month
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
WELD COUNTY DHS
NEEDS BASED CARE ASSESSMENT
BEHAVIOR ASSESSMENT
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
" f Con; Rating ooilthons •,., •� r� ..-ht... ,,
'3x
* , (Check one box for each eatego;7 y
,.
Assessment, teas Mild/ • Moderate/ .H1¢hl'I.
' None Mild Moderate 'Moderate H„ igh UM Severe 7.,mments:
0 1 L1/2 2 2112 ` 3 31/2 ''
Aggression/Cruelty to
Animals ❑ ❑ ❑ O ❑ O O
Verbal or Physical ❑ ❑ ❑ ❑ O O O
Threatening
Destructive of El O El O O El ❑
Property/Fire Setting
Stealing ❑ ❑ ❑ O ❑ ❑ 0
Self-injurious Behavior O El ❑ El O O 0
Substance Abuse ❑ ❑ ❑ O ❑ ❑ ❑
Presence of Psychiatric
Symptoms/Conditions O O O ❑ O O O
Enuresis/Encopresis
❑ ❑ El ❑ O O O
Runaway ❑ O O O El ❑ ❑
Sexual Offenses
O ❑ O ❑ O ❑ O
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
BEHAVIOR ASSESSMENT CONTINUED
Please rate the behavior/intensity of conditions which create the need for services that apply to this child.
Rata'g bf Conditions "fix
(Check one bx for each category) .' tw .-**
3 t.4
Assessment Areas-A , `* - Mild/ y ate/ ll H meats
� : None- Mild Moderate Moderate , ilia severe t
0 1)>x 11/2 :. a x21/2 3 3t/2
2 ''.'
Inappropriate Sexual ❑ ❑ ❑ El ❑ ❑ ❑
Behavior
Disruptive Behavior ❑ ❑ ❑ El ❑ El ❑
Delinquent Behavior ❑ ❑ ❑ 0 0 0 El
Depressive-like 0 ❑ ❑ ❑ El ❑ El
Behavior
Medical Needs
(If condition is rated
"severe", ❑ ❑ O ❑ O El El
please
complete the Medically
fragile NBC)
Emancipation El ❑ El 0 El ❑ 0
Eating Problems El ❑ ❑ ❑ El ❑ ❑
Boundary Issues ❑ ❑ ❑ ❑ ❑ El El
Requires Night Care El 0 0 El ❑ El ❑
Education 0 ❑ ❑ El ❑ ❑ El
Involvement with ❑ ❑ ❑ ❑ ❑ ❑ El
Child's Family
CHILD'S OVERALL LEVEL OF NEED FROM BEHAVIOR ASSESSMENT:
(check level of need) El 0 ❑1 O 11/2 ❑ 2 0 2'/2 0 3 0 3'/
Social Services Division Policies and Procedures
(Rate Methodology Exhibit A)
Section V
WELD COUNTY DHS
Requested Services from Agency
Please indicate the services that are requested for this child.
The following information will be reflected on the child specific contract.
(Please be specific)
❑ Adoption Services ❑ Medical Services
❑ Other: NA 0 Doctor/Dentist Appointment Coordination
❑ Provider agrees to work with family ❑ Medication Evaluation(not covered under fee for
service)
❑ Therapeutic Services funded through Medicaid ❑ Medication Monitoring
Fee for Service: (TRCCF)
❑ Individual Therapy 0 Nursing Services/Coordination
❑ Group Therapy ❑ Physician Services/Coordination
❑ Interactive Group Therapy ❑ Occupational Therapy
❑ Family Therapy 0 Speech Therapy
❑ Psychological Testing ❑ Child Find
O Pharmacological Management ❑ Other:
❑ Treatment not funded by Medicaid Fee for ❑ Education:
Service:
❑ Home Based Intervention 0 On-Grounds School
❑ MST Multi-Systemic Therapy 0 Coordinate Assessment for Special Education
❑ Offense Specific Treatment 0 Public School Attendance
❑ Occupational Therapy
❑ Drug and Alcohol Treatment 0 Speech Therapy
❑ Attend Special Education Meetings
❑ Urine Analysis/Drug Screening/Breathalyzer ❑ Other:
❑ Sexual Abuse Victimization Treatment 0 Visitation Coordination
❑ Independent Living Skills Training 0 Monitor phone calls and correspondence
❑ Anger Management ❑ Transportation for family/parent/child visits
❑ Behavior Modification Services ❑ Other:
❑ Behavioral Assessment ❑ Other:
O Recreation Services ❑ Interpreter Services
❑ Case Management ❑ Other:
❑ Attend Court Hearings
❑ Transportation: To include: 0 Other:
Levels of Care:
Provider Level:
Case Management Level:
Therapy Level:
Date Staffed:
Participants:
I
Comments:
Social Services Division Policies and Procedures
(Rate Methodology Exhibit B)
WELD COUNTY DEPARTMENT OF HUMAN SERVICES
NEEDS BASED CARE
RATE TABLE
LEVEL RECOMMENDED 4 MEQ,ICAL:
OF PROVIDER RATE RECOMMENDE AGENCY RATE: THERAPY RATE
NEEDS:''
SERVICE P1-P5 Al TI ADDENDUM
Level > Rate Case Management - Therapy . Level
(Admin.Maint) ` (Admin.Services)
Age 0-10...$16.32 Basic Maint $4.93 Level
($496) day/$150mo 0 $0
County Age 11-14...$18.05 Therapy not needed or Level 0...$0
($549) No crisis intervention,Minimal CPA provided by
Basic
Maint. Age 15-21...$19.27 another source, i.e.mental (None)
($586) involvement,one face-to-face visit health.
+$.66 Respite Care
($20) with child per month.
Level 1 $4.93/$150
$19.73 Level 1 $8.22 day/$250 mo mo
Minimal crisis intervention as Level 1
1 +$.66 Respite Care needed, Regularly scheduled therapy,
"$299
one face-to-face visit per month with
($20.39 day/$620 mo) child, up to 4 hours/month.
2-3 contacts per month
$23.01
+$.66
1 1/2 Respite Care Level 1 1/2 $9.86 day/$300 mo
($23.67 day/$720
mo)
Level2 $11.51 day/$350
$26.30 mo Level 2 $9.861$300 mo
Occasional crisis intervention as Level
2 +$.66 Respite Care needed, Weekly scheduled therapy, 2..$4.47
5-8 hours a month with 4
($26.96 day/$820 mo) two face-to-face visits with child, hours of
2-3 contacts per month group therapy.
$29.59
+$.66 Level 2 1/2 $13.15 day/$400
2 1/2 Respite Care mo
($30.25
day/$920 mo)
$32.88 Level 3 . $14.79 day/$450 mo Level 3 $14.79/$450 mo
Ongoing crisis intervention as
+$.66 Respite Care needed, Regularly scheduled weekly
multiple sessions, can include Level
3 weekly face-to-face visits with child, more 3..$6.02
($33.54day/$1020 mo) than 1 person,i.e.family
and intensive coordination of therapy,
multiple services. for 9-12 hours/monthly.
$36.16
+$.66 Level 31/2 $16.44 day/$500
3 1/2 Respite Care mo
($36.82
day/$1,120 mo)
$39.45 Level 4 $18.08 day/$550 mo - Level 4 $14.79/$450 mo
Ongoing crisis intervention as
+$.66 Respite Care needed, Regularly scheduled weekly
4 multiple sessions,can include
TRCCF which includes high level of case more Level
Drop management and CPA involvement than 1 person,i.e.family 4....Neg.
Down ($40.11 day/$1220 with therapy,
mo) child and provider and 2-3 face-to-
face for 9-12 hours/monthly.
contacts per week minimum.
Social Services Division Policies and Procedures
r
Assess/ $13.15 day/$400 mo
Emergen $30.25 day/$920 mo
cy Level (Includes Respite)
Rate
As of
Admin.Overhead Rate: 7/01/08
$6.91 day/$210.00
month
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